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Management of Diabetes: Sick day management

A diabetic may not be able to take the usual diet if he/she develops indigestion, stomach upset, nausea or any other illness In such situations, the diabetic should take usual or at least part of the carbohydrate and protein allowance, minerals and fluids, in the form of liquids or a soft diet. Small and frequent feeds are likely to be retained rather than two large meals. Sodium and potassium may be lost due to excessive urination, sweating or diarrhoea and should be replaced by taking vegetable soups, broths, fruit juice, coconut water etc. Plenty of liquids should be taken and the daily intake of fluids should be noted (see Table 19.1). Exercise should be avoided.

Any one of the following feeds supply 10 g carbohydrates.

Bread

Buttermilk

Coconut water

Cornflakes

Jam

Milk

Orange juice

Sour lime sherbet

Sweet lime juice

Sago kheer

1 slice, small

1 cup + sugar

2 teaspoons

1 cup

1/2 cup

2 teaspoons

3/4 cup

1 cup + Sugar 2 teaspoons

3/4 cup

Five to six portions of these foodstuffs within 6 to 8 hours should be taken.

Urine should be tested frequently for glucose and ketones and the results should be recorded. Blood glucose should be tested. While infection increases the blood glucose, reduced food intake reduces the blood glucose level. Insulin should never be omitted, but its dose has to be adjusted. A changeover from intermediate-acting insulin to short-acting insulin is advisable. One should try to keep blood glucose levels little above the customary desired range. Hypoglycaemia should be avoided. Metformin should be avoided when there is a stomach or bowel upset. Hospitalisation is essential in presence of persistent vomiting, significant fluid loss or ketones in urine.

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Management of Diabetes: Sick day management