Managing Cold and Flu Season With Type 1 Diabetes

Lindsay Cohen, RDN

Credit: Mama-Betes

For anyone living with Type 1 diabetes, the change of seasons often marks the start of the dreaded cold and flu season. Where a typical person might only experience a few days of fatigue and congestion, a virus for someone with Type 1 diabetes can create a significant challenge in maintaining stable blood sugars. Successfully navigating potential sick days with diabetes requires preparation, knowledge, and flexibility.

Why Illness Spikes Your Blood Sugar

If you have ever experienced being sick with Type 1 diabetes, you know the frustration. More often than not, your blood sugars become stubbornly resistant to your usual insulin doses. This is your body’s fight-or-flight system kicking in. When your immune system detects an infection, your body pumps out more stress hormones, such as cortisol and adrenaline.

These hormones signal the liver to release its stored glucose into the bloodstream, providing a quick source of energy to help the body fight the infection. These same stress hormones cause your body’s cells to become temporarily more insulin-resistant.

All of this can result in high blood sugars, the potential for ketones, and an increased risk of diabetic ketoacidosis (DKA) if left unmanaged. DKA is a medical emergency that often involves uncontrollable vomiting, shortness of breath or inability to keep fluids down.

Blood Sugar Management Considerations

When you are sick, your blood sugar management strategy may need to be adjusted. Your insulin sensitivity factor or correction factor may become less effective when you are sick, and you may need to adjust the timing and amount of your correction doses.

Your care team can provide specific doses and formulas, but the goal is to keep your blood sugar below 250 milligrams per deciliter to help prevent ketone production. It is also important not to stop or severely reduce your basal insulin, as doing so could lead to dangerously high blood sugar levels.

Your Sick Day Kit

The most crucial aspect of managing Type 1 diabetes during illness is preparation. Having a solid, preestablished sick day plan is key.

It is recommended to keep a sick day kit on hand, which should include the following:

• Glucose and ketone monitoring supplies: Blood glucose meter, test strips and a method for checking for ketones.
• Fast-acting carbohydrates: If you cannot eat or keep food down, you need easily digestible sources of sugar to prevent low blood sugar. This includes regular (nondiet) soda, fruit juice, honey or popsicles.
• Sugar-free fluids: Water and other sugar-free fluids flush ketones and prevent dehydration. Broth, diet soda, sugar-free sports drinks and water are all good options to include.
• Sick day medications: A thermometer, over-the-counter medications such as ibuprofen or acetaminophen, and a nonexpired glucagon kit in case of a low blood sugar emergency should be available.
• Insulin dose adjustment instructions: Do not wait until you are too sick to think clearly to call your care team. Your kit should include instructions from your endocrinologist or diabetes educator regarding when and how to adjust your insulin doses when you are sick.

Navigating Over-the-Counter Medications

Some medications can affect blood sugar levels, so it is best to always discuss your medication choices with your pharmacist or diabetes team.

Many liquid cold and cough syrups, throat lozenges and chewable tablets contain sugar to improve their taste. If you take a dose every four to six hours, you are taking in carbohydrates that should be accounted for. You may be able to find sugar-free or diabetic-friendly formulations of some over-the-counter medications.

Certain active ingredients, such as pseudoephedrine (found in many popular decongestants like Sudafed), are central nervous system stimulants. Just like caffeine, they can raise blood sugar levels by triggering the release of adrenaline, which signals the liver to release glucose.

In Summary

Living with Type 1 diabetes during cold and flu season can be especially stressful. Because everyone’s needs are different, it’s important to stay aware and informed by testing your blood sugar frequently and checking ketones when necessary. Above all, remember that your diabetes care team is always just a phone call away, ready to support you through any challenges.