Surviving Sick Days

This may not seem fair since you're already dealing with diabetes every day -- several times a day. You'd think one disease at a time would be enough. Unfortunately, having diabetes doesn't include anything to keep you from getting the flu, cold, or some exotic jungle fever. Everyone gets colds. Even a virus once in a while. But until you visit the Amazon, you don't have to worry so much about exotic jungle fever.

Once one of these common illnesses has invaded your body, you not only have to deal with sniffling and sneezing, headaches and body aches, you have to deal with your diabetes being out of whack. A cold or the flu creates stress in your body which in turn, messes with your diabetes. Since you know sooner or later one of these viruses will catch up with you, now is a good time to think about a plan. Think about the best way to deal with your diabetes at the same time you are dealing with someone else's virus. (How kind of them to pass it on to you.)

The best time to think through your sick day plan is when you are feeling well. Brains don't like to work when they have a fever or when you're busy coughing and sneezing. After you make a plan for yourself, talk about it with your health care team. Your doctor or diabetes educator will help you make sure the plan is just right for you and your diabetes.

Check, Check, and Re-Check

How many times has someone on your health care team told you it's important to check your blood glucose (sugar)? Well, when you're sick it's double, triple, maybe even a hundred times more important to check, check, and recheck!

Being sick can do some real wacko things to your blood glucose (sugar), real fast. And since you're probably not feeling too great in the first place, you might not notice the highs or lows sneaking up on you.

Taking care of yourself when you're sick means doing two different checks --  blood glucose (sugar) checks like you do every day, and ketone checks.

Blood Glucose Checks

There's a good chance your blood glucose (sugar) levels will rise when you're sick or getting sick. That's because your body is sending out hormones to fight whatever bug has invaded you. Sooner or later those hormones will win the battle and kick the sick bug out of your body. That's good. But those hormones also make it difficult for your body to use insulin. That's bad, and it can be dangerous.

Check your blood glucose (sugar) at least every 3 or 4 hours to see how you're doing. Your doctor or health care team may tell you to take more insulin if your numbers read too high.

Don't skip a shot!

You may be eating less. But you still need insulin to balance out the battle your hormones are fighting. So, unless someone on your health care team tells you to skip a shot -- don't do it!

Checking for Ketones

Ketones aren't something you check every day. But make sure you check for them when you're sick. If you haven't done this before, be sure to ask your health care team about how and when to do it.

Ketones happen when your body starts to use its own fat for energy. (That's called ketoacidosis.) It does this if you don't have enough insulin, or you can't eat the foods you need.

Having too may ketones in your body is very dangerous. If the ketone level gets too high, you can go into a deep sleep called a coma. And if you're not treated quickly, ketoacidosis can kill you. Don't get scared about that -- get smart and be prepared to take care of ketones before they happen!

You'll test for ketones by dipping a special plastic strip into your urine. After a few seconds, the strip will change colors and tell you if your ketone level is low, moderate, or high. (Some blood glucose monitors also measure ketones using a little bit of blood.)

if you test moderate or high have an adult call your doctor or health care team right away! They'll know what to do to get more insulin in your body and stop the ketones from hurting you.

But I Don't Want to Eat!

When you're not feeling well, you might not want to even think about food. Sometimes just thinking about it makes your stomach do flip-flops. And if you actually eat something, your stomach might really rebel and send it right back up.

No matter what messages your stomach sends, it is  still important to try to eat. Choose foods from your normal meal plan which will be easy on your stomach. And try to eat something with about 15 grams of carbohydrate every hour or so. Here are some ideas.

• Regular ice cream (1/2 cup) -- 15 grams
  
• Low fat ice cream (1/2 cup) -- 10 grams
  
• Fruit juice bar (3 oz) -- 9 grams
  
• Frozen yogurt (1/2 cup) -- 15 grams
  
• Sherbert (1/2 cup) -- 22 grams
  
• Gelatin or Jello® sweetened (1/2 cup) -- 19 grams
  
• Cooked cereal (1/2 cup) -- 15 grams
  
• Toast (1 slice) -- 15 grams
  
• Soup (1 cup) -- 15 grams
  
• Chicken noodle soup (1 cup) -- 9 grams
  
• Cream soup (1 cup) -- 9 grams, (made with water)
  
• Tomato soup (1 cup) -- 16 grams, (made with water)
  
• Rice (1/3 cup) -- 15 grams
  
• Applesauce, unsweetened (1/2 cup) -- 14 grams

If you have a fever, and you're throwing up or have diarrhea, it is very easy to become dehydrated, which means your body is losing too much fluid. In small sips, try to drink a cup of fluid each hour. If your blood glucose (sugar) is running too high, try sugar-free liquids like water, tea, sugar-free ginger ale, or even broth (chicken, beef, or vegetable). If you need to raise your blood glucose, try to drink things with about 15 grams of carbohydrate in them. Here are some ideas.

• Apple juice (1/2 cup) -- 15 grams
  
• Grape juice (1/3 cup) -- 12 grams
  
• Regular cranberry juice cocktail (1/3 cup) -- 12 grams
  
• Reduced calorie (light) cranberry juice cocktail (1 cup) -- 10 grams
  
• Ginger ale (1/2 cup) -- 10 grams
  
• Milk (1 cup) -- 12 grams
  
• Sports drink (1 cup) -- 14 grams
  
• Regular cola or root beer (1/2 cup) -- 14 grams

If you use diabetic exchanges instead of grams of carbohydrate, remember the following:

• Each starch/bread exchange contains about 15 grams of carbohydrate
  
• Each fruit exchange contains about 15 grams of carbohydrate
  
• Each milk exchange contains about 12 grams of carbohydrate

Cough, Sniff, Sneeze, Yuk!

Since the flu or a cold can make you feel so crummy, you'll probably want to take some kind of medicine to help you quit coughing or sneezing or get rid of fever and chills. But remember, medicines that you can buy without a prescription can raise or lower your blood glucose (sugar), too. Decongestants to clear your stuffy nose and cough syrups can make your blood glucose (sugar) go up. Some medicines have things in them like dextrose, glucose, fructose, and dextrin which are all names for sugar. Aspirin and some antibiotics, on the other hand, can make your blood glucose (sugar) go down.

That doesn't mean you can't use these medicines to help you feel better. But ask your health care team about which medicines are best for you. Ask if you need to adjust your insulin when you take these medicines. Make a list of their recommendations and put it in your sick day plan. When your head hurts, it's easier to read a list than try to remember what in the world they told you to take.

Hello? Doctor?

Parents tend to get pretty nervous when they have a kid who has some virus on top of having diabetes. They get nervous because diabetes can do crazy things when it's competing with an intruder. Even if you're doing all the right things, your diabetes might just do whatever it pleases. So don't be surprised if your parents decide to call the doctor. In fact, it's a good idea for them just to check in so the doctor knows what's going on. And they definitely should call if:

• There is a rise in your ketone levels.
  
• There are ketones in your urine for more than 12 hours.
  
• Your ketone levels are moderate to high
  
• You have unusually high blood sugar levels.
  
• You are vomiting or have diarrhea for more than 6 hours.
  
• You have a high fever that keeps going up or one that lasts more than a day
  
• You are having abdominal pains

Stay One Step Ahead of the Sick Bug

It's not fair, but it's still going to happen. You're going to get sick even though you already have diabetes. Learning this important information before some bug catches up with you will help you rise to the challenge of taking care of your diabetes while you feel lousy. If you make the sick day kit described below, you'll have a head start when some virus attacks your body.

The reality is that if you are taking care of your diabetes all the time, you are probably healthier than many of your friends, and you just might be able to brush off some of those bugs that come looking for you.

Grab a Bag. Use Your Brain

Get a "sick days" bag ready to go so you're prepared for the next time a bug catches you. After you have talked about this kit with your health care team, put it in your medicine cabinet or a drawer or closet. Just make sure you -- or your parents -- remember where it is. In a large zipper baggie, stash the following things:

• At the top of a piece of notebook paper write BLOOD CHECK CHART." Use this to write down the results of blood checks, which you will be doing every 3- 4 hours.
  
• On another piece of paper write "KETONE CHART." Use this to write down the results of your urine checks.
  
• Put the lists of food and drinks mentioned in this brochure into your kit. Your health care team may want to add to the list.
  
• Make a list of medicines your doctor recommends for you to take when you have a cold or the flu.
  
• Add a magazine or a comic book to relieve boredom.
  
• Find a silly photograph of yourself or a friend or a pet to include. When you're feeling crummy, it always helps to have a laugh.
  
• Do you have a little stuffed animal that makes you feel good when its around? If you do and it will fit in the baggie, stick it in, too.
  
• Make a get-well card just for you. When you pull out the sick day kit, you will have instant mail. Your first get-well card!
  
• Make a tape or CD of your favorite music. Be sure to put on the songs that you love but no one else likes. When you're sick no one is going to tell you to "turn off that junk." So turn it up and enjoy.
  
• You might also want to keep some of your favorite "sick days" foods (like ginger ale and canned soup) on hand so no one has to run the store if you come down with something.

These are just a few ideas to get you started. You'll probably come up with lots more to add to the list!