Ketones

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.

Diabetes and exercise: When to monitor your blood sugar

Exercise is an important part of any diabetes treatment plan. To avoid potential problems, check your blood sugar before, during and after exercise.

Diabetes and exercise go hand in hand, at least when it comes to managing your diabetes. Exercise can help you improve your blood sugar control, as well as boost your overall fitness and reduce your risk of heart disease and nerve damage.

Diabetes and exercise pose unique challenges, too. Remember to track your blood sugar before, during and after exercise. Your records will reveal how your body responds to exercise — and help you prevent potentially dangerous blood sugar fluctuations.

Before exercise: Check your blood sugar before your workout

If you’re taking insulin or medications that can cause low blood sugar (hypoglycemia), test your blood sugar 30 minutes before exercising and again immediately before exercising. This will help you determine if your blood sugar level is stable, rising or falling and if it’s safe to exercise.

Consider these general guidelines relative to your blood sugar level — measured in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L).

  • Lower than 100 mg/dL (5.6 mmol/L): Your blood sugar may be too low to exercise safely. Eat a small carbohydrate-containing snack, such as fruit or crackers, before you begin your workout.
  • 100 to 250 mg/dL (5.6 to 13.9 mmol/L):  You’re good to go. For most people, this is a safe pre-exercise blood sugar range.
  • 250 mg/dL (13.9 mmol/L) or higher: This is a caution zone. Before exercising, test your urine for ketones — substances made when your body breaks down fat for energy. Excess ketones indicate that your body doesn’t have enough insulin to control your blood sugar. If you exercise when you have a high level of ketones, you risk ketoacidosis — a serious complication of diabetes that needs immediate treatment. Instead, wait to exercise until your test kit indicates a low level of ketones in your urine.
  • 300 mg/dL (16.7 mmol/L) or higher.: Your blood sugar may be too high to exercise safely, putting you at risk of ketoacidosis. Postpone your workout until your blood sugar drops to a safe pre-exercise range.

Diabetic ketoacidosis: over-the-counter ketones test

You can easily find ketone tests at your pharmacy. Ask your doctor about testing and recording methods. Urine tests are simple, but to get good results you have to follow directions carefully.

Here’s how most urine tests go:

  • Get a sample of your urine in a clean container.
  • Place the strip in the sample (you can also pass the strip through the urine stream).
  • Gently shake excess urine off the strip.
  • Wait for the strip pad to change color. The directions will tell you how long to wait.
  • Compare the strip pad to the color chart on the strip bottle. This gives you a range of the amount of ketones in your urine.
  • Record your results

Small or trace amounts of ketones may mean that ketone buildup is starting. You should test again in a few hours.

Moderate or large amounts are a danger sign. They can poison the body. Never exercise when your urine checks show moderate or large amounts of ketones and your blood glucose is high. These are signs that your diabetes is out of control.

Diabetic ketoacidosis is a life-threatening medical condition. If you develop mild signs and symptoms, contact your doctor immediately.

If your doctor suspects diabetic ketoacidosis he/she will do some tests. Sometimes additional tests may be needed to help determine what triggered the episode of diabetic ketoacidosis or what damage the ketoacidosis may have caused.

Blood tests used in the diagnosis of diabetic ketoacidosis will measure: blood sugar level, ketone level, and blood acidity. Other tests may include: blood electrolyte tests, urinalysis, chest X-ray, or an electrocardiogram.

If you’re diagnosed with diabetic ketoacidosis, you may be treated in the emergency room or admitted to the hospital. Treatment usually involves a three-pronged approach: fluid replacement, electrolyte replacement, and insulin therapy.

Hyperglycemia

Your blood sugar level is an essential measure for your health. You have to learn how to monitor it and to make it part of your daily routine. Your doctor or a diabetes educator can help you with this.

An appropriate diet and some physical activity can help you lower your blood glucose level.

But there are special cases as well. If you have a high level of blood sugar you may check for ketones in your urine. If you have ketones you should not exercise. This may cause the opposite effect.

If you think you have hyperglycemia contact your doctor.

More info on hyperglycemia can be found here.

During a hyperglycemic event

Treating Hyperglycemia

Your blood sugar level can be lowered by exercising. However there is a counter indication to that. In case your blood sugar level is above 240 mg/dl, you may check your urine for ketones. If you have ketones, you should not exercise. Exercising with ketones is counterproductive, and may make your blood sugar level even higher.

Making changes in your food intake can help as well. Your dietitian can help cutting the amount of food you eat. If exercising and dieting are not enough then your doctor may change your medication or insulin, or even the timing of that.

Work with your doctor to find the safest way for you to lower your blood glucose level.

Hyperglycemia can be prevented with good diabetes management. Another important practice is to learn to detect hyperglycemia early so that you can  treat it before it worsen.