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Advice for people with diabetes and their families

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Diabetes and being ill

When you have diabetes, it’s important to know how to cope when you’re unwell. Especially if you have to go into hospital.

Being ill can upset your diabetes management, so you need to know what to do to keep your blood glucose (sugar) levels as close to target as possible. Some people will know these as sick day rules.

You'll need to know how to manage insulin or other diabetes medications, blood or urine tests, and your diet. This is really important if you go into hospital. Always tell the healthcare professionals treating you that you have diabetes. You should have high-quality care while you’re in hospital – it’s one of your 15 Healthcare Essentials and something you’re entitled to get.

How being ill can affect your diabetes

Illness and infections, as well as other forms of stress, can raise your blood glucose (sugar) levels. As part of the body’s defence mechanism for fighting illness and infection, more glucose is released into the blood stream. This can happen even if you’re off your food or eating less than usual.

People who don’t have diabetes just produce more insulin to cope. But when you’ve got diabetes, your body can’t do this. The symptoms of diabetes can add to those of the original illness or infection and make it much worse.

Feeling or being sick, or having diarrhoea can make your blood sugar levels drop, because you're not absorbing food as usual.

Being dehydrated when you have diabetes

Having a temperature or being sick can lead to dehydration. In some cases, severe dehydration and very high blood sugar levels can mean that you need to go into hospital

So it’s important to be prepared and follow our advice on coping when you're sick. You might want to give this information to a friend or family member, so they can help you if you get sick.

Managing your diabetes when you’re sick

  • Don't panic – contact your diabetes team who will help you if you have any queries or if you are unsure about what to do.
  • Keep taking your diabetes medications – even if you don't feel like eating. But there are some medicines that you shouldn’t take as much of or stop taking altogether. Make sure you talk to your diabetes team as soon as you’re feeling ill so they can give you the right advice.
  • If you check your blood sugar at home you'll probably need to do it more often – at least every four hours, including during the night. If you don't test your blood sugar levels at home, be aware of the signs of a hyper (hypergylcaemia).
  • Stay hydrated – have plenty of unsweetened drinks, and eat little and often.
  • If you have type 1 diabetes, check your ketones if your blood sugar level is high (generally 15mmol/l or more, or 13mmol/l if you use an insulin pump, but your team may have given you different targets). If ketones are present, contact your diabetes team.
  • If you take a certain type of diabetes tablet called SGLT2i and become unwell, you should stop taking these. You need to check your ketones and your blood sugars (if you've been told to do this and have the kit), and speak to your healthcare team. The brand names of these tablets are Forxiga, Invokana and Jardiance. Taking these tablets when you're not very well could increase your risk of developing diabetic ketoacidosis (DKA), so you need to know the symptoms to look out for.
  • Keep eating or drinking – if you can’t keep food down, try snacks or drinks with carbohydrates in to give you energy. Try to sip sugary drinks (such as fruit juice or non-diet cola or lemonade) or suck on glucose tablets or sweets like jelly beans. Letting fizzy drinks go flat may help keep them down. If you're vomiting, or not able to keep fluids down, get medical help as soon as possible.

If you’re taking steroids

Some conditions, like Addison's disease, severe asthma, rheumatoid arthritis and lupus are treated with steroids. If you have diabetes, taking high doses of steroids for periods of time can make your blood sugar levels rise.

This shouldn’t stop you taking steroids if your doctor has prescribed them, even if your blood sugar levels are affected. But you should talk to your doctor about how best to manage your diabetes while taking steroids. You may need an increase in medication or it may need to be changed. If the steroids have been prescribed for a short period of time, your blood sugar levels will usually go back to normal when you stop taking them.

If you need to go to hospital 

You may be in a situation where you need medical attention for something not related to your diabetes, like an accident or injury. This means you might have to go to the Accident and Emergency department of your local hospital. And you might have to wait for a while before being seen. 

Make sure you tell someone as soon as you arrive that you have diabetes and that you might need to eat to avoid having a hypo. If you’re told you need to have surgery and that you can’t eat or drink anything, tell your doctor you have diabetes. If you feel you need to eat or drink, check with the staff first.

You may have to stay in hospital. This may be for something diabetes related, or not. While you’re there, it’s really important that your diabetes is cared for – it’s one of your 15 Healthcare Essentials. Here are some tips to help you:

  • Talk to your doctor or nurse about your diabetes and agree a plan to manage it during your hospital stay.
  • Ask a staff member if you have any worries about managing your diabetes, whether that’s practically or emotionally.
  • Check that ward staff have discussed your diabetes care with the diabetes team. If they haven't yet, make sure they do.
  • Your nurse or doctor should make sure you get your feet checked every day to help keep them healthy.
  • The hospital should give you the medication you normally use – but this may take some time so take some with you to avoid delays.
  • Take your own supplies of diabetes equipment, like your blood-testing kit or pump supplies (they probably won't be able to provide supplies for your pump).
  • While in hospital, your blood sugar levels may be higher or lower than normal. This might be because you’re ill, feeling stressed and or because you’re not being very active. You might need to test your blood sugar levels more often and adjust your treatment.
  • You should get advice and support about avoiding and managing hypos and hypers.
  • You should have help choosing meals and snacks, and the staff should make sure medications correspond with meal times if needed.
  • Don't assume that everyone treating you will know you have diabetes – it's always better to keep mentioning it.
  • Speak to your doctor or nurse about planning your discharge from hospital and your future diabetes care.

If you’re not getting this care and support in hospital, speak to your doctor or nurse, or the diabetes team. 

And we can help too – we’ve created a list of essential health checks and services you’re entitled to get when you have diabetes. Talk to your healthcare team about this and make sure you know what action to take if you’re not getting this level of support.

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