DIABETES STRESS OF ACUTE ILLNESS AND SURGERY

Acute illness, injury, and surgery are situations that may evoke a counterregulartory hormone response resulting in hyperglycemia. When pt are ill, they should continue with regular meal plan while increasing the intake of no caloric fluids, such as broth, water, diet gelatin, and other decaffeinated beverages. They should also continue taking oral agents and insulin as prescribed and check blood glucose at lease every 4 hours. If the glucose is greater than 240, urine should be tested for ketones every 3 to 4 hours. Patient should report moderate to large ketone levels to the HCP. When the illness causes the pt to eat less than normal, she or he should continue to take oral hypoglycemic medications or insulin as prescribed while supplementing food intake with carbohydrate-containing foods. Examples include soups, juices, and regular decaffeinated soft drinks. HCP should be notified promptly if the pt is unable to keep any fluids or food down. The pt should understand that meds should not be withheld during times of illness because counterregulatroy mechanisms often increase the blood glucose level dramatically. Food intake is also important during this time because the body requires extra energy to deal with the stress of the illness. Extra insulin may be necessary to meet this demand and to prevent the onset of DKA in the pt with type 1 diabetes. During the intraoperative period adjustments in the diabetic regimen can be planned to ensure glycemic control. The pt with type 2 diabetes that had been on oral agents should understand that this is a temporary measure and it should not be interpreted as a worsening of diabetes. Pt who are undergoing surgery or any radiologic procedures that involve the use of a contact medium are instructed to hold their metformin the day of surgery or the procedure until 48 hours after the and after serum creatinine had been checked and is normal.

SICK DAY GUIDELINES FOR DIABETES

What happens when you are sick When you are sick, your body reacts by releasing hormones to fight infection. But these hormones raise blood sugar levels and at the same time make it more difficult for insulin to lower blood sugar. When you have diabetes, even a minor illness can lead to dangerously high blood sugar. This may cause life-threatening complications, such as diabetic ketoacidosis or a hyperosmolar state. Plan ahead Work with your doctor to make a sick-day plan for you or your child with diabetes. Discuss your target blood sugar goal during an illness, how you should adjust your insulin dose and timing (if you take insulin), and when you need to contact your doctor for help. Also, make sure you know how often to check blood sugar and urine ketone levels. Keep your plan in a convenient place, and include contact information in case you need to reach your doctor at night or on the weekends. Steps to take during an illness Here are some general sick-day guidelines: Continue taking your pills for diabetes (if you have type 2 diabetes) or insulin, even if you are vomiting and having trouble eating or drinking. Your blood sugar may continue to rise because

of your illness. If you cannot take your medicines, call your doctor and discuss whether you need to adjust your insulin dose or other medicine. Try to eat your normal types and amounts of food and to drink extra fluids, such as water, broth, carbonated drinks, and fruit juice. Encourage your child to drink extra liquids to prevent dehydration. o If your blood sugar level is higher than 240 milligrams per deciliter (mg/dL), drink extra liquids that do not contain sugar, such as water or sugar-free cola. o If you cannot eat the foods in your regular diet, drink extra liquids that contain sugar and salt, such as soup, sports drinks, or milk. You may also try eating foods that are gentle on the stomach, such as crackers, gelatin, or applesauce. Try to eat or drink 50 grams (g) of carbohydrate every 3 to 4 hours. For example, 6 saltine crackers, 1 cup (8 fl oz) of milk, and cup (4 fl oz) of orange juice each contain approximately 15 g of carbohydrate. Check your blood sugar at least every 3 to 4 hours, or more often if it is rising quickly, even through the night. If your blood sugar level rises above 240 mg/dL and your doctor has told you to take an extra insulin dose for high blood sugar levels, take the appropriate amount. If you take insulin and your doctor has not told you to take a specific amount of additional insulin, call him or her for advice. If you take insulin, do a urine test for ketones every 4 to 6 hours, especially if your blood sugar is higher than 300 mg/dL. Call your doctor if you have more than 2+ or moderate ketones in your urine. Check your child's urine for ketones at least every 6 hours, even through the night. Weigh yourself and check your temperature, breathing rate, and pulse frequently if your blood sugar is higher than 300 mg/dL. If you are losing weight and your temperature, breathing rate, and pulse are increasing, contact a doctor. You may be getting worse. Don't take any nonprescription medicines without talking with your doctor. Many nonprescription medicines affect your blood sugar level.

When to call your doctor Minor illnesses in people with diabetes-especially children with type 1 diabetes-can lead to very high blood sugar levels and possible emergencies. When children are sick, watch them closely for signs that they need immediate medical attention. Call 911 or other emergency services if you or your child has: Symptoms of diabetic ketoacidosis (DKA), such as abdominal pain, vomiting, rapid breathing, fruity-smelling breath, or severe drowsiness. Symptoms of dehydration, such as a dry mouth and very yellow or dark urine. Dehydration is particularly dangerous in children and may be caused by vomiting and diarrhea. A low blood sugar level that continues. It may not be necessary to call your doctor every time you or your child with diabetes has a mild illness, such as a cold. But it is a good idea to call for advice when you are sick and: Your blood sugar level is higher than 240 mg/dL after taking the adjusted amount of insulin in your sick-day plan.

You take oral diabetes medicine and your blood sugar level is higher than 240 mg/dL before meals and stays high for more than 24 hours. You have more than 2+ or moderate ketones in your urine. You still have a fever and are not feeling better after a few days. You are vomiting or having diarrhea for more than 6 hours. When you are sick, write down the medicine(s) you have been taking and whether you have changed the dosage of your diabetes medicines based on your sick-day plan. Also note changes in your body temperature, weight, blood sugar, and urine ketone levels. Have this information handy when you talk to your doctor.

FOOT CARE
When bathing your Feet: Wash feet everyday with mild soap and warm water Check the temperature of your bath water with a thermometer (temp. should not be warmer than 90F) Dry your feet well always dry between your toes carefully Use lotion to keep your skin from getting dry. DO NOT USE LOTION BETWEEN TOES. DO NOT: Soak feet for more than 10 minutes. Walk barefoot Remove corns or calluses yourself. Use adhesives or band aids on your feet. Put a hot water bottle or heating pad on your feet Use any chemicals on your feet Wear tight socks, shoes, or garters Sit with legs crossed smoke DIABETES CAN DAMAGE NERVES. Because of decreased feeling in the feet, diabetics must: Check their feet two times a day. Look for cuts, changes in color, or temperature. Check the bottom of the Feet! File or cut toe nails straight across Wear shoes that fit and wear clean socks everyday See your doctor or Podiatrist if you have Ingrown toenails Cracking or peeling skin Cuts, sores, or changes in foot color Pain in your feet or legs Warts on your feet Puncture wounds on your feet