Overview: Diabetic Self-management and Emergencies During Coronavirus

In most cases people can take steps on their own to correct when blood sugar is too low or high. Those steps are outlined later in this article. Sometimes, people need help. If you are close with someone who has diabetes, consider having a discussion with them about what they want in case of an emergency.

Diabetes and Illness

People with diabetes who get sick with the flu or common cold should stay home and limit contact with others. Other recommendations from the Centers for Disease Control (CDC) include:

  1. Continue taking diabetes medication and insulin.
  2. Test blood glucose every four hours.
  3. Drink extra (calorie-free) liquids.
  4. Eat as normally as possible.
  5. Weigh yourself daily
  6. Check your temperature daily.

The CDC recommends that you contact a health care professional or go to the nearest hospital emergency department if any of the following occur:

  1. Your too sick to eat.
  2. You are not able to keep food down for 6 hours or more.
  3. You are having severe diarrhea.
  4. You have lost 5 pound or more.
  5. You have a fever over 101 degrees F.
  6. Your blood sugar level is < 60 mg/dl or > 300 mg/dl.
  7. You have ketones in your urine.
  8. You have trouble breathing.
  9. You feel sleepy or are not thinking clearly.

Diabetes and Coronavirus

We are learning more about Coronavirus every day. People with Type 2 diabetes are at increased risk of severe illness from COVID-19, and people with Type 1 diabetes may be at greater risk as well.  You can not ensure you have no risk of infection from Coronavirus. When protective measures and strict social distancing can not be maintained, people with diabetes should seriously consider avoiding activities.[i]

High blood sugar (over 250 mg/dl) and low blood sugar (under 70 mg/dl) can be dangerous, and symptoms can turn into an emergency quickly. Knowing the symptoms and what to do when your blood sugars are high or low may save your life.

High Blood Sugar; ( > 250 mg/dl )

The problem with high blood sugar is that your body can start burning fat instead of blood glucose and/or you blood can become acidic in a way that damages vital organs. This can cause medical emergencies that can be fatal.

When your blood sugars regularly exceed 180 mg/dl you should work with your health insurance provider and doctor to find and schedule an appointment with an Endocrinologist.  An Endocrinologist specializes in Diabetes and get help you develop a treatment and management.  You can find one in your area by searching The American Association of Clinical Endocrinologists website.

There is also an uncommon and very serious problem called Hyperosmolar Hyperglycemic Syndrome (HHS) when blood sugar is extremely elevated ; > 600 mg/dl. According to WebMD, HHS happens mostly in older people with uncontrolled diabetes who are sick or have an infection, and often occurs over days or weeks.[ii]

Symptoms

Frequent urination, a fruity smell on your breath, extreme thirst, nausea, vomiting, and stomach pain. Any sudden or unexplained symptom is a signal to contact a doctor. At a minimum you should use a home test or dipstick test to check your urine for ketones. If ketones are present, you should contact your doctor for next steps

Treatments for High Blood Sugar

Drink water – to help your body release urine. You should discuss this method with your health care providers because you can drink too much water; specially if you have heart or kidney issues.

Administer Insulin – discuss with your doctor how much rapid acting insulin to inject when your blood sugar level is too high and check your blood sugar again after 30 minutes to ensure your blood sugar is going down.

Exercise – your body will burn sugar when your heart pumps faster than usual. Any exercise should be discussed before-hand with your health care providers, especially if you are a Type 1 Diabetic.

Low Blood Sugar; ( < 70 mg/dl )

Blood sugar can also be too low. This is called hypoglycemia. Without treatment, low blood sugar can also become life threatening. Blood sugar most often drops too low because a person takes too much insulin, consumes too much alcohol, misses meals, or does too much exercise.

Many times people with diabetes can feel when their blood sugar is too low. However, that’s not always the case. Even for people who have had diabetes for a long time. Symptoms of low blood sugar to be aware of include confusion, dizziness, nausea, hunger, nervousness, sweating, weakness, tiredness, tingling in extremities, and headache. More sever symptoms include seizures and a loss of consciousness.

Treatment for Low Blood Sugar

If at any time a person loses consciousness someone should call 911.

If a person is experiencing mild symptoms or knows that they have low blood sugar they should eat a high carb snack like a glucose tablet, candy, sweet juice, sugar. The American Diabetes Association recommends that you take 15 grams of a carbohydrate and test yourself after 15 minutes. If levels are still below 70 mg/dl take another 15 grams of carbs and test yourself again after 15 minutes.  Once blood sugar levels rise above 70 mg/dl eat a meal. If symptoms continue after eating 30 grams of carbohydrates seek medica help.

In an Emergency

Signs of a possible emergency include the persistence of any of the symptoms outlined above for a prolonged time. Symptoms indicating that the problem is overwhelming the body include chest pain, difficulty breathing, a sudden fever, a severe headache, weakness in a part of the body, seizures, and loss of consciousness.

When any of these symptoms are experienced a call to 911 or trip to the hospital emergency department is needed.  WebMD states that you should give them a glucagon shot to raise their blood levels. aPatientsPlace.com does not support untrained people giving medications to people unless there are no other options.

Diabetes also makes people 2 to 4 times more likely to have a heart attack. Know the common signs of a heart attack and call 911 immediately or go to a hospital emergency department when needed. Stroke risk is also increased with diabetes. Know the symptoms and how to seek emergency care.

In the Emergency Department the primary goals are rapid evaluation and stabilization.[iii] Once the person is stabilized their primary care doctor and Endocrinologist, if they have one, should be contacted for post-discharge follow up and diabetes management care planning.

References

[i] Centers for Disease Control and Prevention. July 30, 2020. People with Certain Medical Conditions. Accessible at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

[ii] WebMD Medical Reference. Nov. 19, 2018. Diabetes Emergencies: How You Can Help. Accessible at https://www.webmd.com/diabetes/diabetes-emergencies-what-to-do

[iii] Ford W, Self WH, Slovis C, McH=Naughton CD. Diabetes in the Emergency Department and Hospital: Acute Care of Diabetes Patients. Current Emergency and Hospital Medicine reports. 2013; 1(1):1-9. Doi:10.1007/s40138-012-0007-x

 

Patient Advocate Foundation

One of the very best resources of  free help and financial assistance in the U.S. Get help navigating your health insurance, accessing treatments, appealing insurance denials, and connecting to care through the Patient Advocate Foundation, or call 800-532-5274. Go to https://apatientsplace.com/help-guidance/ for hundreds of links to free help with your healthcare.

Checklist – Next Steps After a Serious Diagnosis

Last Revised:07/24/2020

If you’ve just been told that you have a serious illness or life-threatening condition, you do not need to take the journey back to health alone. In fact, this will happen to most people if they live long enough, and it happens millions of times in America every week.

Use the following steps to insure the highest quality care and best outcomes for yourself…, or click the Step-by-Step Patient Guidelines for more information;

1- Understand and balance your emotions.

2- Take control.

3- Learn about your condition.

4- Learn about your health insurance. 

5- Schedule and prepare for follow up appointment.

6- Find Support.

7- Ask questions of your doctor, specialists, other patients, and your insurance company.

8- Confirm your diagnosis.

9- Keep as many routines as possible.

10- Get and file copies of all your medical records; including doctor’s notes.

11. Consult an experienced specialist.

12. Schedule a second follow-up with your primary care to discuss treatment and care options.

13. Get second and even third opinions.

Click here to learn how.

Schedule a phone chat, video chat, or via email to discuss your personal circumstances.

Managing Anxiety

Anxiety is a normal emotion. When set against the uncertainty of a pandemic, civil unrest, job loss, financial pressure anxiety can seem over-whelming.

You are not alone. There are many people who feel the same as you. More important, there are resource available to help you.

The Anxiety and Depression Association of America can help you understand the difference between normal anxiety and General Anxiety Disorder. A Patients Place always recommends that a partnership with your primary physician is the best weapon against illness and disease, and the best way to maintain your physical and emotional health. If you are not able to discuss your feelings with your primary care physician, you should find a new one who is more available and you feel more comfortable with. Here’ a link to guidelines to finding a primary care physician.

The Centers for Disease Control (CDC) offers a list of healthy ways to cope with stress and anxiety. You may notice that simply taking an anti-anxiety medication is not on the list.

It’s important to remember that everyone reacts to situations, life in general, stress, and therapy differently. If you need additional support use the free support and guidance service at https://apatientsplace.com.

Revised: 07/24/2020