Diabetes Management in Flu Season


By: Clay Wirestone

The crowd in the small Boston theater laughed and clapped. The comedy show was a good one, and I was enjoying it from a cramped seat in the balcony. It was October 29, a Friday, and while it was brisk outside, winter hadn’t yet clamped down.

But the date was more important than I thought. The viruses that attack during the winter flu season had already begun to circulate, and some of them were in that very theater. During the show, dozens of people coughed and sneezed. And at some point during my two hours in the theater, I breathed in a tiny bit of evil.

You might call it a germ. But for me it was the beginning of more than two weeks of coughing, sore throat, visits to the doctor, and challenging diabetic control–all from one evening’s light entertainment.

Prevent, if possible

The ordeal was partly my fault. According to the Centers for Disease Control and Prevention, the most important thing an individual can do to protect against the flu is get a flu shot. And as a diabetic, I’m at greater risk for developing complications from the flu. (I’m type 1, but type 2s are also considered at risk.)

Guess who wasn’t vaccinated? Sure, I wind up getting a shot every year, but it’s usually in November or December. I had an appointment scheduled for the next week, and I was expecting that my doctor, as usual, would suggest the shot. But it was too late.

The other thing I failed to do, according to diabetes educator and author Constance Brown-Riggs, was prepare a sick day plan. I should have decided on the medical professionals with whom I needed to check (doctor and insulin pump coach, for example), made sure I had sick time ready at work, had food and drink at hand, and generally been ready for the vilest of viruses. “A plan prepared in advance can make getting a cold just a minor illness and not a life-threatening condition,” Brown-Riggs says.

I didn’t have such a plan. Sure, I can offer excuses — it had been years since I had been sick for more than a day or two. As a working journalist, I had to prepare for a feisty election day on November 2. But excuses don’t count for much after you’ve fallen ill.

Facing real risks

I soldiered on as the bug descended, working election night and plowing through deadlines. But I finally hit a wall. I was running a low-grade fever, blunted but not eliminated by pain relievers. My throat throbbed, and a cough took up residence. I had to stay home.

My doctor liked that idea. She tested me for strep (negative, thank goodness) and urged me to get some rest. She’s joined in that opinion by the CDC, which recommends that anyone with flu stay home and rest during any fever, and continue staying home and resting for a full 24 hours after it subsides.

But that appointment with my doctor — some four days after the show and while I was still running a fever — was only the beginning of the ordeal, because I had only begun to recognize the consequences for my diabetes. In short, everything went haywire. My blood sugars soared. I checked often enough to ensure they were blunted by insulin, but it didn’t seem to matter that I was eating only a bit of pudding and a few spoonfuls of soup.

As Brown-Riggs points out, this is a common side effect for diabetics. “A seasonal cold, flu or any kind of infection can cause blood glucose levels to increase,” she says. “Illness is stressful to the body, and the stress hormones that are released when sick cause the liver to produce more glucose, resulting in hyperglycemia.”

Brown-Riggs recommends that both type 1 and type 2 diabetics check their blood sugars and ketones regularly while ill, staying on guard for diabetic ketoacidosis. Type 1s may need to increase their insulin intake, and type 2s may need to go on insulin for a time. Brown-Riggs emphasizes, though, that such decisions should be part of a diabetic’s sick day plan and cleared with your doctor.

Finally reaching out

I lumbered along through my first week of sickness. The fever lifted, and I felt slightly more energetic. But my cough got worse, making it difficult for me to fall asleep some nights. I went through two-and-a-half bottles of cough syrup.

Some 10 days after I first started feeling under the weather, I contacted my doctor again. I needed something extra, I said. The coughing was keeping me awake at night. She prescribed a five-day antibiotic, and within a night I was feeling better. After another day, I realized that I had been lying to myself throughout this entire process. I hadn’t actually been feeling better or recovering. True, I didn’t have a temperature, but that didn’t translate into health. My final step, that seeking of that extra help — and the extra prescription — helped me turn the corner.

Brown-Riggs says that diabetics shouldn’t hesitate to call their care providers. Cases like mine, when the illness lingers, are no-brainers. She also recommends picking up the phone if you’ve been throwing up or having diarrhea for more than six hours, if your blood sugars are above 240 for an extended period, if you test positive for a moderate or large amount of ketones, or if you suspect you have diabetic ketoacidosis.

But what about my lack of fever? It had lifted, and that meant everything was better, right? Wrong. The CDC notes that not everyone who has the flu will run a fever. The thermometer can confirm that you’re feeling lousy, but it’s not the only authority. How your actual body feels — when you’re not denying the obvious and pushing yourself hour after hour — matters most.

Lessons learned

I never thought of myself as the stereotypical tough guy who denies illness at all costs, the kind of man who shows up at work ashen-faced and grim, hacking into an ever-growing pile of tissues while angrily denying he’s sick. After all, I’m a type 1 diabetic. I know what my body is doing, and I pay attention to my biofeedback throughout the day. I know when my blood sugar goes low. Most of the time, I can tell when it goes high as well.

But the simple seasonal flu managed to blindside me. It managed to make me look like one of those fake tough guys, and it made me doubt the signals my own body was sending me. Once I admitted that I was sick and got extra help, I got better. And once I got better, I immediately saw a drop in my blood sugars.

The simple facts are these:

— I should have gotten a flu shot earlier.

— I should have had a general plan in place for getting sick.

— I should have taken more time off from work.

— I should have asked for extra help from my doctor sooner.

— I should have increased my insulin basal rate after a few days of high blood sugars.

As Brown-Riggs says, “It’s most important to remember that ‘an ounce of prevention is worth more than a pound of cure’ and make a sick day plan in advance.”

Facts about the 2010-2011 flu season

According to the Centers for Disease Control and Prevention:

— Although its timing can vary, flu season generally reaches its apex in January and February. The bug can attack as late as May.

— The 2009 H1N1 virus that caused widespread concern last flu season will likely continue to infect people, along with other seasonal bugs.

— This year’s flu vaccine protects against three strains: an H3N2 virus, an influenza B virus, and the H1N1 virus. The match between circulating viruses and what the vaccine protects against is generally good; the two have mostly matched in 16 of the last 20 flu seasons.

For much more information from the agency about the flu, go to cdc.gov/flu. Diabetes educator Constance Brown-Riggs has more advice about sick plans in her new book, The African American Guide to Living Well with Diabetes.



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