Looking After Yourself

Things you can do to help yourself include:

• Eating a healthy,  balanced diet
• Taking exercise regularly
• Drinking alcohol in moderation, not more than 1 drink per day for women and 2 drinks per day for men
• If you smoke -try to stop smoking. It is certainly unhealthy for everyone, but it is especially important to stop if you have diabetes. This is because you already have an increased risk of developing circulatory problems and cardiovascular disease. Smoking further increases your risk of developing these diseases

And finally - if you manage your insulin doses yourself, be careful with how much insulin you take at this time. If you are unsure about how many units to take, contact your healthcare professional. If you are finding it difficult to cope or if your blood glucose or ketone levels are rising too high, it is also best to contact your healthcare professional for advice.*

When you are ill

It can be particularly difficult to control blood glucose levels when you are ill or have an infection as your body releases more glucose into your blood stream to help fight the illness. This release of glucose makes it more difficult to manage your blood glucose levels – not what you need when you are already feeling unwell.

Why your glucose rises when you are ill
When you are ill, particularly if you have a fever, your body needs more energy, and therefore glucose, to fight the infection. Normally extra insulin is produced to cope with the rise in glucose, but when you have diabetes your body cannot meet the extra demand for insulin. This happens even when you have completely lost your appetite and cannot eat at all.

Many people with diabetes make the mistake of thinking that, because they are eating very little, they should cut down or even stop their insulin. This is wrong. In fact you many need more insulin than normal.

Advice for when you are ill
Here are some suggestions for you to follow if you are unwell:

• Make a plan: 
  Have a plan of what you will do when you are ill before it happens. Your GP, Practice Nurse, DNS or the staff at your diabetes clinic will be able to help you. Even with a great plan you may still need their help so keep the phone number of your clinic, DNS or Practice Nurse handy
   
• Keep taking your diabetes treatment: 
  It is essential that you keep taking your insulin. Missing an insulin injection means that your blood glucose will continue to rise but your body will not be able to use it as fuel. Instead, you will start to break down fat. Breaking down a lot of fat results in ketones in your blood. At high levels ketones are dangerous and can cause ketoacidosis leading to diabetic coma.

• Keep drinking: 
  It is very important not to become dehydrated when you are ill, particularly if you are being sick or have diarrhoea. Take small quantities of fluids such as sugar-free drinks, tea or clear soup every 15-30 minutes.
   
• Keep eating too: 
  You must continue to eat when you are ill. Try taking normal meals if you can but if you don't feel like it take small meals and eat more frequently. Soft foods and liquids are often the easiest to eat when you feel unwell. Foods you could try include:
  - A bowl of soup
  - A glass of milk/mug of milky drink
  - A glass of fruit juice
  - A small carton of ordinary fruit yoghurt
  - A small bowl of ice cream
  - A small bowl of jelly

During the day, try to eat one portion of one of these foods each hour. If you are being sick and cannot keep anything down take regular sips of sugary drinks such as Lucozade® or ordinary lemonade.
 

Illness and blood testing

• Measure your blood glucose regularly:
  When you are ill you must measure your blood glucose regularly - at least four times a day. Record your results, as you may need to discuss them with your GP or healthcare team.
   
• If your sugars are rising:
  You may need to increase your testing to every two hours so you can spot in plenty of time if you need to adjust your insulin dose, you may need extra soluble insulin between your usual insulin injections.
   
• Measure your ketone levels:
  If you have been given a meter with the option of checking ketone levels, then you should check them if your blood glucose is over 16.7 mmol/L or if you are vomiting. This will tell you if you are at risk of diabetic coma

If you are vomiting and have consistently high ketones or blood glucose levels you may need to go to hospital. Seek medical advice or go straight to Accident & Emergency.

*The NHS recommends that people with diabetes with a blood glucose level over 28 mmols/L should seek emergency medical advice.