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Sick Day Management Counseling: 3 Tips for Success

Jun 29, 2020

By John Bucheit, PharmD, BCACP, CDCES

As practices have made major changes to their approach to patient visit in light of COVID-19, it’s a good time to review sick day management and counseling tips. Many clinicians are providing the majority of their diabetes care over the phone or using a telehealth platform, and diabetes care and education specialists can use this opportunity to ensure clients are well versed in sick day management.

Sick day management has always been a cornerstone of diabetes education. Acute sickness can cause transient increases in insulin resistance and thereby resulting in hyperglycemia. Increases in blood glucose levels may contribute to worse outcomes, such as delayed cure or longer hospital stays, or precipitate hyperglycemic crises.

Two common hyperglycemic emergencies are diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Both DKA and HHS are emergencies and must be treated in hospital setting. With careful education and self-management, hospitalizations can sometimes be prevented.

Counseling individuals on what to expect if they become ill provides them with the tools needed to manage their condition. Here are three tips to help them succeed:

  1. Understand the symptoms of severe hyperglycemia. This can include stomach pain, nausea, difficulty breathing, confusion or extreme thirst, and urinary frequency. Blood glucose levels are usually elevated for DKA and HHS, but there are major differences in presentation of each. DKA can occur quickly as a result of insulin deficiency whereas HHS takes days and higher blood glucose values to occur. In general, individuals should call their health care provider if they experience large increases in blood glucose that stay persistently above 240 mg/dL.
  2. Follow traditional sick day recommendations. While there is still much to learn about COVID-19, people with diabetes should follow standard sick day recommendations for adults and children. Blood glucose monitoring is essential and should be checked before meals and at bedtime. Continuous glucose monitors are another excellent alternative resource for monitoring. Ketone (urine or blood) strips can be used to identify those developing DKA, especially for those with type 1 diabetes. If blood glucose levels are consistently greater than 240 mg/dL, it is appropriate to check for ketones. Individuals should contact their health care provider if they receive a “moderate” or “high” result.
  3. Ensure proper fluid intake and medication taking. Many times fluid intake in conjunction with proper medication taking are all someone needs to avoid hyperglycemic crises. Fluid intake with non-sugary beverages prevents dehydration, which further exacerbates HHS and DKA. Medications to manage diabetes should mostly be continued to treat hyperglycemia even if the individual is not eating. Exceptions to this medication rule include meal-time insulin and SGLT-2 inhibitors. Meal-time insulin can be held in the absence of food, but during acute illness, individuals may require correctional doses if blood glucose values rise. SGLT-2 inhibitors reduce glucose levels, but this class is associated with an increase in DKA even in the presence of normal readings. Most should be instructed to stop SGLT-2 inhibitors to prevent DKA.

Overall, many of these recommendations can be proactively addressed, but most importantly, individuals should be encouraged to contact their care team if they are having problems. 


ADCES Perspectives on Diabetes Care

The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.

Copyright is owned or held by the Association of Diabetes Care & Education Specialists and all rights are reserved. Permission is granted, at no cost and without need for further request, to link to, quote, excerpt or reprint from these stories in any medium as long as no text is altered, and proper attribution is made to the Association of Diabetes Care & Education Specialists.

HEALTHCARE DISCLAIMER: This site and its services do not constitute the practice of medical advice, diagnosis or treatment. Always talk to your diabetes care and education specialist or healthcare provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately. To find a diabetes care and education specialist near you, visit DiabetesEducator.org/Find.

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