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.
- 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.
Here are a few simple things you can do to help prevent injuries, dehydration, and hypoglycemia when exercising:
- Talk to your doctor about which activities are safest for you. Your doctor’s advice will depend on the condition of your heart, blood vessels, eyes, kidneys, feet, and nervous system. Still, many people with diabetes can do the same activities as someone without diabetes.
- Warm up for 5 minutes before starting to exercise and cool down for 5 minutes after. Your warm up or cool down should be a lower intensity than the rest of your time exercising. This helps get your blood flowing and warms up your joints.
- Avoid doing activity in extremely hot or cold temperatures. Choose indoor options when the weather is extreme.
- Drink plenty of water before, during, and after activity to stay hydrated.
- If you feel a low coming on, be ready to test for it and treat it. Always carry a source of carbohydrate with you so you’ll be ready to treat low blood glucose. This is especially important if you are on insulin and have type 1 diabetes.
- If exercising for an extended period (more than an hour or two), you may want to have a sports drink that provides carbohydrates. Be careful to check the nutrition facts though, you may need to water down the drink so that you don’t have too much, which can cause your blood glucose to spike.
- Wear a medical identification bracelet, necklace, or a medical ID tag that identifies you as someone with diabetes in case of emergency, and carry a cell phone with you in case you need to call someone for assistance.
- Activities should be energizing but not overly difficult. Use the “talk test” to make sure you are not pushing yourself too hard. If you become short of breath and you can’t talk, then slow down. This is most important when you are just starting to increase the activity in your routine. As you become fit, you’ll be able to exercise at a higher intensity and chat with others while you do it.
- Take care of your feet by wearing shoes and clean socks that fit you well.
- You should also check inside your shoes before wearing them. Socks that are made out of a material that reduces friction and pulls moisture away from your skin can also help protect your feet.
- Carefully inspect your feet before and after activity for blisters, redness, or other signs of irritation. Talk to your doctor if you have a foot injury or a non-healing blister, cut, or sore.
- Stop doing an activity if you feel any pain, shortness of breath, or light-headedness. Talk to your doctor about any unusual symptoms that you experience.
Before jumping into a fitness program, get your doctor’s OK to exercise — especially if you’ve been inactive. Discuss with your doctor which activities you’re contemplating and the best time to exercise, as well as the potential impact of medications on your blood sugar as you become more active.
During your visit:
- Tell your provider if you have any pain in your chest.
- Talk with your provider about joint or bone problems that make it difficult for you to exercise.
- Ask about how increasing your activity level might impact any medicines you take for diabetes, blood pressure, and/or heart conditions.
- Ask what exercises are safe for you and what you need to avoid.
- Ask if there are times when you should avoid activity.
Your health care provider should help support you in your efforts to become more active.
If you have other health conditions besides diabetes, such as heart disease, issues with your vision/eyes (retinopathy), or nerve problems (neuropathy), you may have some limitations when it comes to physical activity. Your doctor can tell you what exercises are best for you and what activities to avoid.
Keep your vaccines up to date.
High blood sugar can weaken your immune system, which makes routine vaccines more important than ever. Ask your doctor about:
- Flu vaccine. An annual flu vaccine can help you stay healthy during flu season as well as prevent serious complications from the flu.
- Pneumonia vaccine. Sometimes the pneumonia vaccine requires only one shot. If you have diabetes complications or you’re age 65 or older, you may need a five-year booster shot.
- Hepatitis B vaccine. The Centers for Disease Control and Prevention (CDC) currently recommends hepatitis B vaccination if you haven’t previously been vaccinated against hepatitis B and you’re an adult aged 19 to 59 with type 1 or type 2 diabetes. The most recent CDC guidelines advise vaccination as soon as possible after diagnosis with type 1 or type 2 diabetes. If you’re age 60 or older and have diabetes and haven’t previously received the vaccine, talk to your doctor about the whether it’s right for you.
- Other vaccines. Stay up to date with your tetanus shot and its 10-year boosters. Depending on the circumstances, your doctor may recommend other vaccines as well.
Preventing long-term conditions – Your own help is needed
If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications, including heart attack, stroke, nerve damage, and kidney disease. Talk to your doctor about ways to stop smoking or to stop using other types of tobacco.
Keep your blood pressure and cholesterol under control.
Like diabetes, high blood pressure can damage your blood vessels. High cholesterol is a concern, too, since the damage is often worse and more rapid when you have diabetes. When these conditions team up, they can lead to a heart attack, stroke or other life-threatening conditions.
Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Sometimes medication is needed, too.
Schedule yearly physicals and regular eye exams.
Your regular diabetes checkups aren’t meant to replace yearly physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications — including signs of kidney damage, nerve damage and heart disease — as well as screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma.
Medication non-compliance is the failure to take drugs on time in the dosages prescribed. It’s a common problem. According to an April 2011 Mayo Clinic Proceedings article, only about half of those who are prescribed medication take it exactly as prescribed.
There are many reasons you might not take your medication as prescribed. They include not understanding medical terms, not being involved in the medical decision making, poor communication on the part of your health care provider, your doctor having an incomplete medical history, limited finances or access to health care, complex medication regimens, cultural barriers, memory issues, health beliefs or misconceptions and many others. It’s a complex issue with no single solution.
So then what can be done? What can you do?
First, ask questions. You have the right to understand your own medical program. Consider inviting a family member or friend to your appointments in order to assist with understanding instructions.
A lot people tend to forget to take their medication. Taking medication is a behavior, and all behaviors can be changed, although change isn’t always easy. Consider tools designed to help — such as medication organizers, dispensers, pill box timers, alarms and written schedules or calendars.
Prepare for your next Appointment
Here’s some information to help you get ready for your next appointment.
What you can do
- Be aware of any pre-appointment restrictions. When you make the appointment, ask if there’s anything you need to do in advance. This will likely include restricting your diet, if you need to complete a fasting blood sugar test.
- Write down any symptoms you’re experiencing, including any that may seem unrelated.
- Write down key personal information, including major stresses or recent life changes. If you’re monitoring your glucose levels at home, bring a record of the glucose results, detailing the dates and times of testing.
- Take a family member or friend, if possible. Someone who accompanies you can help you remember information you need.
- Write down questions to ask your doctor. Ask about aspects of your diabetes management you’re unclear about.
- Be aware if you need any prescription refills. Your doctor can renew your prescriptions while you’re there.
Preparing a list of questions can help you make the most of your time with your doctor. For diabetes, some questions to ask include:
- Are the symptoms I’m having related to my diabetes or another condition?
- What else can I do to protect my health?
- What are other options to manage my diabetes?
- I have other health conditions. How can I best manage these conditions together?
- Should I see another specialist, such as a dietitian or diabetes educator?
- Is there a generic alternative to the medicine you’re prescribing?
- Are there brochures or other printed material I can take with me? What websites do you recommend?
Don’t hesitate to ask any other questions you have.
Don’t be afraid to ask about any measurement you do not understand.
Remember that every target should be personalized so don’t be afraid to discuss your results thoroughly with your doctor
Here are some examples of how you can prepare for your visits with your doctor:
- Be aware of any pre-appointment restrictions. If your doctor is going to test your blood sugar, you will need to follow instructions for the tests to be conducted
- Write down any symptoms you’re experiencing
- Ask a family member or friend to join you, if possible
- Bring a notebook and a pen or pencil
- Write down questions to ask your doctor