Everyday illness and type 2 diabetes

When you are sick your body releases stress hormones to help you fight the illness, infection or stress. Stress hormones can cause your liver to put more glucose (sugar) into your bloodstream. Stress hormones can also make it harder for your insulin to do its job properly. This can cause your BGLs to rise.

What happens to your body when you are sick?
When you are sick your body releases stress hormones to help you fight the illness, infection or stress. Stress hormones can cause your liver to put more glucose (sugar) into your bloodstream. Stress hormones can also make it harder for your insulin to do its job properly. This can cause your BGLs to rise.
People who do not have diabetes are able to keep their BGL in target because their body releases more insulin when they are sick. People with type 2 diabetes may not make enough of their own insulin or their insulin may not work very well.  If you are unwell and have high BGLs you are at risk of developing a condition called Hyperglycaemic Hyperosmolar Syndrome (HHS). HHS may show up as very high BGLs, severe dehydration, drowsiness and confusion. HHS is very serious and can be dangerous.

What is a sick day?
A “Sick day” is when a person with diabetes has an illness (usually lasting 1-4 days) and needs their usual diabetes care routine changed. This change is usually only until the person is well again. A sick day plan should be followed at this stage.

What is a sick day plan?
A sick day plan is step by step written instructions on how you will manage your diabetes when you are sick. Your diabetes care team, which includes your doctor and diabetes nurse educator, should talk to you and create this plan with you before you become sick. A sick day plan is written just for you so that you know what to do if you become sick. Your sick day plan should tell you how to look after your diabetes on your own and to know when it is time to call for help. Your sick day plan should be created when you are first diagnosed with diabetes and should be reviewed every 1-2 years.

When should you start following your sick day plan?
•    You are sick or have any signs of illness, even if your BGLs are within your target range
•    Your BGLs are greater than 15 mmol/L for more than 8 to 12 hours, even if you are feeling okay

What should be included in your sick day plan?

Your sick day plan should include the following:
1.    Your blood glucose target range
2.    How often and how much to drink, to lessen your risk of dehydration
3.    When and how often to check BGLs
4.    When and how to make changes to your medicine and or insulin, or when to call for help.

For example:
a)    If you are not eating and use Byetta. Byetta may need to be stopped until you are well again.
       Byetta can cause nausea and vomiting on an empty stomach.
b)    Metformin (which has a number of different brand names) may need to be stopped,
       especially if you have diarrhoea or vomiting. Continuing to take Metformin can lead to dehydration and
       make you very sick.
5.    When to contact your doctor or diabetes nurse educator
6.    Which hospital to go to if you are too unwell to care for yourself

In most cases, when you are sick you will need more medicine or insulin. Some people who are managed with diet or medicine alone may need insulin to help keep their BGLs in target until they are well again. Your doctor will advise you if you need to start or change medicine or insulin. Do not take more insulin or medicine without your diabetes nurse educator or doctor’s advice.
In some cases, you may experience hypoglycaemia (BGL less than 4 mmol/L) if you take certain diabetes medication and or insulin, for example, if you vomit, or have diarrhoea. Your doctor or diabetes nurse educator might suggest you take less medicine or insulin until you are well again.
DO not stop taking your diabetes medicine or insulin unless you have been advised to do so by your doctor or diabetes nurse educator.

Important things to think about

1.Don’t be afraid to ask for help! When you are sick, looking after your diabetes can be hard.  You may need to ask a friend or family member to stay with you until you are well enough to look after your diabetes on your own.

2. Think about buying a medic alert button (alerts friends or family that you are unwell or injured) especially if you are an older person or live alone.   
Prepare a sick day kit  

Be ready for the next time you are sick. The last thing you will feel like doing when you are sick is to go shopping to buy medicine or food.
Here are some tips on what to include in your sick day kit:

•    Have some canned or boxed food in your pantry- for example canned beans, corn, tuna, dry crackers, lemonade/sweetened drinks
•    Copy of your sick day plan
•    Telephone numbers to call when you are sick, for example: family or friends, doctor,
     diabetes nurse educator, local hospital
•    Pain relief such as Panadol or Nurofen
•    Insulin (if prescribed) keep this in the fridge
•    Extra insulin pens or syringes if you take insulin
•    In-date blood glucose testing strips
•    An extra blood glucose meter
•    Thermometer
•    Glucagon - if prescribed to you by your doctor
•    Sugar free cough syrup or throat lozenges

Note: Every six months, check that your kit is fully stocked and items have not passed their use by date.

Are you going on a holiday?

People can get sick even when going on holiday. When travelling, along with your Sick Day Kit, Make sure you include the list below:

Name and phone number of the local hospital, where you will be staying. Important for you to know this information before you travel. .
Brand names of insulin or medicine can differ in other countries. If you are travelling overseas, you should find out the brand name of your medicine or insulin before your travel. Remember to bring with you the names in your kit so that if  you run out of your medicine or insulin or lose it, you will be able get more in the country you are in.

•    Extra diabetes medicine or insulin
•    Anti-nausea medicine such as Maxalon
•    Immodium in case of diarrhoea
•    Hydrolyte is case of vomiting or dehydration
•    If you are likely to get an infection such as urine or bladder infection, bring along antibiotics
•    Wear an ID bracelet at all times, especially if you are taking insulin

Things to remember:

•    Develop a sick day plan with your doctor or diabetes nurse educator before you become sick
•    Ask a friend or family member to stay and help you until you are well again
•    Prepare a sick day kit

Go to hospital or your medical clinic if:

•    Vomiting continues
•    Your blood glucose level is greater than 15 mmol/L for more than 24 hours
•    Hypoglycaemia (low blood glucose level) is severe and BGL cannot be kept above 4 mmol/L
•    You are too sick and you or your support person is unable to carry out regular blood glucose monitoring

For more information please read the information sheet on sick days and type 2 diabetes - Sick days & type 2 diabetes (PDF)