How to look after yourself when you are unwell

1. How to look after yourself when you are unwell GO THROUGH THIS PRESENTATION AND TRY AND THINK ABOUT THE QUESTIONS.

2. How do you feel when you are unwell? Rough?! You’ll have symptoms of your illness i.e. • Cold – sneezing, runny nose, cough, shivery, tired, headache • Chest infection – cough, coughing up stuff, hot, tired and aching • Urine problems – passing a lot of urine, and going oftenwhich could be painful, tired and aching • Tummy problems – feeling sick, vomiting, diarrhoea, pain, tiredness, loss of appetite

3. Plus…. If you are unwell and your blood glucose is high, how may also feel? • Tired, aching, and drowsy • Thirsty and dry • Passing more urine and going more often • Blurred vision • Loss of appetite • Feeling sick and vomiting • Tummy pain

4. So, have you noticed anything about the illness and high blood glucose symptoms? Your illness symptoms and high glucose symptoms can often be the same – this means if you don’t test your blood glucose you might not realise it is high, as you might think it is a symptom of your illness! So, rule No. 1 when you are unwell…..

5. RULE NO. 1 Test your blood glucose at least 4 times a day or more frequently if they are unstable. Also if your blood glucose is higher than 15mmol/l (or 13.9mmol/l if you are using an insulin pump), you should test for blood ketones.

6. Why do your blood glucose levels go high in the first place? This can be quite frustrating and a bit annoying if you are already feeling rough due to your illness. So what’s happening to do this inside your body? If you think of an infection or illness as the enemy, and your body has to fight the infection. What happens?

7. To do this your body needs more energy as it needs to work harder than usual to fight the infection. • To get this extra energy it needs to find more glucose. This extra glucose is found in your liver and fat cells. • Extra glucose is released from you liver and fat cells and goes into your blood stream. • However, to be used as energy in the bodies cells it needs insulin to pass into the cell. If no or not enough insulin is in your blood it cannot pass into the cell and will stay in your blood. • This is how your blood glucose will rise unless you take insulin and usually more than your usual dose. • So……..

8. RULE NO. 2 You must take your insulin even if you are not eating, and you might need to take a bigger dose than usual depending on how high your blood glucose level is and how much extra glucose your body needs. For information see in the illness section called insulin and adjusting.

9. RULE NO. 3What happens if you don’t feel like eating? Often during illness people don’t want to eat. However, by eating carbohydrate food this gives you glucose to use as energy to fight the illness. What else could you eat instead of your usual bread, potatoes, cereal, pasta etc.? Have things such as: sugary drinks, ice-cream, smoothies, and custard. Remember though, you need insulin with these foods as they contain glucose!

10. RULE NO. 4 The other very important thing is to drink plenty of water. Remember we’ve said in previous sections that if your blood glucose is high you become dehydrated? This can happen during illness especially if your levels are high. So, Rule No. 4…..Sip on water!

11. What if I have ketones? • Rule No. 5 – test for ketones • A ketone level of under 0.6 is normal. • If your ketone level is 0.6 – 1.5 this is a warning sign telling you that you are starting to produce ketones which is a poison and if left untreated you will become very unwell. • If your ketone level is over 1.5 you will probably need to come into hospital. So, what do you do?

12. Ketones continued… If you have over 0.6 ketones you are at risk of becoming very ill. We discuss this in detail in the “what is type 1” section. What you need to do is: • Drink a lot of water as you will be dehydrated. • Test your blood glucose every 1-2 hours. • You need to take fast acting insulin to lower your blood glucose. If you know your correction dose you can take this every 2 hours. However you must be careful because if you take insulin every 2 hours it can “stack up” in your blood and cause a hypo.

13. More on ketones… • Think of the cause…have you stopped taking insulin, have you been eating too much carbohydrate or glucose drinks (especially if you aren’t feeling like eating and have been drinking lucozade or something instead to give you energy), and maybe not taken enough insulin to cover it? Or if you have an infection or illness this can cause high blood glucose levels.

14. When should you get help? • If you are unwell and feel like you need some support you can contact your diabetes team. If you cannot contact them, you can phone your GP, or for out-of-hours call NHS 24. • If you have high blood glucose levels and possibly ketones, and are unsure of how to adjust your insulin you should contact the above. • If you have ketones over 1.5 you should contact your on-call diabetes doctor or diabetes specialist nurse, or NHS 24 out-of-hours. • If you have any level of ketones and are feeling nauseated, are vomiting, have tummy pains, or are feeling drowsy you should go to your nearest A&E department.

15. Rule No. 6IMPORTANT!Get help if you are unsure of what to do when you are ill The important thing with ketones is don’t feel that you are bothering your diabetes team if you are unsure what to do. It’s much easier to deal with high blood glucose levels and small amounts of ketones if found early, rather than leaving it till you feel very unwell.

16. Finally… Before anything happens, if you are unsure how to look after your diabetes when you are unwell, contact your diabetes team, GP or NHS 24.