The Simple Keys to Managing Illness with T1D - The Diabetes Link

Whether you have diabetes or not, everyone catches the flu or a stomach bug from time to time. But as someone who lives with diabetes and works with people managing it every day, I know being sick is no fun. If you’re living with type 1 diabetes, it’s especially important to be cautious when you’re under the weather. Illness can throw off your blood sugar levels, cause dehydration, and lead to other complications if you’re not careful. That’s why having a game plan is crucial. Let’s break down some key tips to help you manage diabetes on sick days and get back to feeling your best!

Key 1: Monitor Blood Glucose and Ketones

Being sick can lead to some seriously out of whack blood sugars. Everyone reacts differently to being sick, but a common issue is the risk of ketone production. Ketones form when your body can’t use sugar for energy and starts breaking down fat instead. When your body is forced to rely on fat, it can cause your blood to become acidic, which is a VERY serious problem (and can lead to DKA – Diabetic Ketoacidosis) This can happen if you can’t keep down carbs or don’t have enough insulin. High levels of ketones can be dangerous, even life-threatening, so keeping an eye on both BG and ketone levels is key.

BG & Ketone Action Items:

• Check BG levels more often, as illness can cause fluctuations.
• Monitor ketone levels regularly, even if BG is in the target range, since you can still have ketones with low BG.
  • Use ketone test strips or a ketone meter to check your levels.

If you have ketones:

• Trace to small: Drink water, give a correction dose if needed, check BG every 2-3 hours, and check ketones every 3 hours until they’re gone.
• Moderate to large: Call your diabetes care team, follow their advice for insulin doses, drink water, check BG every 1-3 hours, and continue checking ketones every 3 hours.

Key 2: Know When to Get Extra Support

Sick days with T1D can be stressful, but most of the time, you can manage things just fine at home. However, there are times when you need extra help. Hopefully you have the support of a friend or family member, but another key is keeping your diabetes care team on speed dial. 

Contact your doctor if you have:

• Vomiting more than once
• Diarrhea more than 3 times or for over 24 hours
• BG over 300 mg/dL consistently for 4+ hours 
• A temperature over 101°F for 24 hours
• Positive ketones

The following signs can indicate diabetic ketoacidosis (DKA), which is serious and can become life-threatening quickly.

Head to the ER if:

• You’re unable to keep down fluids for 3+ hours
• BG is over 300 mg/dL even after correction doses
• You have difficulty breathing
• You notice a fruity odor on your breath
• You feel confused
• You have nausea, vomiting, and abdominal pain

Key 3: Adjust Insulin Dosing

Blood glucose levels can change a lot when you’re sick, so your insulin needs might change too. Always consult your doctor or diabetes care team to find the best strategy for you, but keep these points in mind:

• Basal insulin is still necessary: Even if you’re not eating, your body needs basal insulin to keep BG stable. Many people might need to increase their basal insulin by anywhere from 20-50% when sick (under medical guidance).
• You may need extra boluses: Sickness often causes higher BG levels. Even without eating, boluses might be necessary every few hours to manage BG and prevent ketone production.

Key 4: Stay Hydrated

Hydration is crucial for everyone, but it’s especially important when you have Type 1 Diabetes and are feeling unwell. When you’re sick, your body loses fluids more rapidly through fever, sweating, vomiting, or diarrhea. This can lead to dehydration, which not only affects your overall health but can also impact your blood glucose levels and increase the risk of complications like diabetic ketoacidosis (DKA).

Why Hydration is Key:

• Helps Manage Blood Sugar: Prevents dehydration, which can cause blood sugars to rise.
• Supports Kidney Function: Aids in flushing out excess glucose and ketones.
• Prevents DKA: Dilutes ketones and maintains normal glucose levels.

Action Items:

• Drink Water Frequently: Sip small amounts throughout the day.
• Use Electrolyte Solutions: Opt for oral rehydration solutions or drinks [Gatorade, Body Armor, Ultima Electrolytes] if experiencing vomiting or diarrhea.
• Watch for Dehydration Signs: Increase fluids if you notice dark urine, dizziness, or dry mouth, and contact your healthcare provider if symptoms get worse.

Key 5: Listen to Your Body

Even when you’re feeling awful, your body is working hard to protect you and recover. Your body always has your back! Think of it like a “software upgrade”—your immune system is getting stronger to make you healthier in the long run. Many of us try to just “power through” a sickness and continue working, going to school etc. Resting, slowing down and listening to your body’s signals are all very important keys to successful sick days with diabetes.

Everyone’s response to illness can vary. Factors like age, weight, the type of illness, and other health conditions can influence how you feel. Pay attention to signals like body temperature, urine color, appetite, cravings, and more. These clues can guide you in supporting your body while it fights off sickness.

For example, if you’re craving salty snacks like chips and pretzels, it’s not just a random craving. These foods contain carbs and salt, which your body might want when you have high blood glucose, inflammation, or are losing fluids through diarrhea or vomiting.

Your body is constantly sending you messages. Make sure to listen!

Conclusion

Sick days can be tough, especially with type 1 diabetes, but being prepared and proactive can mean the difference between a short, manageable illness and a multi-day hospital stay. And let’s be honest, we’d all prefer the first option!

To recap, here are the five keys to managing sick days with diabetes:

1. Closely monitor your blood glucose and ketones.
2. Know when to seek extra help.
3. Adjust your insulin as needed.
4. Stay hydrated.
5. Pay attention to what your body is telling you.

By following these simple steps, you can confidently manage your diabetes during illness and get back to feeling your best in no time!