Preparing for H1N1 - Special Tips for People With Diabetes

The H1N1 pandemic is a growing concern among everyone. As of September 27, the virus had caused over 4000 deaths worldwide, and according to the Centers for Disease and Prevention, 27 states are reporting widespread influenza activity.

But people with diabetes should take extra precautions in the face of H1N1. Influenza can make blood glucose management trickier than usual, leaving diabetes patients vulnerable to dangerous complications. The CDC has therefore recommended that diabetics receive the H1N1 vaccination as it becomes available this fall.

For those wary of the controversial effects of the vaccine-preservative Thimerosal, individual doses free of the mercury-containing preservative will be available for patients who ask for it. A nasal spray version containing a substantially weakened form of the virus is also available. The nasal spray however, is not recommended for pregnant women or patients with compromised immune systems, asthma, diabetes, heart disease, or other chronic conditions as it does contain bits of live virus.  

Getting the vaccine is only one step, however. People with diabetes also need to know how the flu will impact their diet, glucose management and medications. The American Diabetes Association says all diabetics should develop a sick day plan with their doctors, so they know exactly what to do when an illness strikes.

Problems arise during times of sickness because it becomes more difficult to keep glucose levels in the proper range. When people are sick, their bodies release extra hormones to help fight the illness. However, these hormones can also raise blood sugar levels and interfere with insulin. Therefore, blood glucose levels should be tested approximately every four hours to ensure everything is remaining stable.

In addition, people with diabetes will want to monitor their ketone levels. Ketones are more likely to build up when people are sick, especially if they’re struggling with an upset stomach. This step is critical because an accumulation of ketones can lead to ketocidosis, a life-threatening condition that can result in a diabetic coma.

People with diabetes should also remember to keep taking their normal medications when sick – even if they are tired and queasy. In regards to over-the-counter drugs, it is important to pay attention to the label because some medications contain sugar. It may only be a small dose, but diabetics might want to ask their pharmacist for a sugar-free alternative. They should also be wary of aspirin – which in large doses can lower blood sugar – and decongestants – which can raise blood sugar.    

Another important consideration for people with diabetes is diet. Although the flu can diminish an appetite, it is very important to keep eating and drinking. Try to maintain a normal diet; if that becomes difficult, consume a normal number of calories by relying on foods that are easy on the stomach. Here are some foods the CDC recommends, and the amount needed to get one carbohydrate serving:

• Soup – 1 cup
• Applesauce – ½ cup
• Macaroni, noodles or rice – 1/3 cup cooked
• Saltine Crackers – 6 squares
• Fruit juice or regular soda – ½ cup

People will diabetes should also drink extra liquids when sick, at least four to six ounces of non-caloric liquid every 30 minutes to an hour. These fluids help eliminate glucose build-up in the blood. 

Finally, people with diabetes should know when to call their doctors for help. According to the CDC, the following instances require medical attention:

• You can’t keep food or liquid down for more than six hours
• You have severe diarrhea
• Your temperature is over 101°F
• Your blood glucose level is lower than 60mg/dL or stays over 300mg/dL
• You have trouble breathing or can’t think clearly
• You lose five pounds or more without trying

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