Cold and flu season is right around the corner! Being sick is never fun, but for people living with type 1 diabetes (T1D), it poses extra concerns.
When a person gets sick, their body is under stress. To combat that stress, the body naturally releases hormones that help fight disease. Those hormones, however, can cause blood-glucose levels in the body to rise and disrupt the way insulin works in the body.
As a chronic health condition, T1D is a full-time job. But illness can throw a wrench right through the middle of your management, and people with T1D are at a higher risk of severe complications from the flu, even when their T1D is well managed. Other research has found that people with T1D who were hospitalized due to the flu were more likely to be older, smokers, or had a previous history of heart disease or stroke.
There does not appear to be a correlation between T1D and severe complications from COVID-19, but further research is needed—and like all illnesses, a COVID-19 infection places the body under that same level of stress, disrupting the way insulin works and complicating T1D management.
That’s why having a sick day plan of action is crucial, especially during cold and flu season!
Prevention
As the old saying goes, an ounce of prevention is worth a pound of cure—and there’s no better way to be prepared this time of year than getting your annual COVID-19 and flu vaccines!
Why do you need a new shot each year? Influenza and COVID-19 are both viruses, and they are evolving constantly as they circulate out in the world. Even though the underlying disease is the same, different strains of COVID-19 and the flu rise and fall over time as they compete with each other to be the most dominant. That’s why scientists and researchers review and update the COVID-19 and flu vaccines every year to target the strains they expect will be circulating.
Getting your flu and COVID-19 shot each fall helps ensure that your immune system has the most up to date viral information, in case you get sick—and getting vaccinated early in the season means your immune system has more time to prepare!
Another way to reduce your chances of getting sick this season? Consider wearing a high-quality, comfortable disposable mask such as a KN-95 or N-95 if you’re spending time in crowded, indoor public spaces where there are likely other sick people—think a city bus, airport terminal, doctor’s office, or pharmacy!
Finally, make sure to wash your hands often during cold and flu season, and make sleep and hydration a priority if you’re not feeling well. A mask can also be an asset here, as wearing one if you’re feeling sick but need to venture out helps prevent the spread of illness to others.
Preparation
Unfortunately, it’s inevitable that you’ll get sick at some point. Luckily, we’ve put together a full sick day guide to help make things a little easier, starting with our sick day checklist:
If you’re using a CGM, closely monitor your levels, or check your blood-glucose every 2 to 4 hours with a glucometer. Sick days can cause unexpected spikes or drops in your blood-glucose.
Drink plenty of fluids—staying hydrated is critical. If you cannot keep fluids down due to vomiting, visit your nearest emergency department immediately. Dehydration can lead to diabetic ketoacidosis (DKA).
It’s important to nibble on some crackers or slowly sip some carbohydrates to prevent ketone development. Your body is already under additional stress from being sick. If you cannot keep food down due to vomiting, visit your nearest emergency department immediately to prevent DKA.
Ketones increase your risk of DKA, which requires intravenous fluids and medical support. If you test positive for moderate or large ketones, call your healthcare team immediately or visit your nearest emergency department. Learn more about ketones.
Your body still needs insulin even if you’re eating very little. In some circumstances, your body may need more insulin while it’s fighting off an infection, a fever, or increased inflammation, which can all cause hyperglycemia (high blood sugar). Talk to your healthcare team to help you adjust your insulin doses.
Have emergency glucagon on hand to treat severe lows and make sure you know how to use it. Today’s single-step emergency glucagon options are easy to use. Ask your doctor for a new prescription and be sure to fill that prescription before you need it.
Talk with your doctor about a prescription for anti-nausea/antiemetic medication like ondansetron (Zofran) to have on hand for sick days.
Work with your diabetes care team to develop a plan for managing your T1D while sick.
Additionally, many over the counter (OTC) medications can affect blood-glucose levels. Sugar-free cough syrups or cough suppressant pills taken orally are good choices for people with T1D. Other drugs, like decongestants, also raise blood glucose.
People with T1D must also be aware of the effects of pain and fever reducers. Acetaminophen, which helps counteract minor aches and fevers associated with the flu or a cold, can cause false or no readings in CGMs and can be toxic to the liver and kidneys. Anyone with kidney complications should speak to their healthcare provider before using these drugs. Ibuprofen should also be administered with care, as it can enhance insulin release and increase the risk of hypoglycemia, or low blood sugar.
Finally, here are a few tips on how different illnesses might affect your T1D management needs. Remember to reach out to your healthcare team for support in adjusting insulin doses during sick days!
You may not see much impact on your blood-glucose levels. More severe colds could lead to high blood sugar. If you’re lying low on the couch, the decrease in physical activity can also call for a bit more insulin.
Nausea and vomiting complicate T1D management. If you or your loved one can’t keep food down or is vomiting, immediately contact the diabetes care team or seek emergency medical care.
Infections of any kind can lead to high glucose levels. Fevers and infections can mean you may need more insulin, even if you are eating very little. Talk to your healthcare team to adjust insulin doses as needed. Don’t forget: get plenty of fluids and rest, rest, rest!
