Managing Sick Days and Diabetes

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

Although anyone can get sick at any time of year, it seems that as we approach fall and winter the chances for illness are greater. When you have Diabetes and get sick— to use a pop culture catch phrase— it’s complicated.

When people living with Diabetes talk about sick days, they’re referring to how they’ll take care of their Diabetes when they get a cold or flu. Illness puts additional stress on the body and your blood sugar levels can increase (or be hard to manage in general). But when you’re sick, the last thing you want to do is figure out how to control the fluctuations in your blood sugar!  Things can get very dangerous very quickly if you don’t know what to look for and how to prepare. That’s why it’s important to plan ahead for when you’re sick so you can try to avoid any additional complications, and why it’s a good idea to discuss sick day management with your provider at your next scheduled appointment (before you get sick).

Some common conditions that can require you to use your sick day plan include (but aren’t limited to) colds, flu, stomach bugs, urinary tract infections, and/or skin infections like an ingrown toenail.  Any illness with fever or gastrointestinal symptoms such as vomiting and diarrhea need special attention—even a mild case of any of these illnesses cans cause challenges with your blood sugar regulation.

I want to review a few key points to help you feel confident with your sick day management.  The first thing is you’ll need to check your blood sugar regularly.  At a minimum you should check before meals and bedtime, and you may need to check more often (especially if you’re using insulin).  Next, you’ll need to keep your dietary intake as close to normal as possible.  This may be difficult, especially if you aren’t feeling well enough to eat, but you need to try to keep your carbohydrate intake stable to help with glucose control.  I’ve included a list from the American Diabetes Association website to help you with some food choices (these foods contain between 10 and 15 grams of carbohydrates):


1 double-stick Popsicle
1 cup Gatorade
1 cup milk
1 cup soup
1/2 cup fruit juice
1/2 cup regular soft drink (not diet)


6 saltines
5 vanilla wafers
4 Lifesavers
3 graham crackers
1 slice dry toast (not light bread)
1/2 cup cooked cereal
1/3 cup frozen yogurt
1/2 cup regular ice cream
1/2 cup sugar-free pudding
1/2 cup regular (not sugar-free) Jell-O
1/2 cup custard
1/2 cup mashed potatoes
1/4 cup sherbet
1/4 cup regular pudding

It’s imperative that you continue to take your medications—however adjustments may need to be made. Dosages of sulfonylureas and basal and bolus insulin may need tweaking based on your intake and glucose values to avoid any hypoglycemia. Over the counter medications can be tricky and since many have added sugar in them, it’s always best to check with the pharmacist first (although there are sugar free cough medications and lozenges available).

It isn’t always necessary to call your provider when you’re sick, but it’s best to call them and let them know what’s going on if:

*You aren’t getting better after a couple of days

*You’re having persistent diarrhea or vomiting and can’t keep any fluids down

*You have a fever above 100.5°F that’s not coming down to normal

*You have ketones in your urine

*Your blood sugar readings are consistently above 240 mg/dl after checking twice over a few hours

The biggest thing about good Diabetes management is being as prepared as possible. Many things that may be required during illness are not the things that people with Diabetes might normally keep on hand. I suggest starting a “Sick Day Tackle Box” that has everything you’ll need so when you are sick, you don’t have to try to gather everything when you feel miserable.  Some items to keep in there include testing supplies (extra glucometer, batteries, test strips and lancets, ketone strips), glucose tablets and a thermometer; as well as some regular jello, juice boxes and small cans of regular soda.  Write an inventory list with the contents of you box and any expiration dates and review it every 6 months.  Also, keep an updated list of phone numbers with your health care provider, local emergency room, and family contact numbers on hand.

Living with Diabetes takes a lot of planning, but that planning can keep you healthier and able to enjoy your life to the fullest. Here’s hoping these suggestions are rarely ever needed and we all have a healthy fall and winter.


Planning for the Unplanned

 By Eileen B. Wyner, NP
Bulfinch Medical Group

First Aid Kit

We are a society of planners. We plan for vacations, retirement, and this week’s dinner menu. We plan for all the pleasant things we hope the future holds for us.  How many times have we heard or read the following saying: “Life is what happens when you are busy making other plans”?  We don’t tend to plan for the unpredictable events that we may face, events that may occur due to both natural and manmade causes, but people living with Diabetes need to have a plan for when the unexpected occurs. This recent New England winter has reminded all of us of the potential for power outages and even the need to evacuate our homes with the high tides of blizzards. It is important to prepare a disaster kit so you can have it ready to use and even to take with you if you have to evacuate your home. While I will be focusing on the scenario assuming that you are at home when an event occurs, it is important to think of having extra supplies in your office and car, too.

The Red Cross suggests that all people have a minimum 3 day supply of food and water, but 7 days would be safer. You should try to have an extra 2 week supply of all your medicines and testing supplies. That can be challenging with the insurance rules, so you should discuss this specifically with your health care provider.  This is a general list of things to include in your disaster kit, but remember to individualize it as needed. Always remember to check your kit every 3 months to look for expired supplies.

General supplies: paper plates, plastic utensils, manual can opener, hand sanitizer and disinfectants, toothpaste, plastic trash bags, flashlight, waterproof batteries and matches, radio, rubber  and heavy work gloves

Personal papers:  important documents  (or at least copies of) such as passport, insurance and financial records, updated medication list; list of important phone numbers, any  external hard drive or thumb drive with important personal/medical data, cell phone chargers and batteries, cash

Water: at LEAST 1 gallon of water per day per person

Food:  non-perishable choices may include crackers, peanut butter, regular soda, diet soda, juice boxes, canned fruit, canned vegetables, canned meat, and Parmalat milk

Medicines: basic first aid kit, non prescription pain/fever relievers such as Tylenol and ibuprofen, Benadryl, antidiarreal medicines, prescription medicines in the original bottle (whenever possible)

Diabetic supplies:  an extra glucometer if possible or at least extra batteries,  extra test strips and lancets, alcohol wipes, an  emergency  source of glucose such as glucose tablets or gel, hard candies such as Lifesavers or  jellybeans, juice boxes, glucagon emergency kit,  extra syringes  or pen needles, ketone strips, extra insulin  pump supplies,  a cool  gel pack for insulin safety.

A special note about medication safety:  Make sure that the people with you know when and how to use the glucagon emergency kit. It is also important to know that insulin will last until the expiration date on the bottle IF unopened.  Insulin will last for 28 days once opened. It is important to remember that insulin must be stored carefully so as not to get too hot or too cold and must be kept out of direct sunlight. Always check ALL the expiration dates on your medications.

It’s important to remember that events that would require implementing your disaster kit may disrupt your eating schedule and cause a great deal of stress which can in turn impact your glucose control. You will probably need to check your blood sugar more frequently and try to make adjustments as best you can under the circumstances.

Get a head start on the stress factor. Set aside some time this weekend to get prepared. It could save your life.

Visit the Red Cross or the CDC websites for more information on emergency preparation and planning.