Maxy sez :Managing Diabetes With a Cold or Flu

Got the sniffles? Here's what you need to know when managing diabetes and fighting off a cold or the flu.

By Madeline R. Vann, MPH

Medically Reviewed by Lindsey Marcellin, MD, MPH
The cold and flu season is on its way. And while sick days bring everyone down, people with type 2 diabetes have some special considerations when they're under the weather.

In addition to choosing the right cold medications and checking in with your doctor about possible dosage changes, good diabetes care means being prepared for the days when you would rather not drag yourself out of bed for a glucose check or a snack.

Pick the Right Cold Medicine

“A lot of [cold and flu] medications, particularly cough syrup, are high in glucose,” says internist Danny Sam, MD, the program director of the residency program at Kaiser Permanente in Santa Clara, Calif. His practice specializes in adult diabetes.

If you have diabetes, your best bet is a medicine that is clearly labeled sugar-free. Almost every major pharmacy has a store brand of sugar-free cold or cough medicine, says Dr. Sam. If you have questions, ask your pharmacist for help.

Check Blood Sugar Often

“Diabetes is not as well controlled when you are sick,” observes Sam. This is because when your body fights infection, it releases a chemical cascade that can alter your body’s glucose and insulin response. As a result, you may need to check your blood sugar more often than you usually do. People with type 2 diabetes may need to check their blood sugar four times a day, and should check their urine for ketones anytime their blood sugar level is higher than 300 mg/dL.

Other medications you may need to take when you are sick can affect your blood sugar levels:

Aspirin may lower blood sugar levels
Certain antibiotics may decrease blood sugar levels in those taking some oral diabetes medications
Decongestants may raise blood sugar levels

Adjust Your Plan 
“You have to monitor your blood sugar more frequently and you may have to adjust your meds,” Sam says. Some people may find their blood sugar spiking more frequently, while other people, especially those plagued by stomach flu or diarrhea, may be facing hypoglycemia, or low blood sugar. Either way, you need to know how to respond to these unusual dips and spikes in blood sugar.

“Touch base with your doctor to get instructions on how to adjust medications,” says Sam. This is especially important if your blood sugar readings stay higher than 240 mg/dL for more than 24 hours.

Alternatively, before cold and flu season sets in, you can talk to your diabetes care team about how to make medication dose decisions if you should get sick. Find out what the acceptable range of blood sugar change is — and exactly when you should call your doctor. Write these instructions down in a notebook so that you can easily refer to them when you do get sick.

But there are some things you shouldn’t change: Unless your diabetes care team or doctor has instructed otherwise based on your blood sugar levels, keep taking your diabetes medications as prescribed.
Feeling Better Without Meds

Remember, as miserable as you feel right now, colds and the flu do not last forever. If you want to feel better, take care of yourself. That means:

Stay hydrated. Drink lots of fluids. Small sips can help you stay hydrated even if you are vomiting frequently.
Snack. You may not feel like it, but you should eat regularly. Snack on fluids like soup or milk, or small portions of easy-to-digest foods like applesauce, crackers, and vanilla wafers.
It’s also a good idea to keep written track of the medications you take, both for diabetes and cough and cold symptoms, as well as the results of your blood sugar tests and other details of your illness.

Illness Prevention Strategies

We’d all like to avoid getting a cold or the flu. If you have type 2 diabetes, your best bet for avoiding sickness   is to keep your disease under control. “Control blood sugar when well,” advises Sam.

Out-of-control blood sugar makes it harder for your body to fight off infections, including those that lead to colds and the flu. If you can keep your blood sugar under control during your healthy days, you will have fewer sick days and, when you do get sick, your body will be able to bounce back faster.

It’s also a good idea to get your annual flu shot and other vaccinations that are recommended for your age range.