Page 21 - The SA Journal Diabetes & Vascular Disease Volume 9 No 4 (November 2012)

VOLUME 9 NUMBER 4 • NOVEMBER 2012 163
SA JOURNAL OF DIABETES & VASCULAR DISEASE PATIENTS AS PARTNERS
to maintain good health. So, if the body encounters something unusual,
for example, an infection, then the various systems within the body react
accordingly to restore good health. This process involves the release of
hormones, including adrenaline and noradrenaline, which are responsible
for increasing the heart rate and blood pressure, dilating blood vessels to
essential organs (heart, brain etc) and constricting blood vessels to non-
essential organs (for instance, the skin), increasing the metabolic rate
and increasing blood glucose.
This process enables the body to deal with ill health. But, for people
with diabetes, blood glucose levels rocket out of proportion to the amount
of food eaten, available insulin or exercise taken. Persistently high blood
glucose levels can lead to ketoacidosis, especially in the presence of an
infection, although this is rare for people with type 2 diabetes.
This mechanism is responsible for the secondary diabetes that oc-
curs following acute illness such as a heart attack or stroke. It can also
be seen in patients taking steroids. In previously healthy, non-diabetic
people, blood glucose often returns to normal following recovery or when
steroids have been discontinued.
People with diabetes need to be aware of the effects of ill health on
their diabetes and need to be advised of what to expect, what to do and
when to worry.
What to expect
People with diabetes need to know that their blood glucose levels will rise
just because they are ill and they might need to temporarily increase their
insulin doses. People not treated with insulin might need their medica-
tion for glycaemic control increasing temporarily, or may benefit from
the introduction of a small amount of rapid-acting insulin to control their
blood glucose levels.
Once the patient has recovered, medication can usually revert to pre-
illness regimens. Patients should be advised to contact their practice for
advice on medication for glycaemic control if blood glucose levels are
Advice to patients with diabetes during illness
• Continue all medications, including insulin
• Test blood glucose levels more often
• Expect blood glucose levels to be higher than usual
• Phone the surgery if you need help with blood glucose control
• Drink plenty of fluids
• Contact the surgery if illness persists or vomiting occurs
• Contact the surgery if you are worried or need further advice.
persistently above 15 mmol/l. This is a general guideline and should be
individualised for each patient as necessary.
What to do
It makes sense to encourage patients to test their blood glucose levels
more frequently when they are ill. All medication should be continued
as normal, including treatment for glycaemic control, whether tablets or
insulin are taken. Patients should rest until feeling better because exer-
cising to reduce blood glucose is not advisable and it will make matters
worse.
Self-medicating with paracetamol, cough medicines and other over-
thecounter remedies for minor illness is fine as long as manufacturers’
instructions are followed and medicines are not out of date. Patients
should aim to drink at least three litres or five pints of water or sugar-free
drinks daily. If the appetite is reduced, advice regarding replacing meals
with appropriate fluids or alternatives should be given.
When to worry
Patients should ring the surgery for advice if they are concerned about
their illness or aspects of their diabetes management. Persistently high
blood glucose levels – 15 mmol/l – will need further consideration with
a view to increasing medication to improve glycaemic control. Patients
need to inform the surgery if vomiting occurs. Secondary care referral
will be necessary if it is persistent and the patient is hyperglycaemic with
ketonuria.