American Diabetes Association Complete Guide to Diabetes: The Ultimate Home Reference from the Diabetes Experts

CHAPTER 8

Blood Glucose Emergencies

• Hypoglycemia

• Hyperglycemia

• Illness

Dealing with high and low blood glucose levels is a fact of life with diabetes, so you should be aware of possible emergencies that can occur. Emergencies include blood glucose levels that are too high or too low.

It is important that you learn to recognize the warning signs and have a plan for dealing with them. Discuss with your health care team what you should be on the lookout for and what you should do if you suspect an emergency situation may be developing. Also, talk to your family, friends, and coworkers about what to do in an emergency. If you are in danger, you may not always be able to handle the situation yourself.


Being prepared is your best bet, and frequent monitoring of blood glucose will alert you in time to prevent most emergencies.


Hypoglycemia

The most common emergency is low blood sugar, which is called hypoglycemia. It can be a problem for people who take insulin or certain diabetes pills, including chlorpropamide, glipizide, glyburide, glimepiride, repaglinide, and nateglinide. Hypoglycemia occurs when blood glucose levels get too low. At the beginning of a hypoglycemic reaction, you might feel dizzy, sweaty, shaky, or faint. If untreated, you could lose consciousness or have seizures.

Hypoglycemia is usually caused by insulin doing its job too well. In people without diabetes, the body stops releasing insulin before glucose levels fall too low. But if you inject insulin, your body has no way to shut it off. Another interesting, if frustrating, fact about diabetes is that the body uses insulin inconsistently. Even if you always give yourself the same dose of insulin or other diabetes medication, you could end up with more than enough insulin to handle the glucose in your blood. This can happen even when you are doing everything (including eating) the same as usual.

It’s impossible to control everything you do to manage your diabetes, no matter how hard you try. Insulin will do its job of clearing glucose from the blood even if it means that blood glucose levels fall too low. Hypoglycemia usually occurs just before meals, during or after strenuous exercise, or when you have too much insulin in your body. Sometimes you may even get hypoglycemia during the night when you are sleeping.

Causes of Hypoglycemia

• Too much insulin

• Too little food

• Too much exercise

• A delayed meal

• Alcohol on an empty stomach

Symptoms of Low Blood Glucose

It’s important that you learn your own signs of hypoglycemia. Different people may have different feelings, so it’s important to know what signals your body gives during a low glucose reaction. Hypoglycemia can occur at any time. The only sure way to know whether you have hypoglycemia is to check your blood glucose.

Symptoms of Hypoglycemia

• Shakiness

• Nervousness or anxiety

• Sweating

• Irritability or impatience

• Chills and clamminess

• Rapid heartbeat

• Lightheadedness

• Hunger

• Sleepiness

• Anger, stubbornness, or sadness

• Lack of coordination

• Blurred vision

• Nausea

• Tingling or numbness in the lips or tongue

• Nightmares or crying out during sleep

• Headaches

• Strange behavior, including delirium, confusion, or personality change

• Seizures

• Unconsciousness


Each person’s reaction to low blood glucose can cause a different set of symptoms. It is unlikely that you will have them all or that you will have the same ones each time.


Hypoglycemic symptoms can serve as important clues to whether you are having a low glucose reaction, but they are not always the full story. Sometimes the symptoms could be due to something else. Unless you check your blood glucose level, you could overtreat or overreact, causing glucose levels to soar.

Very often, hypoglycemia occurs when blood glucose levels fall below 70 mg/dl. However, many people have glucose readings below this level and feel no symptoms. Others may start to have symptoms of hypoglycemia when their blood glucose is higher than 70 mg/dl. All of this can be very confusing. To start, ask your provider or educator what glucose levels to look out for when you suspect hypoglycemia. Make note of the symptoms you are experiencing. You will soon learn what level is too low for you.

Hypoglycemia at Night

While it may seem difficult to figure out whether you’ve had hypoglycemia in your sleep, there are some clues.

• Pajamas or sheets are damp with sweat in the morning

• Restless sleep or nightmares

• A headache or feeling of tiredness when you wake up in the morning

• Ketones in your urine in the morning without a high blood glucose reading

You may want to check your blood glucose around 2 or 3 a.m. a few times to try to match your results with your food intake, physical activity, and medication doses from the previous day and evening. This will help you pinpoint what is really going on.

Hypoglycemia Unawareness

Some people have a hard time knowing when their blood glucose level has fallen to a dangerous level. People who tend to miss these early symptoms are said to have hypoglycemia unawareness. For them, the first symptom of low blood glucose can be impaired thinking.

Hypoglycemia unawareness seems to occur more frequently in people who have had a lot of low blood glucose episodes or who have had diabetes for a long time. In addition to unawareness, a person’s body may not respond properly. Someone with hypoglycemia unawareness may not respond immediately to treatment, and the hypoglycemia may last longer.

People with hypoglycemia unawareness are less likely to be awakened from sleep when hypoglycemia occurs at night, and they have less strong defenses against hypoglycemia during exercise. It is common in pregnant women and people who intensively manage their diabetes. There is some evidence that frequent episodes of low blood glucose can make someone have hypoglycemia unawareness.

This is a dangerous condition, and if you think you have hypoglycemia unawareness, you should consult with your health care team. Sometimes, just avoiding mild hypoglycemia can help restore a person’s awareness of the symptoms of hypoglycemia. Other times, the solution will be to increase blood glucose goals to higher numbers.

Some Safety Nets for Hypoglycemia Unawareness

• Increase the number of times you check every day or check at different times

• Always check before driving. If levels are under 100 mg/dl, eat and test again. If glucose levels are higher than that but falling, eat and test again before driving

• Discuss your hypoglycemic episodes with your health care team so you can look for patterns to use as warning cues

• Educate the people you’re with every day about hypoglycemia and how to help you

• Wear an ID bracelet that identifies you as a person with diabetes

• Ask for prescription glucagon, and be sure those around you know how to use it. (Find out more about glucagon later in this chapter.)

• Attend a class on blood glucose awareness training offered at a specialty diabetes clinic

Treatment of Hypoglycemia

Check your blood glucose level if you think you have hypoglycemia. Talk to your health care team about the blood glucose level at which you should begin treating for hypoglycemia. Although it’s best to check before treating, this may not always be possible. What if you don’t have your monitor with you? Should you wait until you get home? No! Eat or drink something immediately. Never wait until you get home, especially if you have to drive.

You need to eat or drink something that contains carbohydrate that can be rapidly absorbed from your digestive tract and into your blood. However, you shouldn’t go overboard. You’ll feel worse later on if you send your blood glucose levels soaring. There are many choices of fast-acting carbohydrates.

You’re best prepared for low blood glucose if you carry around a measured amount (15 grams) of “pocket carbohydrate.” The easiest and most convenient fast-acting carbohydrate is found in glucose tablets or gel, which come in a variety of flavors. Check the annual Diabetes Forecast Consumer Guide for a list of current over-the-counter products for treating low blood glucose. Usually, two to five glucose tablets or one package of glucose gel will bring quick relief, but check the instructions and dosing on the package to make sure.

Recheck your blood glucose 15 minutes after you’ve treated your low blood glucose. If you still have low blood glucose, you may need to take another dose of 10–15 grams. Check again in another hour. If blood glucose is low, you may need another 15 grams of carbohydrate.

Fast-Acting Carbohydrates for Hypoglycemia

Each has about 15 grams:

• 2–5 glucose tablets

• 1 gel tube

• 2 tablespoons raisins

• ½ cup regular soda (not diet)

• 4 ounces orange juice

• 5–7 Lifesavers

• 6 jellybeans

• 10 gumdrops

• 3 teaspoons sugar, honey, or corn syrup

• 6–8 ounces nonfat or 1% milk


After an episode of severe low blood glucose, readings may run high for some hours afterward, as a result of your body fighting back against the low blood glucose. High blood glucose readings immediately following a low reading can lead to a misinterpretation of the pattern. Talk to your health care provider about these patterns, because if you treat for the high readings, you may begin a dangerous cycle of fluctuating blood glucose levels.


Special Considerations for Hypoglycemia

Physical Activity

Exercise and other physical activity lowers blood glucose levels, so you have to be extra careful to avoid hypoglycemia during and sometimes after exercise (if you take insulin). When you first begin an exercise program, you will need to monitor your blood glucose levels after exercise to find out how your body responds. If you feel as though you are becoming hypoglycemic while you are working out, stop at once. Don’t say, “I’ll just do one more lap” or “Just 5 minutes won’t hurt.” Stop.

Treating Hypoglycemia during Physical Activity

• Check your blood glucose right away and treat hypoglycemia if you need to.

• If you want to continue your workout, eat a snack, take a 15-minute break, and check to make sure your blood glucose has come back up above 100 mg/dl before starting back. If you start too soon, your blood glucose may drop again, quickly.

• Studies show that hypoglycemia is even more likely to occur 4–10 hours after you exercise than during the activity or shortly after.

Sexual Activity

If you are prone to hypoglycemia when you work out or at night, you may also have a low blood glucose reaction following sexual activity. This can be especially true if you have sex at night. This is when your blood glucose levels typically dip, so you may need to adjust your insulin or have a snack before or after sexual activity. Be especially careful if you are combining sexual activity with alcohol.

Avoiding Lows During and After Sex

• If you use insulin, you need to be watchful for low blood glucose during or after sex.

• Check your blood glucose first. This may slow you down a bit, but it’s better than having to deal with low blood glucose at an inopportune moment.

• Eat just before or right after active sex, just as you would if you were exercising.

• Consider having a snack before going to sleep for the night.

• If you use an insulin pump, you may want to set a temporary basal or disconnect it during sex to avoid going low. See more about insulin pumps and plans in chapter 13. The length of time you can safely keep the pump off without an injection depends on how active you are. Ask your health care team for advice about this.

Heart Disease

Hypoglycemia can cause your heart to beat faster than normal. If you have heart disease, talk to your doctor about how hypoglycemia might affect you. You may need to keep your blood glucose levels a little higher to reduce the risk of developing hypoglycemia.

Alcohol

Alcohol lowers blood glucose levels. Normally, when your blood glucose levels begin to drop too low, your liver will convert stored glycogen to glucose. This helps protect you from a severe reaction temporarily and gives you time to recognize and treat hypoglycemia. But alcohol interferes with this process. If you drink alcohol, you may have a severe hypoglycemic reaction with little warning. Read more about alcohol and your meal plan in chapter 10.

Dawn Phenomenon

Your body has a normal mechanism that wakes you up and gives you energy to start the day. Your body responds to this wake-up call of hormones. These hormones depress the activity of insulin, allowing blood glucose to rise between around 4 and 8 a.m. This is called the dawn phenomenon. The dawn phenomenon can be one reason for blood glucose readings and ketone levels that are high when you wake up.

If high morning blood glucose levels seem to occur mysteriously, discuss the problem with your health care team and talk about the best way to treat it.

Severe Hypoglycemia

You could develop severe hypoglycemia if your symptoms of low blood glucose go unnoticed or are ignored. People who are elderly or who take diabetes pills, such as sulfonylureas, are more likely to develop severe hypoglycemia. You may lose consciousness if your brain has been deprived of blood glucose for too long. This is a real emergency. The best way to deal with severe hypoglycemia is to take precautions so that it doesn’t happen in the first place. Be alert to your symptoms and treat yourself right away. Don’t wait to see if it gets worse or put off treatment until a more convenient time.

You may become so confused and irritable that you refuse help during a hypoglycemic reaction. Those around you may have to be persistent to get you the help you need. They can save you from a coma and a trip to the hospital by insisting that you take some form of glucose quickly. Your life will be easier and safer if those with whom you spend the most time can spot a low glucose reaction and know what to do about it.

Someone else must take over if you become unconscious. You will not be able to eat or drink anything, but your blood glucose levels need to go up immediately. The safest remedy is to get a glucagon injection. Your helper should call for emergency help at once if he or she does not know how to inject glucagon. Glucagon will not work in someone who does not have enough glucose in the liver, which can occur with starvation, or in those whose liver does not effectively release stored glucose, which can occur with excessive alcohol intake.


Severe Hypoglycemia and Sleep

If you live alone, you may be concerned about having a severe hypoglycemic reaction while you are sleeping. Your best bet is to monitor your blood glucose levels before you go to sleep and occasionally during the night. If your blood glucose level is dropping, eat a small snack before going to sleep. Try mixing uncooked cornstarch into the snack or eat a product that contains slow-digesting carbohydrates. Many people who take insulin are able to reduce their risk of nighttime lows by switching to an insulin pump.


If you are prone to hypoglycemia, you’ll need to train someone you trust to inject glucagon. Talk to your provider about whether you should buy a glucagon kit, which is available by prescription. Ask your family members or friends to learn how to use glucagon, so they know what to do.

How to Inject Glucagon

1. Typically, glucagon kits are brightly colored and include step-by-step instructions.

2. A glucagon kit has a syringe filled with diluting fluid and a bottle of powdered glucagon. You must mix the diluting fluid with the powder immediately before it is injected. The instructions for mixing and injecting glucagon are included in the kit.

3. Inject glucagon into the buttock, arm, or thigh.

4. Turn the person on his or her side so if there is vomiting, he or she will not choke.

5. Feed the person with appropriate carbohydrate immediately when he or she wakes up and is able to swallow. Start with nondiet soda, juice, glucose tablets or gels, and then additional carbohydrate.

6. Check blood glucose. If the person does not wake up within 15 minutes, call for an ambulance. The dose may be repeated after 20 minutes.

7. Always call your provider and emergency personnel when a severe reaction occurs in order for help to arrive and appropriate care to be administered. Ask for instructions on emergency procedures when you get the prescription. Read the instructions that come with the glucagon and share them with friends, family, and coworkers.

8. Kits usually last a year before expiring (check the date on the box). However, premixing the glucagon and diluting solution will make the mixture last only 48 hours in the refrigerator.

Always let your health care providers know if you have taken glucagon and had a severe hypoglycemia episode. Also, tell them if you are having frequent bouts of even mild hypoglycemia. By working together, you might find a pattern in your insulin, meals, or activity routine that may be causing the hypoglycemia. With clues, you and your health care team can do some problem solving and decide on changes to prevent severe hypoglycemia.


Tell a Friend

Either you or a member of your health care team should instruct family, friends, or coworkers about the signs of severe hypoglycemia—and what to do if it develops.


Pregnancy and Severe Hypoglycemia

Many pregnant women, who have intensive blood glucose goals, may experience hypoglycemia unawareness. Thus, they are more likely to have mild and moderate bouts of hypoglycemia. Pregnant women should keep up a consistent blood glucose monitoring routine and check their blood glucose when hypoglycemia is most likely (between meals and in the middle of the night). You need to treat any blood glucose level below 70 mg/dl. You’ll have to take special precautions if you are pregnant and become unconscious.


Treating Severe Hypoglycemia during Pregnancy

• You may need only half the normal dose of glucagon at the beginning of a severe episode of hypoglycemia.

• After 15 minutes, if you do not regain consciousness or your blood glucose levels do not rise, you need another shot and someone should call 911 for emergency help.

• Make sure that those with whom you spend time know that you are pregnant and know what to do if you have a low blood glucose episode.

• Ask your health care provider about the dose of glucagon you need.


Hyperglycemia

High levels of glucose in your blood over time may lead to long-term complications. But blood glucose levels can also become dangerously high in the short term and cause a life-threatening situation that could result in coma or death. It is important to know the warning signs and treatments for hyperglycemia, which are different for people with type 1 and type 2 diabetes.

Type 1 Diabetes and Diabetic Ketoacidosis

Too little insulin in your body leads to too much glucose in your blood. A rare and serious—but often preventable—emergency can arise when blood glucose levels rise. Diabetic ketoacidosis, also called DKA, occurs when you don’t have enough insulin. It is mostly a problem for people with type 1 diabetes. A person with diabetes may have such low levels of insulin that his or her liver may produce unchecked levels of glucose and ketones, especially during illness or stress. It can occur in people with type 1 diabetes who have not yet been diagnosed.

Diabetic ketoacidosis can start innocently enough; you miss a dose of insulin, the insulin you’ve been using has gone bad, or your insulin pump tubing gets blocked. The lack of insulin leads to an undetected high blood glucose level, which can progress to a coma, shock, pneumonia, difficulty breathing, and even death.

Diabetic ketoacidosis can occur during periods of stress or illness, when the body releases hormones that promote the release of stored glucose and block the effects of insulin. Sometimes when you are sick and can’t eat, you may think, “I shouldn’t take insulin today.” But your body still needs insulin to cover its 24-hour insulin needs, even if you aren’t eating. Plus, you are likely producing extra glucose. So, in addition to your usual dose of insulin, you may actually need extra insulin. Drinking plenty of fluids will also help. Talk with your health care providers ahead of time about a plan of action for dealing with ketoacidosis and how to prevent it when you are stressed or ill.

Signs of DKA

• High blood glucose above 240 mg/dl and not falling

• Classic signs of hyperglycemia: intense thirst, dry mouth, need to urinate frequently

• Lack of appetite or pains in your stomach

• Vomiting or nausea

• Blurry vision

• Fever or warm, dry, or flushed skin

• Difficulty breathing

• Feeling of weakness

• Sleepiness

• A fruity odor on your breath

Testing for Diabetic Ketoacidosis

You can use a test strip to measure the amount of ketones in your urine. Urine test strips are available over the counter, and you can find out more about using them in chapter 7. Some blood glucose meters also check for ketones.

You’ll want to test your urine for ketones whenever your blood glucose is over 240 mg/dl or you feel ill. If your urine shows trace or small amounts of ketones, it’s a sign that you need more insulin or carbohydrate.

When to Test for Ketones

• If your blood glucose is over 240 mg/dl and not falling

• When you are ill, especially if you have a high fever, bouts of vomiting, or diarrhea

• When you have severe fatigue, fruity breath, breathing difficulties, or a hard time concentrating

• During pregnancy, if your blood glucose is over 200 mg/dl or as your health care provider recommends

How to Check for Ketones in Urine

Equipment

• Ketone test strip

• Cup or a clean container to contain the urine, if desired

• Watch or other timing device

Instructions

1. Dip a ketone test strip in a urine sample or pass it through the stream of urine.

2. Time test according to the directions on the package.

3. The strip will change colors if ketones are present. Compare test strip to package color chart.

4. Record the results.

5. Contact your provider as recommended based on your results.

If Your Urine Shows Moderate or Large Amounts of Ketones

• Call your health care team immediately or use the plan that you and your health care team have already put in place.

• You probably need to take extra rapid- or short-acting insulin right away.

• Drink plenty of sugar-free fluids to prevent dehydration.

• Seek emergency help at once if your ketones do not promptly go down or if you are vomiting and can’t stop.

• Make sure those who spend time with you know what to look for and what to do if you have signs of diabetic ketoacidosis.

Illness calls for more frequent blood glucose monitoring and urine testing for ketones. Do both at least every 4 hours until you’re feeling better. Check your urine for ketones any time you feel queasy or are vomiting (even if your blood glucose isn’t high). A buildup of ketones can cause nausea.

Pregnant women should also test for ketones frequently. Daily urine ketone testing can help detect elevated levels and prevent diabetic ketoacidosis, which can be very dangerous for the developing baby.


Blood Ketone Testing

Your doctor may prefer that you check for ketones in your blood rather than in your urine. Testing ketone levels in the blood actually yields more accurate results than checking ketones in urine. Usually, blood ketone levels are checked by drawing blood and testing the sample in a lab—obviously, this is something done at a clinic or hospital. However, some newer blood glucose meters can check blood ketone levels in addition to blood glucose levels, making this test easy to perform at home.


Type 2 Diabetes and Hyperosmolar Hyperglycemic Syndrome

People with type 2 diabetes have less dramatic swings in blood glucose levels compared with people with type 1 diabetes, in general. However, people with type 2 diabetes can sustain high blood glucose levels over prolonged periods without even knowing it. This can wear on the body and may cause diabetes complications. You can guard against chronic hyperglycemia by monitoring your blood glucose levels regularly.

Acute hyperglycemia can occur in people with type 2 diabetes and is life threatening. Hyperglycemia in people with type 2 diabetes does not usually produce ketones. But blood glucose levels can soar to over 600 mg/dl and even as high as 1,000 mg/dl. This sometimes happens before diabetes is diagnosed. Extreme hyperglycemia can cause a coma.

Hyperosmolar hyperglycemic syndrome (HHS) occurs almost exclusively in people with type 2 diabetes. It can happen to people who manage their diabetes with food and exercise only and those who take diabetes medications.

One-third of all cases of HHS are caused by undiagnosed diabetes. HHS results from stress, infections, heart attacks, strokes, corticosteroid medications, and even diuretics. Sometimes something as simple as not being able to get a drink of water can contribute to developing HHS. It occurs more often in people who have restricted mobility, such as the elderly, or in people who cannot take good care of their bodies. Also, as you age, your sense of thirst diminishes, and it’s harder to sense the need to drink enough fluids.

HHS occurs because rising blood glucose levels cause you to urinate more and become dehydrated. This process may go on for days and weeks. Extreme dehydration eventually leads to confusion and inability to get a drink or make it to the toilet. The blood gets thicker with more glucose and less fluid. Eventually, the severe dehydration leads to seizures, coma, and death.

Signs of HHS

• Dry, parched mouth

• Extreme thirst, although this may gradually disappear

• Sleepiness or confusion

• Warm, dry skin with no sweating

• High blood glucose. If it’s over 300 mg/dl on two readings, call your health care team; if it’s over 500 mg/dl and not falling, have someone take you to the hospital immediately.

If you experience any of the above signs of HHS, check your blood glucose levels at once and call your provider. Be sure those around you know what to do because you may not be able to react.

You’ll be alerted to high blood glucose levels well before HHS sets in if you check your blood glucose even once a day. To be sure, test your blood glucose levels three or four times a day when you are sick. It’s also very important to drink plenty of alcohol-free, sugar-free fluids. You may need to take insulin, even if you don’t ordinarily use it.

Special Precautions for HHS

• Ask your doctor or pharmacist if certain medications may increase your risk for HHS, such as glucocorticoids (steroids), diuretics, phenytoin (Dilantin), cimetidine (Tagamet), and beta-blockers (especially Inderal).

• HHS can occur in people having peritoneal dialysis or intravenous feedings, so you’ll need to check blood glucose frequently.

• About one-third of cases of HHS occur in people living in nursing homes. This can happen when residents are confused or have to wait for staff to offer them something to drink, leading to dehydration. Family members may have to educate staff of the patient’s needs and ask for regular blood glucose monitoring.

Illness

When you’re sick, your body releases hormones to fight the illness. These hormones also counteract insulin and raise your blood glucose levels. Extremely high blood glucose can lead to diabetic ketoacidosis and HHS.

So, when you’re sick, you’ll want to check your blood glucose more frequently than ever. Also, be sure to talk to your health care team before you get ill about what you should do in the event of illness. You and your health care team can work together to come up with a plan to help you handle common illnesses, such as colds or the flu.

Sick-Day Action Plan

You and your doctor may want to answer these questions when developing a plan for your next illness.

• How often should I monitor my blood glucose?

• When should I call the doctor?

• Should I test for ketones?

• What medication changes should I anticipate? How should I manage doses of my insulin or other medication?

• Which over-the-counter medications are safe to take?

• How should I choose appropriate foods and fluids while I’m sick?

Tips during Illness

• Monitor. Check your blood glucose and ketone levels about every 3–4 hours. If the levels are too high or you are pregnant, you may need to monitor more often.

• Food. Make substitutions for your usual food if nausea and vomiting make it difficult to eat. Try to eat or drink your usual amount of carbohydrates. Talk to your dietitian about ways to cover your basic eating plan. Prepare a sick-day plan before you even become sick. Try to keep some comforting foods, like soup, on hand, especially during the cold and flu season.

• Liquids. Drink plenty of caffeine-free liquids. You may need regular soft drinks or sports drinks with sugar or carbohydrate if you are losing fluids by vomiting, fever, or diarrhea. These drinks may help prevent the hypoglycemia caused by not eating or taking extra insulin. Try sipping 3–6 ounces an hour to keep your blood glucose even.

• On Hand. Keep a thermometer on hand and a small supply of common sick-day medications that are safe to take. Be sure to read the labels. Be sure to consult with your health care team to find out which medications are safe to use.

• Insulin. If you have type 1 diabetes, continue to take your insulin—even if you can’t eat. You may even need extra insulin to take care of the excess glucose your body releases when you are sick. Ask your provider about what blood glucose levels call for a change in your insulin dose.

Cold Medicines

Some cold medicines sold over-the-counter to treat colds and flu can affect your blood glucose level. Many cough and cold remedies labeled “decongestant” contain ingredients, such as pseudoephedrine, that raise blood glucose levels and blood pressure. Talk to the pharmacist or your provider before you take any over-the-counter medication.

In addition, some cough and cold remedies contain sugar and alcohol. Make sure you read the label and find out exactly what “active ingredients” as well as “inactive ingredients” any medication contains. A small amount of sugar or alcohol is probably fine, as long as you’re aware of it.

Pain medications are usually safe in small doses. You don’t have to worry about taking an occasional aspirin for a headache or fever. Many people with diabetes take a daily, coated “baby” aspirin to protect against cardiovascular disease. This is safe for people with diabetes, if it is recommend by their health care team. Check with your doctor to see if you can safely take ibuprofen.

Call the Doctor

You’ll want to call your health care provider if you experience any of the following:

• You have been sick for 1 or 2 days without improvement.

• You have experienced vomiting or diarrhea for more than 6 hours.

• You have moderate to large amounts of ketones in your urine or blood ketones are 0.6–1.5 mmol/l or higher.

• You are taking insulin and your blood glucose levels continue to be over 240 mg/dl or the level determined by you and your provider.

• You have type 2 diabetes, you are taking oral diabetes medication, and your pre-meal blood glucose levels are 250 mg/dl or higher for more than 24 hours.

• You have signs of extreme hyperglycemia (very dry mouth or fruity odor on the breath), dehydration, or confusion and disorientation.

• You are sleepier than normal.

• You have stomach or chest pain or any difficulty breathing.

• You have doubts or questions about what you need to do for your illness.

Keep records of your condition during your illness so that you’ll have the information ready when you call your doctor. These records will make it easier for your doctor to determine how sick you are and to keep track of your progress in getting well.

Things to Tell Your Health Care Provider

• Blood glucose levels and your urine ketone results—starting when you first realized you were ill

• Insulin doses and diabetes pills you have taken and when you took them, as well as any other medications you’ve taken

• The amount of time you’ve been sick

• Symptoms such as your temperature, your appetite and fluid intake, any weight loss, or any other problems

• Your pharmacist’s phone number



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