Day Adjustments to Meal Plans
General (at home) Adult Diabetic Sick Day Instructions
- Confirm that the following supplies are available:
- glucose testing supplies
- ketone strips
- drinking water
- caffeine free beverages, both sugar & sugar-free
- regular jell-o & sugar-free jell-o
- glucose tablets/glucagon kit, insulin pump batteries (type 1 DM)
- sufficient medications/syringes, etc.
- Continue routine medication unless instructed to change by your health care provider.
- Consult the pharmacist regarding over-the-counter medications
- Try to adhere to your normal meal plan.
- Check your blood glucose and urine ketones at 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 >240 mg/dl several 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.
- 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 2014 Recommendations For Diabetes Care in the Hospital (excerpts)
- Clearly identify a diagnosis of diabetes mellitus in the medical record
- Known diabetics should have blood glucose results available to all members of the health care team
- Blood glucose (BG) monitoring should be initiated for any non-diabetic patient at high risk for hyperglycemia
- high-dose glucocorticoid therapy
- enteral or parenteral nutrition therapy
- octreotide or immunosuppressive medication
- Critically ill patients: "Insulin therapy should be initiated for treatment of persistent hyperglycemia starting at a threshold of no greater than 180 mg/dL (10 mmol/L). Once insulin therapy is started, a glucose range of 140–180 mg/dL (7.8–10 mmol/L) is recommended for the majority of critically ill patients."
- Non-critically ill patient BG goals: "There is no clear evidence for specific blood glucose goals. If treated with insulin, the premeal blood glucose targets generally <140 mg/dL (7.8 mmol/L) with random blood glucose <180 mg/dL (10.0 mmol/L) are reasonable, provided these targets can be safely achieved."
When sick, diabetics should: