I had an accident what am I supposed to do?

You may be in a situation where you need medical attention for something other than diabetes, such as an accident or injury. This might involve a wait in the hospital for a while before being seen. Make sure you tell someone as soon as you arrive that you have diabetes and that you might need to eat to avoid going hypo (usually people are advised not to eat or drink while in A&E, in case they need surgery). If you feel you need to eat or drink, check with the staff first.

What to eat when I am sick?

Eating and drinking can be a big problem when you’re sick but it’s important to stick to your normal meal plan if you can. In addition to your normal meals, drink lots of non-caloric liquids to keep from getting dehydrated.

What if you can’t stick to your normal meal plan? Your sick-day plan should contain a meal plan. Try to take in your normal number of calories by eating easy-on-the-stomach foods like regular (non-diet) gelatin, crackers, soups and applesauce.

When your stomach is upset, try to eat small meals. Try carbohydrates, such as:

  • Bread
  • Cooked cereal
  • Mashed potatoes
  • Noodle or rice soup
  • Saltines
  • Gelatin (such as Jell-O)
  • Graham crackers

Many foods have the right amount of carbohydrates (about 15 grams) for your sick-day diet. Remember, on sick days it is OK to eat some foods you might not normally eat, if you cannot eat your regular foods. Some foods to try are:

  • ½ cup apple juice
  • ½ cup regular soft drink (non-diet, caffeine-free)
  • 1 Popsicle (1 stick)
  • 1 slice of dry toast
  • ½ cup cooked cereal
  • 6 saltine crackers
  • ½ cup frozen yogurt
  • 1 cup Gatorade or sports drink
  • ½ cup regular ice cream (if you are not throwing up)
  • ¼ cup sherbet
  • ¼ cup regular pudding (if you are not throwing up)
  • ½ cup regular gelatin/Jell-O
  • 1 cup yogurt (not frozen), sugar-free or plain
  • Milkshake made with ½ cup low-fat milk and ¼ cup ice cream mixed in a blender (if you are not throwing up)

If you throw up, do not drink or eat anything for 1 hour. Rest, but do not lie flat. After 1 hour, take sips of soda every 10 minutes.

Fluids you can drink if you are dehydrated are:

  • Water
  • Club soda
  • Diet soda (caffeine-free)
  • Tomato juice
  • Chicken broth

If your blood sugar is less than 100 mg/dL or falling quickly, it is OK to drink fluids that have sugar in them. Try to check their effect on your blood sugar, the same way you check how other foods affect your blood sugar.

Fluids you can drink if your blood sugar is low:

  • Apple juice
  • Orange juice
  • Grapefruit juice
  • Gatorade or other sports drink
  • Tea with honey
  • Lemon-lime drinks
  • Ginger ale

If you have already taken your insulin and are sick to your stomach, drink enough liquids with the same amount of carbohydrates that you would normally eat. If you cannot keep food or liquids down, go to the emergency room for treatment. You will receive fluids through a tube in your blood vessel (intravenous).

Keep Your Notebook Handy

No matter what kind of diabetes you have, measure your blood glucose and urine ketones more often than usual. If you have type 1 diabetes, you may need to measure blood glucose and urine ketones every four hours. Measuring ketones is very important because these waste products are more likely to build up when you are sick and lead to ketoacidosis.

If you have type 2 diabetes, checking blood glucose four times a day may be enough. You might only need to measure ketones if your blood glucose is higher than 300. If you do not have a meter, talk to your diabetes educator about getting one.

Diabetes Medications

When sick, you will still need to continue medications for your diabetes. Even if you are throwing up, don’t stop your medications. You need them because your body makes extra glucose (sugar) when you are sick.

If you have type 1 diabetes, you may have to take extra insulin to bring down the higher blood glucose levels. If you have type 2 diabetes, you may be able to take your pills, or you may need to use insulin for a short time. In either case, work with your doctor to develop your sick-day plan.

Medications to Watch Out For

You may want to take extra medications when you are sick. For example, if you have a cold, you may want to take a cough medicine.

Always check the label of over-the-counter medicines before you buy them to see if they have sugar. Small doses of medicines with sugar are usually okay. But to be on the safe side, ask the pharmacist or your team about sugar-free medicines.

Many medications you take for short-term illnesses can affect your blood glucose levels, even if they don’t contain sugar. For example, aspirin in large doses can lower blood glucose levels. Some antibiotics lower blood glucose levels in people with type 2 diabetes who take diabetes pills. Decongestants and some products for treating colds raise blood glucose levels.

If you must go to the emergency room or see a different doctor than usual, be sure to say you have diabetes, or have your identification bracelet in plain view. List all the medications that you are taking.

Your blood glucose level can also be affected by medications you take for chronic or long-term conditions.

How to manage your diabetes when you are sick

Making a Sick-Day Plan

Prepare a plan for sick days in advance. Work with your doctor, or a diabetes educator. The plan will include when to call your doctor, how often to measure blood glucose and urine ketones, what medications to take, and how to eat.

Also, attach to your plan a list of phone numbers for your doctor, diabetes educator, and dietitian. Make sure you also know how to reach them at night and on weekends and holidays. Then when illness strikes, you will be ready.

When to call your doctor

You do not need to call your doctor every time you have a sniffle. But you will probably want to call if certain things happen.

For example:

  • you’ve been sick or have had a fever for a couple of days and aren’t getting better
  • you’ve been vomiting or having diarrhea for more than 6 hours
  • you have moderate to large amounts of ketones in your urine
  • your glucose levels are higher than 240 even though you’ve taken the extra insulin your sick-day plan calls for
  • you take pills for your diabetes and your blood glucose level climbs to more than 240 before meals and stays there for more than 24 hours
  • you have symptoms that might signal ketoacidosis or dehydration or some other serious condition (for example, your chest hurts, you are having trouble breathing, your breath smells fruity, or your lips or tongue are dry and cracked)
  • you aren’t certain what to do to take care of yourself

Be ready to tell what medications you’ve taken and how much, how long you’ve been sick, whether you can eat and keep food down, whether you’ve lost weight, and what your temperature, blood glucose level, and urine ketone level are. To be prepared, keep written records of all these things as soon as you become sick.

Successful diabetic athletes

The Olympic athlete is an icon of superior physical, mental, spiritual fitness, and discipline. Kris Freeman, 2010 U.S. Olympic cross-country skier, best exemplifies this type of athletic persona. Exercise and type 1 diabetes is a balancing act for the Olympic and non-Olympic athlete that can never be perfected. The feat is challenging for any athlete, let alone an individual with type 1 diabetes.

Long endurance sports such as cross-country skiing, distance cycling, and marathon running can deplete the muscle stores of glucose that may take up to 18-24 hours for the body to replace. If the muscles lose the glucose stores the energy is gone and the race is over (also called hitting the wall). Kris Freeman has trained intensely through trial and error using multiple variables to best determine any situation he may confront and how to balance his diabetes management to pursue the best outcome.

What should I do if I experience hypoglycemia?

Everyone with diabetes should be prepared to treat hypoglycemia, but people with type 1 are at the highest risk for hypoglycemia. People with type 2 are less likely to have issues with hypoglycemia during or after exercise, unless they are on insulin or an insulin secretagogue.

If you experience hypoglycemia during or after exercise, treat it immediately. Use the same process as you would any other time of the day:

  1. Have at least 15-20 grams of fast-acting carbohydrate (sports drinks, regular soda, or glucose tabs are all good ideas).
  2. Wait 15-20 minutes and check your blood glucose again.
  3. If it is still low and your symptoms of hypoglycemia don’t go away, repeat the treatment.
  4. After you feel better, be sure to eat regular meals and snacks as planned to keep your blood glucose level up.

 

If you want to continue your workout, you will usually need to take a break to treat your low blood glucose, depending on what activity you are doing and how much insulin you have circulating in your bloodstream. If you do stop exercising, check to make sure your blood glucose has come back up above 100 mg/dl before starting to exercise again.

Keep in mind that low blood glucose can occur during or long after physical activity. It is more likely to occur if you:

  • Take insulin or an insulin secretagogue
  • Skip a meal or don’t eat something within 30 minutes to two hours after stopping
  • Exercise for a long time
  • Exercise strenuously

If hypoglycemia regularly interferes with your exercise routine, talk to your doctor about adjusting your treatment plan. Your provider may suggest eating a small snack before you exercise or they may make an adjustment to your medication(s).

How can I overcome my barriers to exercise?

If you’re not active, it’s likely that you have at least one barrier or reason why. Perhaps you’ve never been very active. Maybe you’re afraid that your blood glucose level will drop.

Think about what is keeping you from being active and then check out some of our solutions to the most common barriers to physical activity. Is there a solution for you?

I don’t have time to exercise for 30 minutes a day.

  • Think about your day – do you have available time slots? Take advantage of any extra time that you may have and pencil in a workout. If you find yourself waiting for the kids to finish practice or watching their game from the sidelines, use that time to take a walk or pace while you watch.
  • Do as much as you can. Every step counts. If you’re just starting out, start with 10 minutes a day and add more, little by little. Work up to at least 10-minute sessions, three times a day. You can also try for 15-minute sessions twice a day.
  • Make physical activity part of your daily routine. For example, walk or bike to work or to the store, exercise while you watch TV, take the stairs instead of the elevator, or do something active with your family to spend time together.

I’ve never been active.

  • Don’t discount your everyday activities. You may be more active than you think. Housekeeping or mowing the lawn counts as activity. Being active is more than just planned exercise.
  • If you have never been active or have not been active for a while, it is important to start slowly. If you feel unsure about your health, check with your health care provider before making big changes in your exercise plan.
  • Starting slowly is important and so is choosing activities that you enjoy. Over time, the activities you do will get easier. You will even find that you can increase the duration and/or intensity.

I’m too tired after work.

  • Find a time when your energy is highest. You could plan to do something active before work or during the day. For example, you could try walking for 30 minutes during your lunch break a few days each week or hitting the gym early in the morning.
  • Remember that increasing the amount of physical activity you do will actually increase your energy.

I don’t have the right clothes.

  • Wear anything that’s comfortable as long as you have shoes that fit well and socks that don’t irritate your skin.

I’m too shy to exercise in a group.

  • Choose an activity you can do on your own, such as following along with an aerobics program on TV or going for a walk.
  • Remember that the everyday activities you do on your own like gardening and household chores get you moving and help burn calories.

I don’t want to have sore muscles.

  • Exercise shouldn’t hurt if you go slowly at first. Choose something you can do without getting sore.
  • Make sure you warm up and cool down.

I’m afraid my blood glucose level will drop too low.

  • The people who need to be most careful about lows are people with type 1 diabetes and those who are on insulin or insulin secretagogues. If you’re taking a medication that could cause low blood glucose, talk to your health care provider about ways to exercise safely.
  • Always be prepared. Make sure you’ve got some regular Gatorade, glucose tabs, or another fast-acting carbohydrate to treat a low if one should occur. Wearing a diabetes ID is another important safety precaution. (See our “12 Quick Safety Tips“)

Walking hurts my knees.

  • Try chair exercises, swimming, biking, or an elliptical machine. These and other low-impact exercises may be less painful.

It’s too hot outside.

  • If it’s too hot, too cold, or too humid, walk inside a school or a shopping center.
  • Think of some other activities that are always available regardless of the weather like using a stationary bike, indoor aerobics classes, yoga videos at home, indoor swimming, stair climbing, calisthenics, or dancing.

I’m afraid I’ll make my condition worse.

  • Remember that getting enough physical activity is important for everyone’s general health – whether you have diabetes or not.
  • Remember that exercise helps lower A1C and has many other health benefits. (See our list of the benefits of physical activity.)
  • If you have certain complications from diabetes and are unsure about your health, talk to your doctor before making any big changes to your fitness routine.

I can’t afford to join a fitness center or buy equipment.

  • Do something that doesn’t require fancy equipment, such as walking, jogging, calisthenics, or using water bottles for weights.
  • Jumping rope and resistance band exercises are other activities that only require one piece of inexpensive equipment.
  • Look for inexpensive resources in your community like community education programs, park and recreation programs, walking trails, school running tracks, or worksite wellness programs. Your employer is another place to check for discounts on gym membership or reimbursement for fitness-related activities

 Exercise is boring.

  • Find something you enjoy doing.
  • Mix it up. Try different activities on different days, and make sure you pick an activity that you enjoy!
  • Exercise with someone else to keep you company.
  • If you can, try exercising while listening to music or watching television.

I don’t really know how to exercise.

  • Select activities that require few skills, like climbing stairs, walking, or jogging.
  • Take a class and develop new skills.

I don’t have the motivation to exercise.

  • Invite a family member or friend to exercise with you on a regular basis. You can also join an exercise group or class in your community.
  • Remember all of the benefits that come with being physically active.
  • Make a plan so you decide when you will do each type of activity. Be sure to set realistic goals and make a plan so you know what you are working toward.

 

What if I don’t feel like exercising today?

Here are a number of things you can do which will already increase your daily exercise.

  • Walk around while you talk on the phone.
  • Play with the kids.
  • Get up to change the TV channel instead of using the remote control.
  • Clean the house.
  • Work in the garden or rake leaves.
  • Take the dog for a walk.
  • Stretch out your chores. For example, make two trips to take the laundry downstairs instead of one.
  • Park at the far end of the shopping center parking lot and walk to the store.
  • At the grocery store, walk down every aisle.
  • At work, walk over to see a co-worker instead of calling or emailing.
  • Take the stairs instead of the elevator.
  • Stretch or walk around instead of taking a coffee break and eating.
  • During your lunch break, walk to the post office or do other errands.

I love sweets, but I know I have to cut them from my diet…

Reconsider your definition of sweet

Diabetes nutrition doesn’t have to mean no sweets. If you’re craving them, ask a registered dietitian to help you include your favorite treats into your meal plan. A dietitian can also help you reduce the amount of sugar and fat in your favorite recipes. Don’t be surprised if your tastes change as you adopt healthier eating habits. Food that you once loved may seem too sweet — and healthy substitutes may become your new idea of delicious.

I get lumps and bumps where I inject insulin. Is there something wrong?

The lumps you describe are fat deposits that may occur when insulin is injected into the same general area on a repeated basis.

These lumps can delay the absorption of insulin and cause unwanted glucose fluctuations that trigger low blood sugar, or hypoglycemia.

You should point these areas out to your doctor. In the meantime, you should avoid those areas for injecting to allow time for them to heal.

You should change injection sites to other areas.

Always keep 2 to 5 cm distance between old and new injection site. Something that could be helpful are “injection site templates”.

One easy way to remember to rotate injection sites is to inject on the right side (of the arm, leg, or belly) for any morning and lunch insulin, and on the left side (of the arm, leg, or belly) for the dinner and bedtime insulin.