The change of seasons can bring cold and flu season to mind.  Having diabetes doesn’t mean that you will get sick more often than someone who does not have diabetes; however, taking precautions to try and prevent illness are extremely important.  Steps such as frequent hand washing, covering your mouth when you cough or sneeze, never sharing food or drinks, and getting the flu shot are vital to the prevention of illness.  If you do get ill with a cold or flu, it can cause problems with your diabetes.  You may not want to eat anything, your blood sugars fluctuate, you just want to sleep, or you’re vomiting.  What do you do to prevent dehydration or ending up in DKA?  The first thing to do is call your Diabetes Team for help.  If vomiting or ketones are present, then activate the emergency pager.   Blood sugar testing should be done often, as well as maintaining hydration.  Insulin injections should never be missed, and be prepared to take extra insulin to correct high blood sugars or clear ketones according to suggestions from the Diabetes Team.  Use the table below for helpful hints when feeling under the weather:

If you are able to eat:

	BG Testing	Ketone Testing	Food and Beverage	Novolog or Humalog	Lantus or Levemir	Follow- Up
Negative or Trace Ketones	Every 2 hours	Every trip to the bathroom	Usual meal with extra water or sugar free drinks	Dose per carbs and blood sugar as usual	Usual dose (never skip long-acting insulin)	Call Diabetes Phone Hour for routine adjustments
Small, Moderate or Large Ketones	Every hour	Every trip to the bathroom	Usual meal with extra water or sugar free drinks	Dose per carbs and blood sugar plus additional insulin if directed by Diabetes Team	Usual dose (never skip long-acting insulin)	Follow the directions of the Diabetes Team

If you are unable to eat:

	BG Testing	Ketone Testing	Food and Beverage	Novolog or Humalog	Lantus or Levemir	Follow- Up
Unable to Eat but Able to Drink with Negative or Trace Ketones	Every 2 hours	Every trip to the bathroom	Drink lots of fluids; if blood sugars are below 150, drink carb containing fluids	Correct high blood sugars only	Usual dose (never skip long-acting insulin)	Call Diabetes Phone Hour for routine adjustments or call the Diabetes Team if ketones become present
Unable to Eat but Able to Drink with Small, Moderate or Large Ketones	Every 2 hours	Every trip to the bathroom	Drink lots of fluids; the Diabetes Team may instruct you to drink fluids containing carbs	Correct high blood sugars only plus additional insulin if directed by Diabetes Team	Usual dose (never skip long-acting insulin)	Follow the directions of the Diabetes Team
Unable to Eat or Drink	Every hour	Every trip to the bathroom	Not applicable	Correct high blood sugars only plus additional insulin if directed by Diabetes Team	Usual dose (never skip long-acting insulin)	Follow the directions of the Diabetes Team; you may be instructed to go to the ER