You’ll be alerted to high blood glucose levels well before HHS sets in if you check your blood glucose even once a day. To be sure, test your blood glucose levels three or four times a day when you are sick. It’s also very important to drink plenty of alcohol-free, sugar-free fluids. You may need to take insulin, even if you don’t ordinarily use it.
Special Precautions for HHS
• Ask your doctor or pharmacist if certain medications may increase your risk for HHS, such as glucocorticoids (steroids), diuretics, phenytoin (Dilantin), cimetidine (Tagamet), and beta-blockers (especially Inderal).
• HHS can occur in people having peritoneal dialysis or intravenous feedings, so you’ll need to check blood glucose frequently.
• About one-third of cases of HHS occur in people living in nursing homes. This can happen when residents are confused or have to wait for staff to offer them something to drink, leading to dehydration. Family members may have to educate staff of the patient’s needs and ask for regular blood glucose monitoring.
Illness
When you’re sick, your body releases hormones to fight the illness. These hormones also counteract insulin and raise your blood glucose levels. Extremely high blood glucose can lead to diabetic ketoacidosis and HHS.
So, when you’re sick, you’ll want to check your blood glucose more frequently than ever. Also, be sure to talk to your health care team before you get ill about what you should do in the event of illness. You and your health care team can work together to come up with a plan to help you handle common illnesses, such as colds or the flu.
Sick-Day Action Plan
You and your doctor may want to answer these questions when developing a plan for your next illness.
• How often should I monitor my blood glucose?
• When should I call the doctor?
• Should I test for ketones?
• What medication changes should I anticipate? How should I manage doses of my insulin or other medication?
• Which over-the-counter medications are safe to take?
• How should I choose appropriate foods and fluids while I’m sick?
Tips during Illness
• Monitor. Check your blood glucose and ketone levels about every 3–4 hours. If the levels are too high or you are pregnant, you may need to monitor more often.
• Food. Make substitutions for your usual food if nausea and vomiting make it difficult to eat. Try to eat or drink your usual amount of carbohydrates. Talk to your dietitian about ways to cover your basic eating plan. Prepare a sick-day plan before you even become sick. Try to keep some comforting foods, like soup, on hand, especially during the cold and flu season.
• Liquids. Drink plenty of caffeine-free liquids. You may need regular soft drinks or sports drinks with sugar or carbohydrate if you are losing fluids by vomiting, fever, or diarrhea. These drinks may help prevent the hypoglycemia caused by not eating or taking extra insulin. Try sipping 3–6 ounces an hour to keep your blood glucose even.
• On Hand. Keep a thermometer on hand and a small supply of common sick-day medications that are safe to take. Be sure to read the labels. Be sure to consult with your health care team to find out which medications are safe to use.
• Insulin. If you have type 1 diabetes, continue to take your insulin—even if you can’t eat. You may even need extra insulin to take care of the excess glucose your body releases when you are sick. Ask your provider about what blood glucose levels call for a change in your insulin dose.
Cold Medicines
Some cold medicines sold over-the-counter to treat colds and flu can affect your blood glucose level. Many cough and cold remedies labeled “decongestant” contain ingredients, such as pseudoephedrine, that raise blood glucose levels and blood pressure. Talk to the pharmacist or your provider before you take any over-the-counter medication.
In addition, some cough and cold remedies contain sugar and alcohol. Make sure you read the label and find out exactly what “active ingredients” as well as “inactive ingredients” any medication contains. A small amount of sugar or alcohol is probably fine, as long as you’re aware of it.
Pain medications are usually safe in small doses. You don’t have to worry about taking an occasional aspirin for a headache or fever. Many people with diabetes take a daily, coated “baby” aspirin to protect against cardiovascular disease. This is safe for people with diabetes, if it is recommend by their health care team. Check with your doctor to see if you can safely take ibuprofen.
Call the Doctor
You’ll want to call your health care provider if you experience any of the following:
• You have been sick for 1 or 2 days without improvement.
• You have experienced vomiting or diarrhea for more than 6 hours.
• You have moderate to large amounts of ketones in your urine or blood ketones are 0.6–1.5 mmol/l or higher.
• You are taking insulin and your blood glucose levels continue to be over 240 mg/dl or the level determined by you and your provider.
• You have type 2 diabetes, you are taking oral diabetes medication, and your pre-meal blood glucose levels are 250 mg/dl or higher for more than 24 hours.
• You have signs of extreme hyperglycemia (very dry mouth or fruity odor on the breath), dehydration, or confusion and disorientation.
• You are sleepier than normal.
• You have stomach or chest pain or any difficulty breathing.
• You have doubts or questions about what you need to do for your illness.
Keep records of your condition during your illness so that you’ll have the information ready when you call your doctor. These records will make it easier for your doctor to determine how sick you are and to keep track of your progress in getting well.
Things to Tell Your Health Care Provider
• Blood glucose levels and your urine ketone results—starting when you first realized you were ill
• Insulin doses and diabetes pills you have taken and when you took them, as well as any other medications you’ve taken
• The amount of time you’ve been sick
• Symptoms such as your temperature, your appetite and fluid intake, any weight loss, or any other problems
• Your pharmacist’s phone number
Part IV
Managing Your Diabetes
CHAPTER 9
Setting Blood Glucose Goals
• Intensive Diabetes Management
Setting your blood glucose goals is one of the first steps you’ll make in order to manage your diabetes. Your goals include the blood glucose levels that you want to aim for on a daily basis.
No matter what kind of diabetes you have, your goal will be to keep blood glucose as close as possible to the level of someone without diabetes. This will help prevent long-term diabetes complications, such as heart and nerve disease and foot and eye problems.
However, keep in mind that blood glucose goals are entirely personal, so you’ll want to talk with your health care