Diabetes and the Flu

The flu season starts in the fall and could last till May. It is a trying time for those of us with diabetes since we seem to be more susceptible and the stress of unwellness can rise our blood sugars. Today we are hearing and reading more about preventing the flu and what to do and not to do if we get sick.

There are differences between the symptoms of a cold and the flu, although sometimes we may use these terms interchangeability. A fever is rare with a cold but often present with the flu. The body aches with the flu and exhaustion and headache can be severe. For more information on the distinguishing factors of the flu and cold, check out Health Canada's website at: https://www.canada.ca/en/public-health/services/diseases/flu-influenza.html. Symptoms of the flu are not the same for everyone. A sore throat may be more common in adults as compared to a child or elderly person.

The vaccination against the flu is offered free of charge in many provinces and states. Several pharmacies /pharmacists offer the flu immunization so find out if your pharmacy offers this service. Most times you don't need an appointment so this could save you some time and fit into your busy schedule easier.

What do you do if you wake up in the middle of the night with a fever, headache, sore throat, diarrhea and vomiting (Table I). Sick day management guidelines are available in the 2018 Clinical Practice Guidelines found on the Canadian Diabetes Website at: https://guidelines.diabetes.ca/docs/patient-resources/stay-safe-whenyou-have-diaabetes-and-sick-or-at-risk-of-dehydration.pdf. It is common practice for Diabetes Associations to have guidelines for sick day management so check the most recent ones published and ask for guidance from one of your health care providers.

Table 1

Recommendations from available resources agree on the following actions:

1) stay hydrated- you lose a lot of body fluid (often referred to as dehydration) with vomiting and diarrhea. Signs of this might include the feeling of being lightheaded or dizzy

2) check your blood glucose more frequently such as every 3-4 hours since your values could be higher even though you may not have eaten or drunk anything for 24 hours

3) check for ketones in the urine if your blood glucose values have been high for 24 hours or more to avoid Diabetic Ketoacidosis (DKA) and

4) adjust insulin/oral medication as required. Remember to ask you health care team about managing your diabetes medication during times of sickness.

It is a good idea to review sick day management periodically with your health care team. Sickness can occur at any time of the year and can be sudden and unexpected. If you are taking other medications for chronic disease such as blood pressure, heart rate, Crohn's disease, know what to do with these medications during sickness. For Type 2 patients who receive oral medications only, it could be possible that during sickness you take none or all of your medications or just one or two. The reason for this is that the different oral medications for diabetes management have different ways of working in the body, it is for this reason you receive a combination of drugs, and during sick times and a poor appetite you might be able to avoid the type that promote insulin secretion. Be sure to confirm this with your diabetes management team. Ask at your Diabetes Clinic if they have printed information on this sort of plan.

I have been fortunate not to have the real influenza (flu) virus often. However my experience has followed the normal course of symptoms. When it does happen I rely on a couple of old remedies to avoid dehydration and elevated blood glucose values for extended times by having a sugar free drink available at the bedside and I check my blood glucose often, maybe even every 2-3 hours. Fluid foods like sugar free drinks or clear broths might be a good option. However, if your blood sugar is on the low side then you need nutrition with some glucose/sugar content and this could be apple juice, regular jello or your own preference.

A word of caution with respect to taking multiple small does of insulin during sickness. Insulin has a duration of action in the body and by taking too many injections too close together, their actions could overlap and result in a severe low blood sugar (hypoglycemic) reaction. I say this from experience so go slow and be wise.

Ketone checking is important when blood glucose has been elevated for extended periods of time. I know many people, including myself, hate to spend the money on ketone strips only to have them go outdated and then to be discarded. It would be nice to have smaller size containers to purchase and use in times of need. Now you can buy strips for urine and for blood which is nice because for years it was only the ketone strips for urine. However, the presence of ketones is not good and therefore if by doing testing you avoid experiencing ketoacidosis, the money is well invested.

The flu can be serious and it is contagious even before you know you are sick. Complications such as pneumonia, worsening of asthma, lung/throat infections are some of the symptoms and reasons that you need to see a healthcare provider. Diabetes is considered a chronic disease and as you already know we are at a higher risk for complications.

The Health Canada Website informs us that over 12,000 hospitalizations and 3500 death occur each year form influenza in Canada. Everyone can take measures to lower this number such as : good hand washing, receiving the vaccination, staying home when you are sick, covering your coughs and sneezes, avoid touching. your eyes, nose and mouth and limit contact with people who are ill.

Diabetes and the flu can be managed but it does require that we think ahead, having extra diabetes supplies available and knowing who to contact and what to do if the need arises.

Thank You for taking the time to read my first blog. I hope you will continue to follow my blog and benefit from the information. Please take a moment and read my "About" section. My goal is to publish a new article every two weeks but please bear with me as I learn the tricks of the trade.