[acb-diabetics] Taking your medicine is healthy for the health care system

Wed Jan 12 23:57:33 GMT 2011

Diabetes Management in Flu Season

Clay Wirestone
Jan 11, 2011 

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 <http://www.diabeteshealth.com/>  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
<http://www.diabeteshealth.com/browse/community/type-1-issues/> , but type
<http://www.diabeteshealth.com/browse/community/type-2-issues/>  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
<http://www.diabeteshealth.com/>  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
<http://www.diabeteshealth.com/browse/products/insulin-pumps/>  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
<http://www.diabeteshealth.com/browse/monitoring/blood-sugar/>  sugars
soared. I checked often enough to ensure they were blunted by insulin
<http://www.diabeteshealth.com/browse/medications/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.

  _____  

Categories: Blood
<http://www.diabeteshealth.com/browse/monitoring/blood-sugar/>  Sugar,
Complications <http://www.diabeteshealth.com/browse/complications-and-care/>
& Care, Health <http://www.diabeteshealth.com/browse/community/health/> ,
Insulin <http://www.diabeteshealth.com/browse/medications/insulin/> , Type 1
<http://www.diabeteshealth.com/browse/community/type-1-issues/>  Issues,
Type 2 <http://www.diabeteshealth.com/browse/community/type-2-issues/>
Issues

  _____  

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