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Diabetes - Dr Shashank Jain

[Home] [Screening for diabetes] [High risk group] [Diagnosis guidelines] [Criteria for diagnosis] [Investigations protocol] [Diabetes in pregnancy] [Targets for control] [Diet Advise] [Exercise] [Complications] [Management] [Drug action]

 

 

Some Facts

 

 

 

 

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India has largest number of diabetics in the world. About 3-5 crore Indians have diabetes.

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Some of the recent surveys indicate that one in every 12 city dwellers above the age of forty is likely to be a diabetic.

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Out of every four diabetics, only one is aware of it.

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This number is on the rise in today's tense, over busy and undisciplined lifestyle and eating habits. 

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Lack of awareness leads to poor control and long term complications

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Long term complications of diabetes can only be prevented / delayed, with early diagnosis and prompt treatment.

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The fact is that if properly controlled, a diabetic can lead a fairly normal life, can achieve any academic or professional excellence and have healthy family life and longevity.  

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Many diabetics may not exhibit typical signs and symptoms of diabetes.  

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A negative test for diabetes does not rule out  occurrence of the disease in future.

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Today it may not be possible to cure diabetes with a 'wonder shot or pill', but it will remain a subject of intense research. Specialists worldwide are engaged in discovering a permanent treatment for diabetes or at least freedom from complications. 

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A variety of comfortable medications to suit individual needs are here and a proof that medical research is moving in the right direction. Today if you are injecting insulin, tomorrow you may be liberated from the 'needles', thanks to discovery of Insulin Inhalers. If you hate to prick your fingers for blood testing, in the future non- invasive Glucometers or Glucowatch will make your life much easier .

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So keep patience, do not fall prey to those around the corner who promise you a cure but in fact give you untested and unprotected so-called cures that may land you in real trouble rather than cure. After all if there was a cure your doctor would be the first person to get it for you, and you would anyway know it as a Nobel Prize winning discovery!

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If the virus that causes autoimmune damage to pancreatic insulin producing cells can be isolated, a vaccine may be developed for its prevention. So far it is a matter of intense research specially to be used in persons during the lucid interval or the so-called honeymoon period of the type 1 diabetes where the child, after initial insulin dependence, enjoys a variable period of "normalcy" but only to get into insulin dependence again.

 

What Is Diabetes? (Diabetes mellitus (DM) , Willis' disease)

 

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In the normal process of digestion, sugars, starches, and other foods are changed into glucose and distributed throughout the body. The rise in blood glucose triggers the release of a hormone called insulin. Insulin allows glucose to leave the bloodstream and enter body cells, where it is used for energy or stored for future use. 

 

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Diabetes is a complex disorder caused by the failure of the pancreas to release enough insulin into the body. It may also be caused by a defect in the parts of cells that accept the insulin. 

 

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In diabetes the body either produces no insulin or too little insulin or cannot use the insulin. As a result, the unused glucose collects in the blood. This leads to high blood-sugar levels.

 

Types of Diabetes.

The two most common types of diabetes are:

  1. Insulin- dependent (type I) or

  2. Non-insulin-dependent (type II) diabetes.

 

Insulin- dependent (type I) 

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Type I diabetes is also called insulin-dependent diabetes. This is the most serious form of the disease. 

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It was previously called juvenile-onset diabetes, brittle diabetes, or ketosis-prone diabetes. 

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In type I diabetes, the pancreas either stops making insulin or does not make enough, so the person must receive daily injections of insulin. 

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This form can occur at any age, although it most often occurs in children and young adults.

 

Non-insulin-dependent (type II) diabetes.

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Type II diabetes is also called non-insulin-dependent diabetes. It was previously called adult-onset diabetes, ketosis-resistant diabetes, or stable diabetes. 

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Type II often develops in overweight adults.

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Type II diabetes allows some production of insulin, but the body is unable to use it effectively. This type most often occurs in adults.

 

Other types of Diabetes.

  1. Gestational diabetes occurs in some women during pregnancy. 

  2. Secondary diabetes includes other types of diabetes linked to disease of the pancreas, hormonal changes, side effects of drugs, or genetic defects. 

  3. A fifth group, the impaired glucose tolerance (IGT) group, includes persons whose blood glucose levels are abnormal, but not high enough to be diagnosed as diabetic. 

 

What causes Diabetes?

No one is sure what causes diabetes, but it is assumed that:

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People are born with a tendency for it. 

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Several different viral infections and a process called autoimmunity are thought to induce type I diabetes. You cannot catch it from someone else. 

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If you are prone to type II, excess body weight is a risk factor, since excess fat prevents insulin from working properly. 

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Type I diabetes cannot be prevented; type II can often be prevented by maintaining a normal body weight and by staying physically fit.

 

Factors contributing to the development of diabetes are:

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A tendency for the disease to run in families,

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Being overweight, 

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An inactive life style,

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A diet high in fat and low in fiber, 

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High blood pressure, and 

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Aging.

 

What are the warning signs for diabetes?

 

Symptoms of type I diabetes usually occur suddenly. 

Symptoms include:

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Frequent urination

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Excessive thirst

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Extreme hunger,

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Dramatic weight loss, 

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Irritability, weakness and fatigue, and nausea and vomiting. 

 

Symptoms of type II may include any of these same symptoms, but they usually occur less suddenly and may be unnoticed or ignored.

 

 Additional symptoms of type II include: 

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Recurring or hard-to-heal infections (especially infections of the skin, gums, or bladder)

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Drowsiness, blurred vision,

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Tingling or numbness of the hands and feet, and itching.

 

How will diabetes affect my life?

Type I diabetes

If you have type I diabetes,

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You will have daily injections of insulin at set times. 

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You will also need to exercise regularly and 

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Eat well-balanced meals that limit sugar, fat, and salt. 

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Your individualized meal plan will probably include three meals and two or three snacks a day at set times to properly balance insulin.

 

Type II diabetes

If you have type II diabetes  

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If overweight, you will first need to bring your weight under control, Restrict sugar intake, and 

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Follow an exercise plan.

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You will also follow an individualized meal plan. 

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If diet and exercise are not enough to control blood sugar, pills or tablets may help the body produce more insulin or use that insulin more effectively. 

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Daily insulin injections may also be needed.

 

What is a blood-sugar test?

The blood-sugar level test takes two forms - a blood test and a urine test. 

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The blood test, which involves pricking a finger for a drop of blood, is most recommended by doctors because it can tell the exact amount of blood sugar at any given moment. 

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Urine-test readings are not as precise. 

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People with type I diabetes often test their sugar levels between 2 and 4 times a day (before and after they eat). 

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People with type II may test themselves less often.

 

What kinds of complications can arise?

The three most common emergency complications for people with diabetes are:

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Hypoglycemia (Low blood sugar)

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Hyperglycemia (High blood sugar) and 

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Ketoacidosis. 

 

Hypoglycemia, 

or low blood sugar, is often referred to as an insulin reaction or insulin shock.  

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It is more common in people whose diabetes is treated by injection. 

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It can occur suddenly if you delayed a meal or ate too little, if you have had extra exercise, or if you have taken too much medication. 

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Symptoms include feeling cold, sweaty, nervous, shaky, weak, or extremely hungry. 

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Some people become pale, get headaches, or act strangely. 

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Treat low blood sugar quickly with some form of sugar; otherwise it can lead to unconsciousness.

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If unconsciousness occurs, glucagon must be injected to raise the blood-sugar level. When glucagon is not available, an emergency medical call should be made or the person should be taken to the nearest emergency room. 

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If you take insulin or have ever passed out because of low blood sugar, inform your doctor, who will probably prescribe a glucagon emergency kit for you to carry with you at all times.

 

Hyperglycemia, or high blood sugar, is just the opposite. 

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It occurs when you eat too much or take insufficient medication. 

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It can also be a response to illness or emotional stress. 

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Symptoms include frequent urination, excessive thirst, fatigue, and nausea. 

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There are usually large amounts of sugar in the urine and blood.

 

Ketoacidosis, or diabetic coma,

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Occurs most often in people with type I diabetes. 

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It occurs when insulin and blood sugar are so out of balance that ketones accumulate in the blood. At high levels these ketones are poisonous.

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 Ketoacidosis takes several hours or days to develop so it can usually be avoided if brought under control at the first signs of high blood sugar or ketones in the urine. 

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Symptoms include dry mouth, excessive thirst, loss of appetite, excessive urination, dry and flushed skin, labored breathing, and fruity-smelling breath. Vomiting, abdominal pain, and unconsciousness may also occur. 

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If your blood sugar is above 240 mg/dL, test for ketones. If you have ketones in your urine, call or get to a doctor immediately.

 

Other complications can include 

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Eye damage

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Kidney disease, 

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Heart attack, 

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Foot infections with gangrene, 

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Stroke, and 

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Impotence. 

 

Controlling blood-sugar levels, you can help prevent these complications.

 

Resources to Help You Cope with Diabetes

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It takes time to adjust to all the changes diabetes brings to your life. There is a lot to learn and a lot to change. You can experience mood swings that have chemical causes. Changes in your blood-glucose level can change the way you feel. Your moods can sometimes change your blood-glucose level, especially if you are stressed about something else.

 

Where can I get some support?

Support can come from a number of sources. 

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First of all, identify friends and family members who are empathetic people you can talk to and who will really listen to you. 

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There are other resources too. These include your health care team and several organizations that will be discussed later. 

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The closer your support person is to your social environment, the more access you are likely to have to that person, so look to those around you first. Find someone you can talk to or who will understand or help you when you are discouraged or when changes in your blood-glucose level affect your mood, and vice versa.

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You are a second resource for yourself. If at times you do not want to talk to someone, write down your feelings. Keep a journal. Try "answering" some of your own entries too. Remind yourself of your goals and accomplishments. Some people find it helpful to memorize the reminders listed below, which were developed by Novo Nordisk, and repeat them to yourself when you need support (Note: when you take the first letter of each reminder and put them together, it spells power.):

 

How to organize
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Planning. Plan what change you want to make and how to accomplish this.

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Overall goal. Choose one goal to accomplish, for example, getting your blood-glucose level to 140.

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Weekly goal. Do one thing each week to help reach your overall goal.

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Experience. Every time you try, you add a positive experience that sets a precedent for more change. You will probably be able to make the changes more quickly than you think.

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Reward. Reward yourself whenever you achieve a goal.

 

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Another thing you can do to support yourself when you feel emotional stress is to do an activity that you enjoy or go to a place that is special to you. 

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Of course, you must always call a member of your health care team if your blood- glucose level is high and does not return to an acceptable range soon.

 

Can I really ask my health care team for support? What kind of support?

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A number of health care professionals can offer you support. 

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Members of your health care team can include your doctor, the office nurse, a diabetes nurse educator, a dietitian, a social worker, and your pharmacist.

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Your team members can provide education and follow-up care, give advice about obtaining emergency care and reimbursement possibilities and information about community services, and tell you how to find information about insurance, licenses, and employment.

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Diabetics and their family members should learn as much as they can about diabetes and how to manage it. 

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Local hospitals and public health departments may offer classes or other educational resources. In larger cities the local association of diabetes educators may be able to help you find educational opportunities. A significant service your physician or diabetes educator can offer you is to support you with pattern management.

 

What is pattern management?

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Sooner or later you need to tie together all the information you have recorded about the foods and the times you eat, your physical activities, your medication records, and your self-monitoring results from blood-glucose and urine-ketone tests. You need to bring all of this information together into an overall plan for controlling your diabetes. This is called pattern management. The records you have kept provide key information about your diabetes control plan. Your doctor and diabetes educator can help you graph these or compare results to understand your patterns and how you can use this to take charge of your diabetes.

 

What if I do not have any close friends or family? Since my professional team has limited time for me, where else can I turn?

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Several nationwide organizations offer support to people with diabetes. They often provide phone support and education. Usually, the people answering the phones have diabetes, so they can speak from experience. 

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Sometimes local groups meet at an religious place or hospital. 

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Your local hospital can usually tell you how to get in touch with such a group if you are interested in joining one.

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Keep in mind too that diabetes journals are usually available at your library. These journals even have organized "pen pals" and other social supports.

 

Coping with Illness and Diabetes

Can general illness cause problems for diabetes?

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The common cold, flu, and other illnesses and infections can make it difficult for people with diabetes to control their blood sugar. 

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Signs of some kinds of infection that can increase blood-sugar levels include bleeding gums, loose teeth in adults, burning and pain during urination, and vaginal itching.

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 Obviously, loss of appetite or vomiting will affect blood-sugar level control, but so can a severe sunburn. 

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In fact, the physical stress of illness alone can raise blood sugar. When you become sick, your body releases stress hormones that oppose the action of insulin. This can lead to hyperglycemia (high blood sugar) and the formation and accumulation of ketones.

 

What can I do about this?

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You will get sick once in a while, but you can work with your health care provider to develop a plan of action for sick days. 

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The most important thing is regular blood-sugar and urine-ketone testing. 

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The plan should also include instructions about when to call your doctor for help, what foods and fluids to take, and what medication changes may be needed.

 

How often should I test my blood and urine when I am sick? 

When should I call my physician?

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Test your blood sugar as soon as you think that you are sick. After that, testing every 4 hours is usually recommended for people with insulin-dependent (type I) diabetes, although some people should test themselves more often. 

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People with non-insulin-dependent (type II) diabetes should check blood-sugar levels 4 times a day, usually before each meal and at bedtime. 

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If your blood sugar is 240 or above, check your urine for ketones. 

 

Call your doctor at once if any of the following situations exist:

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Vomiting occurs more than once

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Diarrhea occurs more than 5 times or for longer than 24 hours

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Breathing is difficult

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Blood-glucose levels are higher than 300 mg/dL on two consecutive readings

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Urine ketones measure moderate or large

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Also notify your doctor if you have an illness that does not improve after 1 or 2 days or if you are unable to eat normally for longer than 24 hours. 

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Finally, you should call your doctor if you have any doubts about anything you should be doing. 

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If you have any of these problems and are unable to reach your doctor, go to your local hospital's emergency room

 

Can medications for other illnesses affect my diabetes?

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Some medicines, such as cough syrups and cough drops, contain sugar. 

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Cold remedies can raise your blood sugar. Read the labels. 

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Never take any over-the-counter product without consulting your doctor or pharmacist.

 

What kinds of medications or items should I keep in my medicine cabinet?

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You should check with your pharmacist or health care provider about appropriate medications to keep on hand. 

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They can recommend sugar-free medications for fever, coughing, colds, and diarrhea; throat lozenges and antacids; and antibiotic ointment for minor cuts. 

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Some over-the-counter products are not recommended for people with diabetes; before using them, get advice from your health care professional. 

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You should also have a fever thermometer. 

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Some people keep a "sick day kit" containing all the items recommended by their health care provider as well as extra testing strips, packets of broth, and so on.

 

Should I stop taking my diabetes medications if I am too sick to eat?

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Even if you cannot eat, your body needs the medication that has been prescribed. This should be done with frequent blood sugar monitoring. If anything, being sick may increase your need for insulin. For instance, people who take insulin may need a more rapid-acting insulin; those who take pills may need to take insulin on sick days. Omitting your medication during an illness can lead to hospitalization.

 

What can I eat on sick days?

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What you should eat will depend on your symptoms or the stage of your illness. Consult your health care provider for suggestions about what foods are appropriate for you.

 

What if I experience nausea or vomiting?

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Sometimes when you are sick it may be difficult to eat foods on your regular meal plan. That is why you need a list of foods and liquids that are suitable for you on sick days. Ask your health care provider for sick day meal plans. 

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The first rule, though, is to drink plenty of fluids. Try to drink at least 8 oz every hour when you are awake.

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These extra fluids should not have any calories.

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Suitable drinks include water, diet soft drinks, and sugarless Kool-Aid. 

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If you cannot eat solid foods, drink fluids containing 50 g of carbohydrates every 3 or 4 hours in addition to drinking sugar-free liquids.

 

Examples of servings containing 10 g of carbohydrates are the following:

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1/3 cup apple juice

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1/2 cup ginger ale or cola (not diet)

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1/4 cup sweetened gelatin

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1/2 cup chicken soup with noodles

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Call your physician or diabetes educator if you are unable to tolerate fluids because of nausea, vomiting, or other illness.

 

 

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