When You Are Unwell: Sick Day Management

Chapter 24 · Vihang Rahul Vasa

If you are ill and your plasma glucose (blood sugar) is running very high or very low, or you cannot keep food or fluids down, consult your doctor today: do not wait for the illness to pass. Sick days are when diabetes can turn serious quickly. This chapter shares what I learned; the plan for your sick days must come from your doctor.

Here is something that catches many people living with diabetes off guard: when you fall ill, whether it is a fever, flu, cold, infection, or any other illness, your plasma glucose (blood sugar) can spike dramatically, even if you have not eaten anything unusual. This happens because illness triggers stress hormones in your body, which in turn cause the liver to release extra glucose.

Similarly, if you are prescribed steroids for any condition, whether for an allergic reaction, asthma, a skin condition, or any inflammatory issue, be prepared for a significant rise in plasma glucose (blood sugar). Steroids are known to raise glucose levels substantially, and this effect can last for as long as you are on that medication, and sometimes for a few days after it is stopped. Always inform any doctor treating you that you have diabetes before they prescribe steroids.

In fact, steroids are not the only culprit. Several commonly prescribed medicines can cause a rise in plasma glucose (blood sugar) levels, including certain antibiotics, blood pressure medications, diuretics, and even some over-the-counter cold and cough syrups that contain sugar. Psychiatric medications deserve special mention here: many medicines prescribed for mental health conditions are well documented to raise plasma glucose (blood sugar) levels, sometimes significantly. This does not mean you should avoid them if you need them, but you and your doctors must be aware of their impact on your glucose. Different psychiatric medicines have different effects on glucose, different interactions, and different prescribing arrangements, so if you are on such medication, it should always be prescribed by your psychiatrist in close consultation with your diabetes specialist, both doctors play equally important roles in your care, and they must work together to find the right balance between managing your mental health and protecting your plasma glucose (blood sugar). When any doctor prescribes such medicines for a different ailment, they must be evaluated very carefully, weighing the advantage of that medicine against its impact on your plasma glucose (blood sugar). In many cases, these medicines are necessary and cannot be avoided, but they should be taken for as long as your psychiatrist judges necessary, under close monitoring, and only after your diabetes specialist has been informed. Never stop or adjust any prescribed medicine on your own: always let your doctors make that decision together.

• Do not independently stop, restart, or change your diabetes medicines during illness. Follow a sick-day plan provided by your treating clinician: some medicines may need temporary adjustment, but only as per your clinician’s advice.

• You may want to consider monitoring your plasma glucose (blood sugar) more frequently during illness.

• Stay well hydrated. Drink water and clear soups. If you are losing fluids, vomiting or loose motions, tell your doctor that you are a person living with diabetes before any electrolyte drink or oral rehydration solution (ORS) is prescribed. Most ORS preparations contain glucose on purpose, it is what helps the body absorb the salts and water, and it will raise your plasma glucose (blood sugar). That does not make ORS wrong for you; it means the choice and the amount should be your doctor’s.

• Contact your diabetes specialist early if your readings remain persistently high during illness. Do not wait for the illness to pass on its own.

• If you are prescribed any new medication by another doctor, always check with your diabetes specialist about possible interactions with your diabetes medicines.

My Emergency Kit: One Bag, Always Ready

Illustration: A first-aid box with basic medical instruments

Illustration: A diabetes testing kit and insulin pen in a zipped travel case

One bag, always ready: a first-aid box and a diabetes testing kit, kept together. Images: iStock by Getty Images (licensed).

Licensed stock images, for educational illustration only; they depict no one connected with this book and endorse no brand, device, or manufacturer.

Over the years I have learned to keep everything I might suddenly need in one small, zipped bag: so that neither I nor anyone helping me has to search cupboards in a difficult moment. Mine contains:

• Glucometer with a spare battery, fresh test strips, lancets and the lancing device, and spirit wipes

• My daily oral medicines, and for those on insulin, the insulin pen with fresh needles, stored as directed

• A pulse oximeter, a digital thermometer, a blood-pressure machine, and a stethoscope: my basic vital-signs corner at home

• A small torch

• A pack of oral glucose, for treating a low plasma glucose (blood sugar) episode quickly (see Chapter 25), or, if your doctor has prescribed one and taught you its use, a glucagon kit

• Every item labelled with my name, age, and an emergency contact number, so that anyone who opens the bag knows exactly whose it is and whom to call

Check the expiry dates twice a year: an expired strip or glucose pack is useless. And remember: what belongs in your kit depends on your treatment. Build your list with your doctor.

Illustration: Chapter 24 illustrated summary. Illness can change plasma glucose.

Chapter 24 Illness can change plasma glucose. Illustrated care includes monitoring, fluids, a doctor-led medicine plan, early medical contact and a ready kit suited to individual treatment.

Chapter at a glance: an AI-generated illustration to be read with the chapter, not instead of it. The people shown are not real.