Making a Sick Day Plan: Patient Tools and Resources

* These tools are not intended to serve as complete and full education. The education tools are made available in a written form for the professionals and patients, to assist in lifestyle changes. More complete patient specific education can take place with a registered dietitian and/or a certified diabetes educator. C a r b o h y d r a t e s ( " c a r b s " ) a r e a v e r y i m p o r ta n t p a r t o f a h e a l th y d i e t . T h e y a r e t h e b o d y 's m a i n s o u r c e o f f u e l, a n d t h e y a l s o p r o v i d e v i t a m i n s a n d m i n e r a l s . F o o d s t h a t c o n t a i n c a r b s h a v e t h e b i g g e s t e f f e c t o n b lo o d s u g a r r e a d i n g s a f t e r m e a ls . T o h e l p c o n t r o l b lo o d s u g a r s , i t is i m p o r t a n t t o k n o w h o w m a n y c a r b s a r e i n f o o d s . I t m i g h t s e e m lik e a g o o d i d e a t o a v o i d c a r b s i f y o u w a n t t o c o n t r o l b lo o d s u g a r , b u t i t is n o t th e h e a l t h y c h o i c e . T h e A m e r i c a n D ia b e t e s A s s o c ia t i o n r e c o m m e n d s a b a l a n c e d d i e t i n c lu d in g p r o t e i n , f a t , a n d c a r b o h y d r a te s . S u g a r i s a ty p e o f c a r b t h a t o c c u r s n a t u r a l ly i n f o o d s l i k e : F r u i ts M i l k S w e e t s a n d d e s s e r t s S t a r c h y f o o d s a r e a l s o c a r b s . T h e y t u r n i n t o s u g a r v e r y q u i c k l y a f t e r t h e y a r e e a t e n . T h e s e in c lu d e : F o o d s m a d e w i th g r a in ( b r e a d , r i c e , t o r ti l la s , c e r e a l , p a s t a ) S t a r c h y v e g e t a b l e s ( p o t a t o e s , c o r n , p e a s ) D r i e d b e a n s F o r a lo n g t im e , e x p e r t s t h o u g h t t h a t p e o p l e w it h d i a b e t e s s h o u l d n o t e a t f o o d s m a d e w i t h s u g a r . N o w w e k n o w t h a t a ll c a r b s a f f e c t b l o o d s u g a r i n m u c h t h e s a m e w a y . Y o u c a n n o w e n j o y a m o d e r a t e a m o u n t o f " s w e e t s " w i t h y o u r m e a l . F ib e r is a c a r b o h y d r a te t h a t i s n o t a b s o r b e d a n d d o e s n o t r a is e b lo o d s u g a r . I n f a c t , f i b e r s lo w s d o w n t h e a b s o r p t i o n o f s u g a r s . W h e n y o u e a t a p i e c e o f f r u i t i n s t e a d o f d r in k in g j u i c e , o r h a v e w h o l e w h e a t i n s t e a d o f w h i t e b r e a d , y o u r b l o o d s u g a r d o e s n o t g o u p a s q u i c k l y . H e r e a r e s o m e t i p s o n h e a l t h y e a t in g w i t h d i a b e t e s : 1 . T r y to f o l l o w a c o n s is t e n t m e a l p l a n a n d s c h e d u l e . E a t in g a b a l a n c e d d i e t w i t h a v a r i e t y o f f o o d s ( f r u it s , v e g e t a b l e s , d a i r y p r o d u c t s , w h o l e g r a i n s , l e a n m e a t s a n d p o u l tr y , f is h , n u t s , s e e d s a n d b e a n s ) w il l h e lp k e e p y o u r b l o o d s u g a r e v e n t h r o u g h t h e d a y . 2 . T h e b e s t k in d o f f a t is u n s a t u r a t e d ( u s u a l l y li q u i d o r v e g e ta b le ) . T h is is h e a l th i e r th a n s a t u r a t e d ( a n i m a l - s o u r c e , s o li d ) f a t s . 3 . U s e s u g a r i n m o d e r a t i o n . C o n s i d e r lo w e r s u g a r o p t i o n s w h e n a v a i l a b l e . 4 .R e a d f o o d la b e l s c a r e f u l ly . 5 . G e t y o u r f ib e r : T h e A m e r i c a n D i e t e t i c A s s o c i a t io n r e c o m m e n d s t h a t a l l a d u lt s e a t 2 0 - 3 5 g r a m s o f f i b e r e v e r y d a y . 6 .D r i n k p le n t y o f w a t e r . 7 .U s e l e s s s a l t. 8 .G e t a c t i v e R e s e a r c h s h o w s th a t e a t i n g a h e a l t h y d i e t a n d b e i n g a c t iv e m o s t d a y s c a n h e l p t h e b o d y u s e it s i n s u li n b e t t e r . I t c a n r e d u c e t h e r i s k o f g e t t i n g d i a b e t e s , a n d h e l p c o n t r o l b l o o d s u g a r in t h o s e w h o a l r e a d y h a v e it . B e in g a c t i v e h a s a l s o b e e n s h o w n t o r e d u c e s t r e s s , i m p r o v e m o o d a n d b o o s t " b r a i n p o w e r ." p p p p l l i i e e s s I t i s a g o o d i d e a t o h a v e t h e s e t h i n g s o n h a n d i n c a s e o f i l l n e s s s o y o u d o n ' t h a v e t o w o r r y a b o u t g o i n g t o t h e s t o r e w h e n y o u a r e n o t f e e l i n g w e l l . T h e r m o m e t e r M e d i c i n e t o h e l p w i t h s y m p t o m s - a s k y o u r h e a l t h c a r e p r o v i d e r w h i c h a r e t h e b e s t c h o i c e s f o r y o u t o u s e : • D i a r r h e a • N a u s e a ( s u p p o s i t o r i e s a r e b e s t ) • P a i n • C o u g h • C o n g e s t i o n • F e v e r I m p o r t a n t p h o n e n u m b e r s ( h e a l t h c a r e p r o v i d e r a n d a f r i e n d o r f a m i l y m e m b e r t h a t c a n h e l p y o u w h e n y o u a r e s i c k ) M e a s u r i n g c u p ( t o m e a s u r e e n o u g h t o d r i n k ) B a c k u p t e s t s t r i p s U r i n e K e t o n e s t r i p s ( i f a d v i s e d b y y o u r h e a l t h c a r e p r o v i d e r ) G l u c o s e t a b l e t s P e n c i l a n d p a p e r Take Good Care of Yourself When You Are Sick! r r b b l l o o o o d d g g l l u u c c o o s s e e l l e e v v e e l l s s : : Over 250 mg/dl - Drink carbohydrate-fre e, caffeine-free liquids in place of a meal. 180-250 mg/dl - Drink some liquid that contains 15 grams of carbohydrate in place of a meal. In addition, you will need additional liquid from water or other carb-free choice. Under 180 mg/dl - T ry to drink or eat usual mealtime carbohydrate amounts. If vomiting occurs after insulin administration, you may need to sip on apple juice, o o d d s s a a n n d d l l i i q q u u i i d d s s t t h h a a t t c c o o n n t t a a i i n n 1 1 5 5 g g r r a a m m s s o o f f c c a a r r b b o o h h y y d d r r a a t t e e s s y y o o u u c c a a n n u u s s e e t t o o p p l l a a n n y y o o u u r r s s i i c c k k d d a a y y d d i i e e t t : : ½ cup apple juice ½ cup regular soft drink (not diet) 1 slice dry toast ½ cup cooked cereal 6 saltine crackers ½ cup frozen yogurt 1 cup Gatorade sports drink 3 graham crackers ½ cup regular ice cream ¼ cup sherbet ¼ cup regular pudding ½ cup regular gelatin/Jell-O C C a a l l l l y y o o u u r r h h e e a a l l t t h h c c a a r r e e p p r r o o v v i i d d e e r r ( ( p p h h o o n n e e # # _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ) ) i i f f : : Y ou have a fever over 101 Y ou cannot keep food or liquid down for more than 4 - 6 hours. Y ou have diarrhea that lasts for more than 6 hours. Y our blood sugars are over 300 for a few readings, or over 250 for a day . Y ou are not sure how to take your medications V omiting and unable to eat or drink for over 4 hours. Sick longer then 24 hours. H H e e r r e e i i s s s s o o m m e e g g o o o o d d i i n n f f o o r r m m a a t t i i o o n n t t o o h h a a v v e e o o n n h h a a n n d d w w h h e e n n y y o o u u c c a a l l l l y y o o u u r r h h e e a a l l t t h h c c a a r r e e p p r r o o v v i i d d e e r r : : Y our name and age How long you've had diabetes Name of diabetes doctor Present problem (temperature, number of times you have vomited or had diarrhea) Blood sugar and ketone levels for last 24-48 hrs. Intake of foods and liquids Usual insulin dosage, time and amount of last dosage S S i i g g n n s s a a n n d d s s y y m m p p t t o o m m s s t t h h a a t t r r e e q q u u i i r r e e c c l l i i n n i i c c o o r r h h o o s s p p i i t t a a l l t t r r e e a a t t m m e e n n t t b b y y a a h h e e a a l l t t h h c c a a r r e e p p r r o o f f e e s s s s i i o o n n a a l l : : Continued vomiting or being unable to keep fluids down Continued diarrhea and progressive weakness or dizziness Unable to concentrate Low blood sugar that does not come up after treatment 1 cup yogurt (not frozen), artificially sweetened or plain Milk shake (½ cup low fat milk and ¼ cup ice cream) 1 double-stick popsicle 1 cup milk ½ cup fr uit juice ½ cup sugar free pudding ½ cup mashed potatoes 5 vanilla wafers 4 lifesavers ½ cup mashed potatoes 1 cup m m p p o o r r t t a a n n t t t t h h a a t t e e v v e e r r y y p p e e r r s s o o n n w w i i t t h h d d i i a a b b e e t t e e s s h h a a s s a a p p l l a a n n f f o o r r h h o o w w t t o o t t a a k k e e c c a a r r e e o o f f h h i i s s / / h h e e r r d d i i a a b b e e t t e e s s d d u u r r i i n n g g i i l l l l n n e e s s s s . . I l l n e s s e s , s u r g e r y , i n f e c t i o n , i n j u r y , o r s t r o n g e m o t i o n s c a n m a k e y o u r b l o o d g l u c o s e g o u p a n d c a u s e y o u r d i a b e t e s t o g e t o u t o f c o n t r o l . T h i s h a p p e n s b e c a u s e d u r i n g i l l n e s s o r s t r e s s y o u n e e d m o r e e n e r g y t o h e a l a n d g e t w e l l . S t r e s s h o r m o n e s c a u s e t h e l i v e r t o p u t s t o r e d s u g a r i n t o y o u r b l o o d s t r e a m t o p r o v i d e y o u w i t h e x t r a f u e l . N o r m a l l y , y o u r b o d y w o u l d p r o d u c e e x t r a i n s u l i n t o u s e t h i s f u e l , b u t w i t h d i a b e t e s , t h i s d o e s n o t w o r k . Y o u r b l o o d s u g a r c a n g o u p , e v e n i f y o u a r e n o t e a t i n g ! W h a t s h o u l d y o u d o ? Y Y o o u u r r d d i i a a b b e e t t e e s s m m a a y y g g e e t t o o u u t t o o f f c c o o n n t t r r o o l l i i f f : : y o u g e t t h e f l u y o u h a v e a f e v e r y o u h a v e a n i n f e c t i o n y o u a r e h a v i n g a n e m o t i o n a l c r i s i s y o u h a v e a p h y s i c a l i n j u r y o r p a i n y o u h a v e d e n t a l p r o b l e m s y o u h a v e h a d s u r g e r y K K e e e e p p a a n n e e y y e e o o n n y y o o u u r r b b l l o o o o d d g g l l u u c c o o s s e e C h e c k y o u r b l o o d g l u c o s e 4 t i m e s a d a y ( b e f o r e y o u r u s u a l m e a l s a n d a t b e d t i m e ) w h i l e g l u c o s e l e v e l s a r e h i g h a n d / o r u n t i l y o u r s y m p t o m s a r e g o n e . W r i t e d o w n b l o o d g l u c o s e r e s u l t s i n y o u r l o g b o o k . H a v e t h i s i n f o r m a t i o n h a n d y i f y o u n e e d t o c a l l y o u r h e a l t h c a r e p r o v i d e r . ( I f y o u t a k e i n s u l i n , y o u r h e a l t h c a r e p r o v i d e r m a y a l s o w a n t y o u t o c h e c k y o u r u r i n e f o r k e t o n e s s e v e r a l t i m e s a d a y . ) D D r r i i n n k k l l o o t t s s o o f f f f l l u u i i d d s s D r i n k a t l e a s t 8 o u n c e s ( 1 c u p ) o f f l u i d s e v e r y h o u r w h i l e y o u a r e a w a k e . H i g h b l o o d s u g a r s c a n c a u s e y o u t o b e c o m e d e h y d r a t e d . T T a a k k e e y y o o u u r r m m e e d d i i c c a a t t i i o o n n s s T a k e y o u r u s u a l d o s e o f m e d i c a t i o n . T h e s t r e s s o f b e i n g s i c k c a n r a i s e y o u r b l o o d g l u c o s e , e v e n i f y o u a r e n o t e a t i n g . I f y o u t a k e d i a b e t e s p i l l s t o c o n t r o l y o u r b l o o d g l u c o s e , t a k e y o u r u s u a l d o s e . I f y o u t a k e i n s u l i n , y o u r h e a l t h c a r e p r o v i d e r c a n h e l p y o u d e c i d e w h e t h e r y o u w i l l n e e d a d d i t i o n a l i n s u l i n d u r i n g y o u r i l l n e s s . I f y o u u s u a l l y t a k e d i a b e t e s p i l l s , y o u m a y r e q u i r e s o m e i n s u l i n u n t i l y o u a r e o v e r y o u r i l l n e s s . S o m e o v e r t h e c o u n t e r m e d i c a t i o n s a n d p r e s c r i p t i o n m e d i c i n e s , a l o n g w i t h h e r b a l t h e r a p i e s c a n f u r t h e r i n c r e a s e b l o o d g l u c o s e l e v e l s . Y o u r h e a l t h c a r e p r o v i d e r w i l l h e l p y o u d e c i d e w h a t y o u s h o u l d d o . W W h h a a t t i i f f y y o o u u d d o o n n ' ' t t f f e e e e l l l l i i k k e e e e a a t t i i n n g g ? ? I f y o u c a n n o t e a t y o u r n o r m a l m e a l s : T r y s o m e s o f t f o o d s t h a t a r e e a s y o n t h e s t o m a c h . T r y a n d e a t t h e s a m e a m o u n t o f c a r b o h y d r a t e s t h a t y o u d o w h e n y o u a r e n o t s i c k . T r y s m a l l e r m o r e f r e q u e n t m e a l s . I f y o u a r e s i c k t o y o u r s t o m a c h , t r y t a k i n g s m a l l s i p s o f f l u i d s e v e r y 1 0 - 1 5 m i n u t e s . Y o u m a y n e e d t o d r i n k s o m e f l u i d s w i t h c a r b o h y d r a t e t o m a k e u p f o r n o t e a t i n g . T h i s w i l l d e p e n d o n h o w h i g h y o u r b l o o d s u g a r i s . ( C o n t i n u e d o n p a g e 2 )