Sick Day Management for Patients with Diabetes
First, I would like to express my sincere condolences to those who lost their lives in the recent earthquake in Kumamoto Prefecture.
I also extend my heartfelt sympathies to all those affected, their families and friends, and everyone currently working hard on rescue and support activities.
I sincerely pray for the earliest possible recovery and reconstruction, and for everyone to be able to return to their daily lives with peace of mind.
During disasters, while attention is often focused on trauma and infectious diseases, it is also a situation that requires extreme caution for those with diabetes.
In evacuation life, meals and fluid intake can become irregular, and it may be impossible to use medication or insulin as usual. As a result, life-threatening conditions such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic syndrome (HHS) can occur.
In the event of a disaster, the basic rule is to follow the instructions of DiaMAT (Disaster Diabetes Medical Assistance Team), medical institutions, or your primary care physician. However, in a large-scale disaster, you may not always be able to consult a medical professional immediately.
Therefore, we have compiled "Sick Day Management" tips that we would like diabetes patients and their families to know.
The most important point to convey
Do not discontinue insulin on your own judgment.
In particular, basal insulin such as Tresiba®, Lantus®, and Insulin Glargine BS is essential not only for lowering blood sugar but also for preventing diabetic ketoacidosis (DKA).
"I'm not eating, so I won't inject" is extremely dangerous.
If your food intake decreases, you may need to adjust your insulin dosage, but please avoid stopping it completely on your own judgment.
In situations where you cannot consult a medical institution during a disaster, it is important to continue your basal insulin.
Sick day management during a disaster
1. For those using insulin
・Do not discontinue on your own judgment.
・Basal insulin is necessary even if your food intake is low.
・Confirm how to handle sick days with your attending physician in advance.
・Insulin is sensitive to high temperatures, so keep it out of direct sunlight and store it with ice packs or similar (avoid freezing).
2. SU drugs (Amaryl®, Euglucon®, etc.)
Hypoglycemia is more likely to occur when food intake decreases.
If you are unable to eat enough, you may need to temporarily stop or reduce your dosage.
3. SGLT2 inhibitors (Forxiga®, Jardiance®, Canaglu®, Suglat®, etc.)
If you are unable to consume enough fluids, or if you have a fever, diarrhea, or vomiting, consider temporarily stopping the medication.
There is an increased risk of dehydration and euglycemic diabetic ketoacidosis (euDKA).
4. GLP-1 receptor agonists / GIP/GLP-1 receptor agonists (Ozempic®, Victoza®, Mounjaro®, etc.)
If you experience severe nausea or loss of appetite and are unable to consume enough fluids or food, consider temporarily stopping the medication.
Especially for those using these for weight loss, do not force yourself to continue; consult your healthcare provider once your condition improves.
5. Be mindful of hydration
Dehydration worsens hyperglycemia.
If you are able to drink, try to consume fluids frequently, even in small amounts.
Seek medical attention as soon as possible if you experience the following symptoms:
・Repeated vomiting
・Unable to drink almost any fluids
・Persistent severe fatigue
・Feeling confused or disoriented
・Rapid or difficult breathing
・Persistently high blood glucose levels
Conclusion
Disasters can happen at any time.
Many medical professionals, including those from DiaMAT, are active in disaster-stricken areas. However, immediately after a disaster, medical support may not be readily available.
That is why it is important to know how to handle "sick days" in advance and to confirm your treatment plan with your doctor.
Even if diabetes is well-managed on a daily basis, it can change suddenly in the extraordinary circumstances of a disaster. On the other hand, there are many cases where serious complications can be prevented with the right knowledge.
I sincerely hope that this article will be useful to diabetes patients and their families affected by a disaster, and that as many people as possible will be able to safely overcome these difficulties.
*This article summarizes general information. Appropriate responses may vary depending on your medical condition and treatment plan. Please prioritize instructions from DiaMAT, medical institutions, or your primary care physician whenever possible.