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Type 2 Diabetes Sick Day Guidelines
These are guidelines to use when you have a minor illness, such as a cold, the flu, or an upset stomach. These guidelines may also be used if you are experiencing a lot of emotional stress or surgery. 1. Test and Record you blood sugar (glucose) every 4 hours.
2. Check and record your temperature every 4 hours.
a. If you have a fever (temperature greater than 99.5), drink some liquid at b. Even if you don’t have a fever, drink 4 oz. of sugar-free, caffeine-free 3. Call your doctor for any of the following: a. 2 Blood sugar levels in a row of greater than 300 mg/dl or lower than 60 b. Vomiting or diarrhea that lasts longer than 6 hours. c. High (101.5˚F) or rising fever or fever for more than 24 hours. d. Illness that lasts longer than 2 days. e. Extreme fatigue (tired), shortness of breath, dizziness or pain. Diet:

When you are ill, it is important to eat the same amount of carbohydrate that you
normally do. If possible, follow your regular diet. If you are having a hard time
swallowing, eat soft foods with the same carbohydrate content as your regular diet.
If you are sick to your stomach or vomiting, try to drink liquids that contain 15 grams of
carbohydrate every hour while awake (1 cup sports drink, ½ cup apple juice, ½ cup
regular soda [not diet], ½ cup gelatin, 1 popsicle). Taking a small sip every 10-15
minutes will help you keep the liquid down.
If your blood sugar is higher than 240 mg/dl, you need to drink sugar-free liquids. If
this does not help bring the blood sugar levels down, call your health care team for
further instructions.
Even after you start to feel better, you will still need to test your blood sugar every 4
hours until you are back to your usual pattern. You may want to keep eating soft foods
and/or liquid carbohydrates until your appetite is back to normal. If you’ve been very sick
to your stomach, start by having clear liquids (things you can see through such as broth,
tea, regular soft drinks, gelatin, apple or grape juice, sports drink, and popsicles, not sugar
free). When you can keep these down, move on to full liquids (orange or tomato juice, ice
cream, and soup), and then to soft foods (oatmeal, toast, plain cooked vegetables,
applesauce, rice, noodles, and crackers).
UMass Memorial Medical Center Diabetes Self Management Education Medications:
Never skip your insulin injection or diabetes medicine when you are sick! Many people
forget that their blood sugar levels go up when they are sick. You may need more
medicine or insulin when you are sick because illness makes your blood sugar rise. If
you are unsure if more medicine is needed, call your doctor for advice.
If you take Metformin for diabetes and are vomiting do not try to take your
Metformin until you can keep down food & liquids again. Get emergency medical assistance if you have any of these symptoms (lactic
acidosis): weakness, increasing sleepiness, slow heart rate, cold feeling, muscle
pain, shortness of breath, stomach pain, light-headed feeling, or fainting. Drinking 3 or more beers or alcoholic drinks in a day can increase your risk
for lactic acidosis.
If you are having surgery or a dye injected study check with your physician
about taking your Metformin and inform the person performing your study about your use of Metformin. If you think you may have vomited your pills, do not take any more pills and Sometimes, your doctor may want you to take insulin for a short period of time instead of pills until your blood sugar comes down and you start to feel better. If you need insulin, you will be taught how to take the insulin. The full dose of daily insulin is usually required. Take the usual dose of intermediate or long acting insulin (NPH, Lantus or If your blood sugar is high, you may need to take frequent doses of short- or
If your blood sugar is too low, you may need to not take your short- or rapid-
acting insulin until your blood sugars rise and you are able to hold down liquids and/or foods. If you have questions or are not sure about the right thing to do, call your doctor And remember: It is a good idea to talk to your doctor about sick day insulin instructions/guidelines before you are sick! UMass Memorial Medical Center Diabetes Self Management Education


CURRICULUM VITAE Paul H. Seigel, M.D., F.A.C.C. Date of Birth: Marital Status: Married PROFESSIONAL AFFILIATION: Baptist Hospital of Miami CURRENT LICENSE: EDUCATION: Medical College of Virginia State University of New York at Binghamton POST GRADUATE TRAINING: Fellowship in Cardiovascular Medicine College of Medicine and Dentistry of New

Frontier Research in Economics Instituto de An´alisis Econ ´omico, CSIC∗I am thankful to Xavier Calsamiglia, Itzahk Gilboa, Clara Ponsat and Debraj Ray for theircomments. I retain full responsibility for the opinions expressed here. This essay deals with trends in economic theory over the past few decades. It isunabashedly subjective and partial. It does not attempt to provide an exhaust

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