Sick Days & T2 Diabetes

Amanda Fryer

Hypoglycaemia (hypos/low blood glucose)

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Commonly defined as a blood glucose (BG) level below 4.0mmols.  Keeping your BG levels above 5mmols is a safer level to be.

You may feel symptoms at a higher level than this if your BG levels have been high for a while and come down quickly.

Any person with diabetes treated with insulin or Sulphonylureas (Diamicron, Amaryl) that increase insulin production, are at risk of having a hypo.

What may cause a hypo?

  • Missed or late meal
  • Insufficient carbohydrate with meal or snack
  • Increase in physical activity – you need to reduce insulin before this. If on oral medication, discuss with your GP.
  • Sickness with vomiting
  • Consuming alcohol on an empty stomach or drinking too much.
  • Accidently taking your insulin twice

NB. You may not experience symptoms of hypo if:

  • You’ve had diabetes for many years (as a result of internal nerve damage)
  • You’ve been having frequent hypos
  • You’re on a medication for blood pressure known as beta blockers.

You’ll only be able to detect a hypo by checking your BG level regularly or wearing a continuous monitoring device.  If you are in this group, it’s important to see a Diabetes Educator who’ll help you create a plan to keep you safe and explain simpler ways you may be able to check and manage your BG.

Treating a Hypo

Step 1: Raise your blood glucose (BG) levels quickly back into normal range by taking 15g of FAST acting carbohydrate food or drink.

Try one of these: 10 Glucodin™ tablets or powder – available from supermarket, 3 BD glucose tablets or 4 Glucojel™ Jellybeans – available from your pharmacy, 150ml Lucozade® or 250mls Gatorade®, 2 x snake lollies or 4-5 x jubes (supermarket varieties).

Other options if these aren’t available: 3 teaspoons of sugar in water, 1 tablespoon of honey or jam, or 1 cup of soft drink or cordial (not diet varietes).

Step 2: Wait 15mins and recheck BG level.  If above 5mmols go to Step 3.  If not, repeat Step 1. 

Step 3: Maintain your BG levels with SLOW acting carbohydrate. This could be your meal (which includes carbohydrate) if it’s due now, or try one of these:

  • 1 piece of fruit – apple, pear, peach,
  • Dried fruit – handful of sultanas, 3-4 dried apricots
  • Muesli bar
  • 1 slice of multigrain bread
  • Glass of milk or tub of yoghurt

Preventing Hypos

  • Eat regular meals, with enough carbohydrate at each meal.
  • Ensure correct medication dose is taken
  • Know/learn how to adjust your insulin if you’re having less carbohydrate, are more physically active or have lost weight.
  • Ensure your BG is above 5mmols when you exercise. If not, have a carbohydrate snack (as listed in Step 3).  Speak with your GP or Diabetes Educator about adjusting your medication these days vs extra snacking.
  • Avoid alcohol on an empty stomach
  • Keep fast acting carb in zip locked bags everywhere: car, handbag, work, etc.

Download your Hypo Treatment Plan here

You must be above 5mmols to drive.  If not, you put at risk:

 

  • Yourself and those in your car
  • Other drivers or pedestrians
  • Your insurance policy to cover you
  • Your license being suspended
  •  

NB –

  • Pull over as soon as you have hypo symptoms
  • Remove the keys from the ignition
  • Treat your hypo
  • You are not to drive until 30 minutes after your BG level is above 5mmols

Always follow up with SLOW acting carb.

If you are unsure about your responsibilities, make an appointment with your GP or Diabetes Educator.

Download your Hypo Treatment Plan here

“Am I at higher risk with type 2 diabetes?”

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No. We all have the same risk of contracting it, so follow all the precautionary measures we’re currently being educated about on TV and social media.

A report from WHO (World Health Organisation), which studied cases in China, said people at the highest risk of severe disease, if contracting it, are those with the following underlying conditions: high blood pressure, diabetes, cardiovascular disease, respiratory conditions like asthma and cancer.

Coronavirus is a new virus, so none of us has immunity to it, but most cases appear to be mild.

For people with type 2 diabetes, if you contract Coronavirus, the severity and duration of this illness may have a greater impact on you. This means NOW is the time to be diligent with getting your blood glucose (BG) levels into a safe range, practice social distancing, and self-isolating if you have symptoms or feel safer.

How can I decrease the severity of illness if I contract Coronavirus?

  • Ensure your BG levels are well managed. This means, as a general guide, between 5-8mmols, but targets may be different for some people. This can help reduce the risk of infection and severity of the disease.
  • Manage your stress levels as well as you can. Ongoing stress contributes to elevated BG levels, fat around the waist and weakens your immune system. Social connection is vital as we physically distance ourselves. We need to keep connected to the world outside, our family and friends. This gives a sense of belonging and of not being alone. There are many groups online to be part of or get creative with phone call catchups.
  • Manage your waist measurement. Any increase will increase your BG levels as it contributes to your cells becoming more resistant to insulin. Reducing 5% of your body weight will have significant benefits to your BG levels, cholesterol and blood pressure. Be careful not to snack on high carb, high fat foods. Get stocked on healthier options too.
  • Now is the time to add physical activity. This is a great stress reliever and will help you stay mentally strong as well as physically. Find some groups to be a part of online – YouTube has videos of every exercise imaginable or keep accountable with friends/family and/or your allied health practitioner on the phone. Get outside – hanging out clothes, gardening, lawn mowing, or doing those jobs you haven’t had time for, plus you get vitamin D and fresh air.
  • If you develop an elevated temperature, this will increase your BG levels. Being prepared for this, staying well hydrated and having a plan is vital. (see our link for the template below).
  • Eat healthy. Make sure you’re giving your body the right food and nutrients to ensure it has the resources to stay strong and fight if necessary.
  • Flu vaccinations. Very important! You don’t want to lower your immunity by catching the yearly flu if you can try and prevent it. The flu vaccine only lasts 4 months, so having it early will mean you will need another in 4 months’ time.
  • The pneumococcal vaccine is available if you are over 65 and are at higher risk. If you are younger, discuss with your GP. It may decrease your risk of secondary bacterial pneumonia which comes after a respiratory viral infection. We don’t know how much protection it gives though in the case of Coronavirus as data isn’t available on this yet.

If you’re not sick now, get prepared! Now is the time to get ahead of the game. Your preparation for this should be just like flu season every year, although we acknowledge Coronavirus is not like the usual flu.

Everyone with diabetes should have a Sick Day Management Kit, which contains everything you may need when you get sick.

Download your Sick Day Management Kit here

Everyone with diabetes should have a Sick Day Management Plan. This is the plan you would prepare with your GP or Diabetes Educator and should have all the instructions on exactly what you need to do when you get sick.

Download your Sick Day Management Plan

These aren’t normal times we’re living in, they’re unprecedented. But it’s a great time to learn all you can about managing your diabetes. This is why we created Driving Diabetes last year to ensure you have the knowledge and skills to be the driver of your condition. Information regarding COVID-19 is changing everday. We’ll keep you updated on our Facebook page. Let us know any other questions you have on our Facebook page or send us a question on the Contact Us page of our website drivingdiabetes.com.au.

Helen & Amanda

“What should I do if I get sick?”

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Coronavirus is a new virus, so nobody has immunity to it; but most cases appear to be mild. For people with type 2 diabetes, if you contract Coronavirus, the severity and duration of this illness may have a greater impact on you. This means NOW is the time to be diligent with social distancing, self-isolating if you have symptoms or feel safer.

A report from WHO (World Health Organisation), which studied cases in China, said people at the highest risk of severe disease are those with the following underlying conditions: high blood pressure, diabetes, cardiovascular disease, respiratory conditions like asthma and cancer.

If you’re not sick now, get prepared! This is the time to get ahead of the game. Your preparation for this should be just like flu season every year, although we acknowledge Coronavirus is not like the usual flu.

Everyone with diabetes should have a Sick Day Management Kit, which contains everything you may need when you get sick.

Download your Sick Day Management Kit here

A Sick Day Management Plan is the plan you would prepare with your GP or Diabetes Educator and should have all the instructions on exactly what you need to do when you get sick.

Download your Sick Day Management Plan

When you’re unwell, your blood glucose levels will tend to increase, so you’ll need to take them more frequently, and may need your medication increased.  It’s important to know which medications you should cease if you become unwell or can’t eat, as some can result in severe adverse effects.

If you’re requiring insulin therapy, it’s important you know how your insulin works and how to adjust your doses safely.  Some people may need a change to their normal insulin regimen, including additional rapid acting insulin, if this isn’t a part of your usual insulin regimen.  Rapid acting insulin will help bring down elevated BG as you can have a correction dose, Discuss safe dosage with your GP or Diabetes Educator), every 2-4 hours.  Don’t attempt to increase your insulin dose without doing this as you could be a high risk of hypoglycaemia.

Also remember if your insulin dosage has been increased while you’ve been sick, it will need to be decreased again to your usual dose once you’re well again. This will help prevent hypoglycaemia.

Download your Hypo Treatment Plan here

You could become very sick very quickly, so go now and get your Kit and Plan ready.

Most people with diabetes we’ve discovered don’t have a plan of what to do when they get sick, so the situation becomes more frightening.  This doesn’t have to be the case and is one of the reasons why we created Driving Diabetes. We want you to have the skills and knowledge to be the driver of your condition; not the passenger, and not knowing what to do when issues come up.  Let’s get you in the driver’s seat.

Let us know any other questions you have on our Facebook page or send us a question on the home page of our website drivingdiabetes.com.au.

Amanda & Helen

“Who can I contact if I don’t know what to do?”

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If you’re unwell, phone your GP practice.  You may be able to have a telehealth appointment.  This is a phone call or face to face on your computer or phone and are bulk billed.

Everyone with diabetes should have a

  • Sick Day Management Kit, which contains everything you may need when you get sick, including contact phone numbers of people who can help you.
  • Sick Day Management Plan. This is the plan you would prepare with your GP or Diabetes Educator and should include all the instructions on exactly what you need to do when you get sick, including which medications to increase or cease.

Having both of these will help you feel calmer and more prepared when you get sick.

Download your Sick Day Management Kit here

Download your Sick Day Management Plan

When to seek medical advice:

  • You can’t keep your BG levels below 15mmols
  • You can’t keep your BG levels above 4mmols
  • Drowsy, confused, deep rapid breathing or shortness of breath
  • Chest pain
  • Can’t keep food or fluids down
  • Persistent vomiting, diarrhoea and/or stomach pain
  • Dehydration with symptoms of extreme thirst, weakness, confusion and only passing small amounts of (dark) urine
  • You don’t feel safe staying at home, even if there is someone with you

We understand it can be scary if you don’t know who to ask when you’re sick.  This is why we created Driving Diabetes where we can teach you how to be the driver of your condition.  Too many people are passengers, and don’t know what to do when issues come up.  Let’s get you in the driver’s seat. Let us know any other questions you have on our Facebook page or send us a question on the Contact Us page of our website drivingdiabetes.com.au.

Helen & Amanda

“I’m on insulin. What do I do if I get sick?”

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If you’re not sick now, get prepared! This is the time to get ahead of the game. Your preparation for this should be just like flu season every year, although we acknowledge Coronavirus is not like the usual flu.

Everyone with diabetes should have a Sick Day Management Kit, which contains everything you may need when you get sick.

Download your Sick Day Management Kit here

A Sick Day Management Plan is the plan you would prepare with your GP or Diabetes Educator and should have all the instructions on exactly what you need to do when you get sick.

Download your Sick Day Management Plan

It’s important you know how your insulin works, when you’re most at risk of hypoglycaemia (hypo) and how to adjust your doses safely.  Ask your GP for a script for rapid acting insulin, if this isn’t your usual insulin.  Rapid acting insulin will help bring down elevated BG levels as you can have a dose (as discussed with your GP or Diabetes Educator) every 2-4 hours.  If you don’t feel confident with adjusting your insulin, this is the time to learn how to.  You should be prepared for hypoglycaemia (hypo)

Download your Hypo Treatment Plan here

Have 4 weeks supply of insulin and needles, and ensure your prescriptions are up to date.  They can be used for 12 months.

If you’re requiring insulin you should be seeing a Diabetes Educator at least once a year. This will keep you updated with newer, improved insulins that may work better for you, or a device which makes giving the injection easier.  It will also help you become more confident in the adjustment of your insulin doses when required and puts you in control.

Now go and get your Kit and Plan ready.  You could become very sick very quickly.

There’s a lot to know about insulin.  Keep an eye out on our blog for more information about the various times of insulin, new ones, those going off pbs very soon. We’ll keep you updated on our Facebook page.  Let us know any other questions you have about medications on our Facebook page or send us a question on the Contact Us page of our website drivingdiabetes.com.au.

Amanda & Helen

“Are there any medications I should stop if I’m sick?”

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Yes, there are. It’s important to know your medications – names, dosage, why you take them, any potential side effects and of course, which ones to cease temporarily and contact your GP if you’re unwell.

This is the time to check your BG levels more frequently, aiming to keep them all under 12mmols.  Over 15mmols you can become quite dehydrated.  Everyone with diabetes should have a Sick Day Management Kit and Sick Day Management Plan personalised to them for times of illness.

Download your Sick Day Management Kit here

Download your Sick Day Management Plan

Are you on any of these? You may be on more than one or a combination.

BIGUANIDES: Metformin is the active ingredient.  Common brand names Diabex® Diaformin® Metex® Glucophage® Formet® Metformin® Diabex XR® Diaformin XR® Metex XR®.

In combination with DPP4i – Janumet® Tragentamet® Galvumet® Nesina Met® Kombiglyze®.

In combination with SGLT2i – Jardiamet® Xigduo®

Temporarily cease and seek medical advice if: Unwell and not able to eat, and tablet is causing nausea or difficult to swallow, kidney function less than 30% (eGFR 30 on blood test).

DPP-4 inhibitors: Brand names Januvia® Trajenta® Onglyza® Galvus® Nesina®.

In combination with Metformin® – Janumet® Galvumet® Trajentamet® Nesina Met® Kombiglyze®.

In combination with SGLT2i – Glyxambi®

Temporarily cease and seek medical advice if: Persistent or severe abdominal pain and see your GP, as risk of pancreatitis.

SGLT2 inhibitors: Brand names – Jardiance® Forxiga®.

In combination with Metformin® – Xigduo® Jardiamet®.

Temporarily cease and seek medical advice if you experience these symptoms of DKA (diabetic ketoacidosis), which is a very serious condition. You’re at risk of developing DKA on this medication, even with normal or mildly elevated BG levels (unlike DKA in type 1 diabetes where BG levels are significantly elevated).

Signs and symptoms of DKA – Extreme thirst, frequent urination, nausea and vomiting, abdominal pain, weakness or fatigue, shortness of breath, fruity breath smell, confusion.

One theory why this may occur with this medication is that SGLT2 inhibitors decrease the production of insulin when your body is under stress.  With insufficient insulin working, glucose can’t be used for energy, so your body needs an alternate fuel source – fat.  This results in high levels of acid bodies called ketones. There are 3 meters in Australia specifically designed to check for blood ketones – Freestyle Optium, Freestyle Libre, and the Glucokey.  They need specific ketone testing strips, different to your glucose testing strips.

Download our Diabetic Ketoacidosis (DKA) Guide

NB. Cease if severe pain, tenderness, redness, or swelling in your genital area, accompanied by fever or fatigue and see your GP immediately. This is a rare infection, but important for you to be aware of.

Ask your GP when you can recommence this medication again.  Usually it’s when you’re eating and drinking normally and feeling well again.

SULPHONYLUREAS:  Common brands names – Diamicron®, Glyade®, Amaryl®.

Combined with Metformin® – Glucovance®

Temporarily cease and seek medical advice if: you’re unwell and aren’t able to eat enough to prevent hypoglycaemia.

Download your Hypo Treatment Plan here

GLP1 AGONIST (Injectable): Brand names – Byetta® Victoza® Bydureon® Trulicity®

Seek medical advice if: you’re also on insulin or a Sulphonlyurea and aren’t able to eat as much carbohydrate as usual.  You may need to decrease your insulin dose or temporarily cease your GLP1 injection to prevent hypoglycaemia.

Download your Hypo Treatment Plan here

Cease immediately and seek medical advice if you have persistent or severe abdominal pain due to risk of pancreatitis.

If you need more information about your diabetes medications speak with your Pharmacist, GP or Diabetes Educator.

There’s a lot to know about your diabetes medication.  We trust this information helps you during this time.  Keep learning and asking questions.  You need to be the driver of your diabetes.  Let us know any other questions you have about medications on our Facebook page or send us a question on the Contact Us page of our website drivingdiabetes.com.au.

Amanda & Helen

“What Can I Eat When I Am Stuck At Home?”

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We’ve all been impacted by COVID-19 and have had to make some life changes to protect ourselves and our families from this virus. But those with type 2 diabetes need to take extra measures as they often have other medical issues like heart disease and high blood pressure.  If their diabetes isn’t well controlled at this time, their immune system won’t be as strong, which puts them at higher risk of a secondary infection if they contracted the virus. So, this blog is about the foods to help you stay strong, boost your immune system and help manage your blood glucose levels.

Families are now transitioning to work from home and distance themselves from social situations and starting to stock up on food and medical supplies in case they become unwell.

What foods should we be buying?

It’s natural to look for products that’ll last a long time in the pantry, in case we can’t leave home to get fresh food. When choosing, it’s important to consider a range of food types to ensure you get the nutrients you need.

Remember, we get glucose from eating carbohydrate foods. Our bodies NEED glucose to function properly.  However, too much carbohydrate will cause blood glucose (BG) levels to rise, as it’s the process of getting glucose into the body’s cells that is affected in type 2 diabetes. If you’re planning meals high in pasta, rice and potato over the next few months, your body may not be able to process this amount of carbohydrate, which may result in higher BG levels.

How will you know if it’s too much?

Check your BG levels before and two hours after your meal.  These should be similar, as it takes two hours for your body to digest your meal and move the glucose into your cells.

Food and drinks that will be helpful at this time:

  • Food and drinks that won’t cause additional rise in BG levels
  • Foods that contain fibre that slows the release of glucose into the blood
  • Drinks to stay hydrated
  • Foods with nutrition so your body has what it needs to boost its immune system.

Some ideas for your next shop:

Fruit and Vegetables

  • Frozen vegetables
  • Canned vegetables – corn, tomatoes, lentils, beans (look for no added salt varieties)
  • Canned soup
  • Avoid packet soups. They have a high sodium content, which can be dehydrating, increase your blood pressure and they also have low nutritional value.
  • Frozen berries
  • Canned fruit in natural juice

Grains high in Fibre

  • Wholegrain wraps, beans, lentils, rolled oats, wholegrain crackers, nuts and seeds

Don’t forget the Calcium

  • Fresh milk, UHT milk or milk powder, yoghurt, almonds, canned fish with bones

Meat or meat alternatives

  • Lean meat, fresh or frozen fish, eggs, tofu, beans, lentils, canned fish (salmon, sardines, tuna)

Are you on medication or insulin that increase you risk of hypoglycaemia (hypo)?

Download your Hypo Treatment Plan here

Tips to help keep your BG levels in range:

  • Include drinks without sugar to stay hydrated. If you don’t drink a lot of water, go for unflavoured mineral water and add your own fresh lemon or sugar free cordial.
  • If choosing to sip on hot lemon and honey, just add 1 tsp honey.
  • Drain the juice from canned fruit.
  • Be careful with potato – one small-medium potato per meal; sweet potato has less effect.
  • Eat smaller amounts of rice or pasta and bulk it up with extra vegetables.

Tips to prevent waist gain while at home:

  • Choose healthier snacks more often than not, low in saturated fat and sugar – wholegrain crackers, fruit toast, unflavoured popcorn, small handful of nuts or a piece of fruit.  Remember you want foods with nutrients to build your immunity, but not the kilojoules.
  • Alcohol – Kilojoules in alcohol are easily consumed. The body will always process alcohol first, (because it’s seen as a poison), so the kilojoules from the food you eat at this time is more likely to be stored as fat.
  • Being out of your normal routine can lead to excess sitting and snacking. This is a good time to practice mindful eating, watching portion sizes, and remember to keep moving – getting up and walking around every hour.
  • Stress is a big contributor to waist gain. It can be defined as ‘a feeling we can’t handle a situation’ which puts our brain into survival mode.  This can result in a lack of clear thinking, resulting in not making the best food, drink or physical activity choices.  In this mode we’re only thinking of now, not long term.  So emotional and over-eating can become an issue.
  • Find ways to decrease your stress levels as best you can. Stress hormones cause fat to be deposited around the waist, it increases BG levels and blood pressure and lowers the immune system.

We trust you’ll find some of this information is helpful.  We understand everyone is unique and will find different things that work for them.  It’s a matter of developing our own tool kit with all the things that work for us, that we can pull out when we need them.

Let us know what you have in your tool kit!

Helen & Amanda

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