managing diabetes during flu season

[Guest guest]

Diabetes Management in Flu Season

Clay Wirestone

Jan 11, 2011

The crowd in the small Boston theater laughed and clapped. The comedy show

was a good one, and I was enjoying it from a cramped seat in the balcony. It

was October 29, a Friday, and while it was brisk outside, winter hadn't yet

clamped down.

But the date was more important than I thought. The viruses that attack

during the winter flu season had already begun to circulate, and some of

them were in that very theater. During the show, dozens of people coughed

and sneezed. And at some point during my two hours in the theater, I

breathed in a tiny bit of evil.

You might call it a germ. But for me it was the beginning of more than two

weeks of coughing, sore throat, visits to the doctor, and challenging

diabetic <http://www.diabeteshealth.com/> control--all from one evening's

light entertainment.

Prevent, if possible

The ordeal was partly my fault. According to the Centers for Disease Control

and Prevention, the most important thing an individual can do to protect

against the flu is get a flu shot. And as a diabetic, I'm at greater risk

for developing complications from the flu. (I'm type 1

<http://www.diabeteshealth.com/browse/community/type-1-issues/> , but type

<http://www.diabeteshealth.com/browse/community/type-2-issues/> 2s are also

considered at risk.)

Guess who wasn't vaccinated? Sure, I wind up getting a shot every year, but

it's usually in November or December. I had an appointment scheduled for the

next week, and I was expecting that my doctor, as usual, would suggest the

shot. But it was too late.

The other thing I failed to do, according to diabetes

<http://www.diabeteshealth.com/> educator and author Constance Brown-Riggs,

was prepare a sick day plan. I should have decided on the medical

professionals with whom I needed to check (doctor and insulin

<http://www.diabeteshealth.com/browse/products/insulin-pumps/> pump coach,

for example), made sure I had sick time ready at work, had food and drink at

hand, and generally been ready for the vilest of viruses. " A plan prepared

in advance can make getting a cold just a minor illness and not a

life-threatening condition, " Brown-Riggs says.

I didn't have such a plan. Sure, I can offer excuses -- it had been years

since I had been sick for more than a day or two. As a working journalist, I

had to prepare for a feisty election day on November 2. But excuses don't

count for much after you've fallen ill.

Facing real risks

I soldiered on as the bug descended, working election night and plowing

through deadlines. But I finally hit a wall. I was running a low-grade

fever, blunted but not eliminated by pain relievers. My throat throbbed, and

a cough took up residence. I had to stay home.

My doctor liked that idea. She tested me for strep (negative, thank

goodness) and urged me to get some rest. She's joined in that opinion by the

CDC, which recommends that anyone with flu stay home and rest during any

fever, and continue staying home and resting for a full 24 hours after it

subsides.

But that appointment with my doctor -- some four days after the show and

while I was still running a fever -- was only the beginning of the ordeal,

because I had only begun to recognize the consequences for my diabetes. In

short, everything went haywire. My blood

<http://www.diabeteshealth.com/browse/monitoring/blood-sugar/> sugars

soared. I checked often enough to ensure they were blunted by insulin

<http://www.diabeteshealth.com/browse/medications/insulin/> , but it didn't

seem to matter that I was eating only a bit of pudding and a few spoonfuls

of soup.

As Brown-Riggs points out, this is a common side effect for diabetics. " A

seasonal cold, flu or any kind of infection can cause blood glucose levels

to increase, " she says. " Illness is stressful to the body, and the stress

hormones that are released when sick cause the liver to produce more

glucose, resulting in hyperglycemia. "

Brown-Riggs recommends that both type 1 and type 2 diabetics check their

blood sugars and ketones regularly while ill, staying on guard for diabetic

ketoacidosis. Type 1s may need to increase their insulin intake, and type 2s

may need to go on insulin for a time. Brown-Riggs emphasizes, though, that

such decisions should be part of a diabetic's sick day plan and cleared with

your doctor.

Finally reaching out

I lumbered along through my first week of sickness. The fever lifted, and I

felt slightly more energetic. But my cough got worse, making it difficult

for me to fall asleep some nights. I went through two-and-a-half bottles of

cough syrup.

Some 10 days after I first started feeling under the weather, I contacted my

doctor again. I needed something extra, I said. The coughing was keeping me

awake at night. She prescribed a five-day antibiotic, and within a night I

was feeling better. After another day, I realized that I had been lying to

myself throughout this entire process. I hadn't actually been feeling better

or recovering. True, I didn't have a temperature, but that didn't translate

into health. My final step, that seeking of that extra help -- and the extra

prescription -- helped me turn the corner.

Brown-Riggs says that diabetics shouldn't hesitate to call their care

providers. Cases like mine, when the illness lingers, are no-brainers. She

also recommends picking up the phone if you've been throwing up or having

diarrhea for more than six hours, if your blood sugars are above 240 for an

extended period, if you test positive for a moderate or large amount of

ketones, or if you suspect you have diabetic ketoacidosis.

But what about my lack of fever? It had lifted, and that meant everything

was better, right? Wrong. The CDC notes that not everyone who has the flu

will run a fever. The thermometer can confirm that you're feeling lousy, but

it's not the only authority. How your actual body feels -- when you're not

denying the obvious and pushing yourself hour after hour -- matters most.

Lessons learned

I never thought of myself as the stereotypical tough guy who denies illness

at all costs, the kind of man who shows up at work ashen-faced and grim,

hacking into an ever-growing pile of tissues while angrily denying he's

sick. After all, I'm a type 1 diabetic. I know what my body is doing, and I

pay attention to my biofeedback throughout the day. I know when my blood

sugar goes low. Most of the time, I can tell when it goes high as well.

But the simple seasonal flu managed to blindside me. It managed to make me

look like one of those fake tough guys, and it made me doubt the signals my

own body was sending me. Once I admitted that I was sick and got extra help,

I got better. And once I got better, I immediately saw a drop in my blood

sugars.

The simple facts are these:

-- I should have gotten a flu shot earlier.

-- I should have had a general plan in place for getting sick.

-- I should have taken more time off from work.

-- I should have asked for extra help from my doctor sooner.

-- I should have increased my insulin basal rate after a few days of high

blood sugars.

As Brown-Riggs says, " It's most important to remember that 'an ounce of

prevention is worth more than a pound of cure' and make a sick day plan in

advance. "

Facts about the 2010-2011 flu season

According to the Centers for Disease Control and Prevention:

-- Although its timing can vary, flu season generally reaches its apex in

January and February. The bug can attack as late as May.

-- The 2009 H1N1 virus that caused widespread concern last flu season will

likely continue to infect people, along with other seasonal bugs.

-- This year's flu vaccine protects against three strains: an H3N2 virus, an

influenza B virus, and the H1N1 virus. The match between circulating viruses

and what the vaccine protects against is generally good; the two have mostly

matched in 16 of the last 20 flu seasons.

For much more information from the agency about the flu, go to cdc.gov/flu.

Diabetes educator Constance Brown-Riggs has more advice