Sick Day Management: Recognizing the Red Flags

Outline for the videotape "Sick Day Management: Recognizing the Red Flags", from The American Association of Diabetes Educators Patient Education Video Series, produced by Milner-Fenwick, Inc., copyright 1997.

**Funded through a grant from the Friends of the University of Michigan Hospitals. **

  1. Recognizing the "Red Flags"
    1. Illness
    2. Injury
    3. Infection

      4.  
  2. Warning Signs or "Red Flags"
    1. Elevated blood sugar
    2. Not eating and/or not taking your insulin
    3. Unexplained elevated blood sugar without obvious signs of illness
    4. Unable to eat for long periods of time due to medical tests or surgery

      5.  
  3. Make Sick Day Plan before you are ill
    1. A Sick Day Plan will assist you in staying out of the emergency room and out of the hospital and help you get well faster
    2. Have a written plan developed ahead of time

      3.  
  4. Body's reaction when under stress (illness, injury, infection):
    1. Your body releases hormones that raise blood sugar, sometimes to dangerously high levels. High levels of blood sugar makes it hard for your body to fight illness. If you don't take action, your blood sugar can continue to increase. If this cycle is not controlled you can end up in the emergency room or in the hospital.
    2. Examples of stresses include: Bronchitis, sinusitis, cold, flu, foot ulcer, broken bone, urinary tract infections, yeast, eye, ear infections
    3. Illness/injury can cause an increased temperature which increases blood sugar

      4.  
  5. Sick Day Plan
    1. Always wear Medic Alert bracelet stating you have diabetes.
    2. Sick day supplies to have available:
      1. Post numbers of your contact person & diabetes care team by the telephone
      2. Notebook
      3. Extra medications, both prescription and over the counter
      4. Blood sugar monitor with extra testing strips
      5. Ketostrips if needed
      6. Written sick day plan
      7. Sick day foods
      8. Thermometer

        9.  
  6. Develop Sick Day Plan with your certified diabetes educator
    1. Check blood sugar more frequently, as often as every 4 hours
    2. Check urine for ketones as directed by your diabetes educator
    3. Contact someone to let them know you're not feeling well, ask them to contact you frequently
    4. Track illness in your sick day notebook
      1. Blood sugar readings
      2. Medication
      3. Temperature
      4. Symptoms such as nausea, vomiting, diarrhea, fatigue, stomach pain, fruity breath
      5. Note medications taken
    5. Stay warm, rest, and drink fluids
    6. Always take your medicine
      1. Your body makes extra blood sugar when under stress – you may need to temporarily increase the amount of medication to treat the increased blood sugar

        2.  
  7. Type I Diabetes
    1. Daily dose of insulin may not be enough
    2. May not have enough insulin to make blood sugar available to your cells for energy. Your cells will then burn stored fat which releases ketones into your bloodstream.
    3. Ketones end up in your urine, causing ketoacidosis
    4. Untreated ketoacidosis can cause coma or death

      5.  
  8. Eating and drinking while ill or under stress
    1. Is best to stick to your normal eating pattern
    2. Drink plenty of non-sugar fluids, e.g. water, diet soda
    3. Consult your sick day menu
    4. Take in normal number of carbohydrates:
      1. Gelatin
      2. Crackers
      3. Soup
      4. Applesauce
    5. If unable to tolerate the above foods, maintain carbohydrate intake with:
      1. Regular soda
      2. Juice
      3. Sports drinks
      4. Popsicles
      5. Sherbet

        6.  
  9. When to call your Diabetes Care Team
    1. High blood sugar
    2. Ketones in your urine
    3. 101 degree fever
    4. Vomiting
    5. Diarrhea
    6. Stomach pain
    7. Chest pain
    8. Breathing trouble
    9. Dry mouth
    10. Fruity breath
    11. If you have any questions as to how to care for yourself

      12.  
  10. Consider vaccines for: Pneumonia, Flu

    11.  
  11. Consult your Diabetes Care Team
    1. Whenever a "Red Flag" is raised
    2. Before any procedures
    3. Before any surgeries

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