Managing sick days with diabetes.

Being ill isn’t agreeable for anybody. But when you’ve got diabetes it tends to get even more difficult to manage your day to day. It has luckily been a long time since I’ve been gravely ill. But like with any other person, it comes around.

I’ve been suffering from a bladder infection for some days now. Apparently this is a common side effect of one of my diabetes meds, the SGLT2-inhibitors (Jardiance). It works by blocking the reabsorption of glucose (blood sugar) by the kidneys, increasing glucose excretion in urine and thereby lowering your blood sugar. The extra glucose in urine creates the perfect environment for bacteria to grow.

It’s a painful business and I had (and still have) some mild fever. I know illness and fever can raise your blood sugar levels significantly due to the extra stress put on your body. I have experienced this in the past but it has become more apparent now. I guess because my body has stopped producing insulin by itself. It has been far more difficult to keep my numbers in range; which added to the feeling of sickness since I had some ‘high blood sugar headaches’ on top of it.

How does an infection increase blood sugar levels?

An infection is a stress on your body’s immune system and causes a stress response; your body will increase the amount of certain hormones (cortisol, adrenaline, etc.) The hormones have a double action: they stimulate the liver to release some extra glucose (gluconeogenesis) and these hormones inhibit the proper action of insulin. Your body becomes more insulin resistant. This is why people living with insulin dependent diabetes will likely have to increase their insulin dose. In healthy people, the pancreas will simply make more insulin to counteract this process.

Why does an infection persist longer in people with diabetes?

High blood sugar can make it more difficult for your immune system to do its work. The abundance of glucose in your blood makes it hard for the white blood cells to move around and reach the infection site.

What can I do?

1) It’s important to take it slow and allow your body to heal. Check your levels regularly and drink lots of fluid to prevent dehydration. Dehydration can add to the already elevated blood sugar levels.

2) You may need extra insulin. I’ve slowly increased my bolus rates since I did experience the higher insulin resistance. I am now using about 1/3 more insulin than before. This was a bit of scary process for my since this is the first time I am ill and injecting insulin. Injection a far larger dose made me feel uncomfortable at first. I have now reached a good ‘new’ dose for time being, but I now my sensitivity will return and so I already fear going low. Diabetes can be a pain.

3) Further you should be aware of the signs of diabetes ketoacidosis (DKA) when your levels are high. These include, but are not limited to; feeling unwell, extreme thirst, nausea, muscle cramps, vomiting, drowsiness, abdominal pain, lethargy.

Since the SGLT2-inhibitors can also induce DKA and I felt nauseous, I tested for ketones but those where very low (0,2).

4) Most important, if you feel unwell or are unsure of how to manage your diabetes, call your physician or diabetes team. They won’t mind you calling and will be able to give you the best advice for your situation.

At this moment, I am awaiting a call from my GP to discuss further treatment. I hope this will be the last hurdle for a long time. I’ve seriously been through enough, if you ask me. Up to better days! I hope this helped creating some insight in why sick days with diabetes can be more difficult and how to manage them.

Back to bed now ;)

A cup of tea and comfy clothes to make me feel a bit better.

* None of this is meant to be medical advice. Always consult your doctor before making any adaptations to your management.