What should I do on days I’m sick?

Many people think they should stop taking their insulin on days they are sick and not eating as much. DO NOT stop taking insulin; increased dosing is often required because the body is stressed.

Steps to take when sick

• Monitor blood sugar every 2-4 hrs
• Do not exercise
• Increase fluids
• Check urine for ketones if blood sugar >240
• Notify clinican if moderate or large ketones
• Make appointment with doctor

What is proper foot care for diabetic patients?

Foot care is extremely important for diabetic patients because improper care can lead to foot ulcers, infection, and even amputation.  Many patients with diabetes have decreased sensation in the feet, therefore they may not notice if they have a cut on their foot, which increases risk for infection. In addition patients with diabetes are at risk for slow wound healing.

Guidelines suggest you should

• check feet at least once daily
• always wear socks and well fitting shoes
• avoid walking barefoot

• when soaking feet, check temperature first
• lotion to prevent dryness and cracking, but not between toes
• cut toenails straight across, file edges
• notify health care provider immediately if any foot problems occur

Why am I waking up with high blood sugar?

When patients wake up with high blood sugar in the morning it is typically due to one to two conditions

Dawn Phenomenon

• There is a decrease in insulin sensitivity between 5-8Am which triggers the liver to secrete glucose and results in early morning hyperglycemia.
• How to correct:
  • Split INH between dinner and bedtime. Avoid carbs at bedtime or increase insulin dose at bedtime
• Classic sign: hypoglycemia at midnight, hypoglycemia 5-8AM

Somogi Effect:

• Taking too much insulin at night or not eating enough at dinner cause a drop in blood sugar. The drop in blood sugar triggers excess secretion of glucagon and cortisol which results in increased blood sugar bt morning
• How to correct: decrease dinner dose of INH or increase food intake
• Classic sign: hypoglycemia 2-3AM/ hyperglycemia in the AM