What are the special considerations for blood glucose management during illness (such as cold or fever)?

Okay, fellow diabetic, you've hit the nail on the head. Getting sick is indeed a major challenge for us. Blood sugar can be like a roller coaster ride, requiring extra vigilance. Based on my own experience and what I've learned, let me break down the key points for you.

---

What's Special About Blood Sugar Management When Sick (e.g., with a Cold or Fever)?

Simply put, when we're sick, our body goes into "battle mode." Think of the cold virus as an invading enemy. To fight this battle, the body mobilizes various "weapons," including stress hormones (like adrenaline and cortisol).

These hormones are well-intentioned – they aim to provide the body with more energy to fight. However, they have a side effect: they cause your liver to release more glucose and also make your body more resistant to insulin.

This leads to a strange phenomenon: Even if you have no appetite, eat very little, or even eat nothing at all, your blood sugar might keep climbing!

Therefore, the core of blood sugar management during illness revolves around dealing with this unique situation of "rising blood sugar without eating."

The "Three Non-Negotiables and Eight Key Points" for Blood Sugar Management When Sick

Remembering the following will help you navigate illness smoothly:

Three Non-Negotiables (Must Do!)

1. NEVER stop your medication or insulin on your own! This is the absolute most important rule! Many people think, "I'm not eating, so I don't need my shot/pills." This is a very dangerous idea. As we said above, your body is producing sugar itself; you need your medication more than usual to control it. Of course, the specific dosage might need fine-tuning based on your blood sugar and your doctor's advice, but you absolutely must not stop it outright.

2. Test your blood sugar more frequently! If you normally test 4 times a day, increase the frequency to every 2-4 hours when sick. It's like navigating a ship in a storm; you need to constantly check your compass and charts to know where you are and where to go next. Only by understanding the dynamic changes in your blood sugar can you and your doctor make the right decisions.

3. Drink fluids like crazy! Fever and sweating dehydrate you, and dehydration raises blood sugar further, creating a vicious cycle. So, ensure adequate fluid intake. Plain water and weak tea are the best choices. Aim to keep your urine clear or pale yellow.

Eight Key Points (Adding Extra Protection)

1. If you can eat, eat on schedule. Try to choose easily digestible carbohydrates like porridge, soft noodles, soda crackers, steamed egg custard, etc. This ensures your body has basic energy supply, preventing low blood sugar from not eating while still taking medication.

2. If you can't eat, "drink" your carbs. If you truly have no appetite or feel nauseous/vomiting, try drinking sugary liquids to replenish carbs, like fruit juice, sports drinks, or even sugary soda (yes, you read that right – they are "emergency medicine" in this special situation). Follow the "15 grams of carbs" rule: aim to consume about 15 grams of carbohydrates per hour (e.g., half a cup of juice) to prevent starvation ketosis.

3. Be vigilant for ketosis! This is one of the most dangerous complications of high blood sugar. When the body can't use sugar for energy, it starts breaking down fat, producing acidic substances called "ketones." Think of them as "exhaust fumes" from burning fat; too many are toxic.

   • When to test for ketones? When your blood sugar is consistently above 13.9 mmol/L, you should test using urine ketone strips or a blood ketone meter.
   • If ketones are present and you have symptoms like nausea, vomiting, abdominal pain, or fruity-smelling breath, go to the hospital immediately, without hesitation!

4. Prepare a "sick day kit" in advance. Like a first-aid kit, have this ready beforehand. It could include:

   • Blood glucose meter, plenty of test strips, lancets
   • Ketone test strips
   • A few bottles of juice or packs of crackers
   • Thermometer
   • Contact information for your primary doctor

5. Get plenty of rest. Rest is the best medicine; it helps your immune system fight the illness faster.

6. Keep good records. Write down your blood sugar readings, what you ate/drank, medication doses, temperature, and symptoms. Bring this record to your follow-up appointments; it's very valuable information for your doctor.

7. Know when to seek help. If any of the following occur, don't tough it out; contact your doctor or go to the ER promptly:

   • Continuous vomiting or diarrhea for over 6 hours.
   • Blood sugar remains very high (e.g., >16.7 mmol/L) and doesn't come down with your usual management.
   • Urine or blood ketones show moderate or large amounts.
   • Fever over 38.5°C (101.3°F) that doesn't subside.
   • Feeling short of breath, confused, or extremely weak.

8. Create a "sick day plan" with your doctor. Ideally, when you're not sick, discuss with your doctor how to adjust your insulin or medication doses if you do get sick, and under what circumstances you need to contact them. Be prepared.

In short, getting sick is like a "pop quiz" for diabetics. While it can be challenging, as long as we know the rules and manage carefully, we can definitely get through it safely. Wishing you good health!