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Sick Day Adjustments to Meal Plans

General (at home) Adult Diabetic Sick Day Instructions

Confirm that the following supplies are available:
- thermometer
- glucose testing supplies
- ketone strips
- drinking water
- sugar beverages & no-sugar beverages
- regular jell-o & sugar-free jell-o
- broth/boullion
- glucose tablets/glucagon kit, insulin pump batteries (type 1)
- sufficient medications/syringes, etc.
Continue routine medication unless instructed to change by your health care provider.
Try to adhere to your normal meal plan.
Check your blood glucose and ketones at least every 2-4 hours
Consult your health care provider if ANY of the following apply:
- you are type 1 and can't keep food down
- diarrhea or vomiting for more than a few hours
- abdominal pain, chest pain, SOB, fatigue, weakness, altered level of consciousness, etc.
- blood glucose >250 mg/dl more than six hours or as instructed
- urine ketones persist more than 6 hours or as instructed
- a blood glucose <70 mg/dl more than twice or as instructed
- blood glucose is <70 mg/dl and you take medication which lowers your blood glucose
- your condition does not improve within 6-8 hours
- if you are concerned about medications or dehydration, etc.
- you take metaformin and you are at increased risk for dehydration.
- you live alone and are at risk of falling or LOC
- temperature >100F
If unable to eat normally, you must maintain adequate carbohydrate and fluid intake. The following are some suggestions that may enable you to avoid dehydration and hypoglycemia:
- drink a cup of no-calorie fluid every hour, while awake, e.g.: water, bouillon/broth, decaf-tea, no-calorie soda unless instructed differently
  - If blood glucose is <150 mg/dl also consume one of the following hourly, while awake: 1/2 cup orange/apple juice, 1 cup of milk, 1/2 cup vanilla ice cream, 1/2 cup of regular jell-o, 1 teaspoon of sugar.
    
    OR
  - If blood glucose is >150 mg/dl also consume one of the following hourly: sugar-free jell-o, sugar-free soda, sugar-free popsicles, or sugar-free kool-aid.

Myocardial infarction, stroke , influenza, infection, surgery, medications, injuries, or any significant stress can increase blood glucose in diabetics and non-diabetics. The body responds to stress and illness by increasing the secretion of glucocorticoids, norepinephrine, epinephrine, growth hormone and inflammatory mediators: cytokines, tumor necrosis factor, Interleukin-2. The action of these substances combine to increase plasma glucose by increasing hepatic glucose output (glycogenolysis & gluconeogenesis) and decreasing insulin mediated uptake by peripheral tissue.

Diabetics have a decreased ability to manage illness or stress related hyperglycemia. The absence of insulin or its effects inhibit the body's ability to store excess glucose and suppress the catabolic effects of glucagon. Diabetics may lack the ability to regain euglycemia even when stress is short-term, as may occur during strenous physical exercise. This fact necessitates constant vigilance and frequent blood glucose monitoring.

ADA 2009 Rcommendations For Diabetes Care in the Hospital

Clearly identify a diagnosis of diabetes mellitus in the medical record
Known diabetics should have a current A1c in their record
Blood glucose (BG) monitoring should be initiated for any patient at risk for hyperglycemia
- known diabetics
- high-dose glucocorticoid therapy
- enteral or parenteral nutrition therapy
- octreotide or immunosuppressive medication
BG goal for critically ill surgical patients is 110 mg/dl
Critically ill non-surgical patients BG <110-140 mg/dl, reduces morbidity & mortality
Non-critically ill outcomes are improved with fasting BG <126 mg/dl
IV insulin is preferred protocol to keep BG < 140 mg/dl
Follow-up testing and education should be a part discharge planning for any patient that is hyperglycemic in hospital.

INSTANT FEEDBACK:

When sick, diabetics should: