The arrival of the colder weather also brings with it cold and flu season. Nobody likes getting sick, but for people living with type 1 diabetes (T1D), there are extra considerations.
Illness of any kind puts a body under stress, and the body releases hormones and antibodies to help fight disease. For someone with T1D, these hormones can be disruptive to blood glucose levels and how the body metabolizes insulin administered.
Having a checklist prepared in advance of getting sick that you can easily refer to can help mitigate some of the additional challenges of colds and flu with T1D.
When sick with a cold or flu, ensure to:
- Check your blood glucose regularly
- Stay hydrated
- Make sure to still eat even if appetite is low
- Check for ketones
- Have glucagon on hand for emergencies
- Have anti-nausea medication on hand
- See your healthcare provider if you aren’t getting better
Closely monitor blood-glucose levels and ketones
When you’re under the weather, you need to monitor your blood glucose and ketones more often than usual. Check your continuous glucose monitor (CGM) if you have one or frequently use finger prick checks. It may be necessary to administer extra insulin to bring down higher blood glucose levels.
Elevated ketone levels often occur when blood glucose is high. This can mean the body is using fat and muscle for energy, instead of sugar. Be on the lookout for ketones, as very high levels could lead to diabetic ketoacidosis (DKA), a dangerous condition that requires immediate medical attention and can be fatal if left untreated.
Medications can also impact blood glucose levels
Many over-the-counter (OTC) medications can affect blood glucose levels.
Pay attention to the sugar content in cough syrups or opt for sugar-free versions. Decongestants for stuffy nose or nasal congestion may raise blood glucose. An alternative option is saline nasal spray.
Acetaminophen, which is often taken to reduce minor aches and fevers from a flu or cold, can cause false or no readings in CGMs and can be toxic to the liver and kidneys if taken frequently or in large dosages. Anyone with kidney complications should speak to their healthcare provider before using these drugs. Ibuprofen can enhance insulin release and increase the risk of hypoglycemia (low blood glucose). Aspirin in large doses can lower blood glucose levels.
Eating and drinking while sick
When you’re sick and don’t have much of an appetite, it’s good to have some easily eaten carbs on hand. Crackers, unsweetened applesauce, or yogurt are relatively easy on the stomach. Consider taking anti-nausea medicine to help you eat, if needed. It’s important to stay well-hydrated, when you’re sick, so if you have difficulty swallowing because of a sore throat, try having some liquids with calories, like a smoothie, soup, or broths.
Be prepared for any contingencies or emergencies
Work with your diabetes care team to develop a plan for managing your T1D while sick. Always have emergency glucagon on hand to treat severe lows and make sure you know how to use it.
Have your doctor’s phone numbers (including how to reach them at night and on weekends or holidays) ready in case you encounter these symptoms:
- Vomiting or diarrhea for more than six hours
- Difficulty breathing
- A fever that doesn’t improve after a couple of days
- High levels of ketones
- Unable to keep food or liquid down and are experiencing hypoglycemia
If you do need to make an emergency room visit, it is very important that you mention that you have T1D. Consider a medic alert bracelet, or information about your T1D that is easily accessible from your phone.
Prevention is key
Preventing illness is always the best outcome. Getting an annual covid or flu vaccine every year can help mitigate severe disease. You might consider masking during cold and flu season in highly populated situations, or on public transit. Make sleep and hydration a priority, wash your hands often, and try to avoid touching your face.
Nobody likes getting sick, but preparation and most importantly – getting the proper rest and time to properly recover – can make it more manageable.
