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.
When living with T1D, having a sick day plan of action is crucial.
Sick day checklist at a glance
- Check your blood sugar regularly
- Stay hydrated
- Don’t stop eating
- Check for ketones
- Have glucagon on hand for emergencies
- Have anti-nausea medication on hand
- Develop a sick day plan with your healthcare provider
Closely monitor blood-glucose levels and ketones
When you’re under the weather, you need to monitor your blood glucose and ketones more often than usual. Check your continuous glucose monitor (CGM) if you have one, or frequently use finger sticks. It may be necessary to administer extra insulin to bring down higher blood glucose levels.
Elevated ketone levels often occur when blood sugar readings are high. This can signify that the body is using fat and muscle for energy, instead of sugar. Be on the lookout for ketones, as very high levels could lead to diabetic ketoacidosis (DKA), a dangerous condition that demands immediate medical attention and can be fatal if left untreated.
Be aware of how medications affect blood sugar
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. On the other hand, aspirin in large doses can lower blood glucose levels.
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.
Tips for eating and drinking while sick
Because it can be difficult to stick to normal eating habits when feeling unwell, it’s good to always have products on hand that will help you maintain a healthy carbohydrate intake. Foods like crackers, unsweetened applesauce, or yogurt are relatively easy on the stomach. Have anti-nausea/antiemetic medication like ondansetron (Zofran) available for sick days so that you can continue to eat and drink, even in small amounts. If you have difficulty swallowing because of a sore throat, liquids like smoothies or soup can be a soothing, short-term solution.
It’s important to stay well hydrated, especially when ketones are present, to flush them out. Water, broth, and sugar-free gelatin, popsicles, or soft drinks are great ways to stay hydrated when experiencing a cold or the flu with type 1 diabetes.
Prepare for emergencies
When living with type 1 diabetes, you must be ready for the worst, even if you never experience it. Work with your diabetes care team to develop a plan for managing your T1D while sick. Always have emergency glucagon on hand to treat severe lows and make sure you know how to use it.
Have your doctor’s phone numbers (including how to reach them at night and on weekends or holidays) ready in case you encounter these symptoms:
- Vomiting or diarrhea for more than six hours
- Having trouble breathing
- A fever that won’t go away after a couple of days
- Large levels of ketones
- Unable to keep food or liquid down and are experiencing hypoglycemia
If you do need to make an emergency room visit, it is very important that you mention that you have T1D.
Prevention is key
Preventing illness is always the best outcome. Getting a flu shot every year is strongly advised. Make sleep and hydration a priority, and wash your hands often during cold and flu season.
Check out our Sick Day Guide for more information on managing cold and flu with type 1 diabetes.
