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Diabetes Positive Approach, Issue #1307-- Cope with Diabetes; Live Healthy
July 02, 2013

I have an idea, why don't we start a smile and praise club? And all that is required to be a member is to smile and compliment someone. Have a little experiment. Smile at someone and if he or she smiles back, you'll feel automatically better. I did it, smiled at someone and when he smiled back at me, I felt a thousand times better.

I must confess I have an ulterior motive for starting this club. I need a little boost because I don't much like the topic for this newsletter. It's all about cold, illness and flu. Remember? We are doing the diabetes tips alphabetically. We just did a series on Children and Diabetes. And now we will tackle all about cold, illness and flu.

In This Issue:

Cold and Flu and Diabetes

Cold and flu are what you want to avoid especially when you have diabetes as it can cause problems with the management of the blood sugar. Getting sick can raise the blood glucose level so talk to your doctor in advance and develop a plan for sick days. Those who have to be on insulin are already living on a tightrope because too much insulin and too little food can lead to low blood sugar and too much food in relation to the insulin dose can result in blood sugar that is abnormally high. This is their normal day. So what happens when cold and flu come into the picture?

Any sickness for a diabetic behaves like a storm. One has to make adjustment in all aspects of diabetes management like in food and drink intake, the medicine dosage and activity levels. Let me ask you this: How many diabetics know how to do self care to avoid going on a roller coaster ride with the blood sugar level? I know that is a tough question.

Here are some guidelines to follow when you are sick:

Keep your regular schedule of meals and drinks. Make sure you have enough non-perishable foods that are easy to prepare and drinks so you can avoid. dehydration. Drink a lot of clear fluids as dehydration may raise the blood sugar level to the stratosphere. Stay away from foods that are high in carbs as they may raise the blood sugar level but have enough sugar sources available to cope with low blood sugar like juice boxes and popsicles.

Test frequently in order to be aware of the dangerous lows and highs as early as possible. Test preferably every 3 - 4 hours. Knowing where the blood sugar is at, is crucial. While it's true that some illnesses are linked to low blood sugar, the truth of the matter is that the blood sugar tides can shift higher when one is sick even with no food intake.

Many make the mistake to test less often when in fact it is during these times when more liquids, more testing and for some perhaps even more insulin are needed. Testing less often could slow down the recovery and increase the risk of getting dehydrated and developing a treacherous metabolic state known as DKA or diabetic ketoacidosis.

Most people don't know the effect of ketones when they are sick. The by-product of the fat that breaks down in the body are called ketones. They will accumulate fast in the bloodstream with inadequate insulin and even with insulin, due to high level of stress hormones from being sick.

One concept that may not be fully understood is the effect of ketones during illness. This is where some make the mistake of taking lower dose of insulin thinking that less food consumption requires less insulin. It is a good thing ketones are acids that can be measured by a urine test known as ketostix. They can also be measured with the use of a meter that samples blood from a finger tip.

When ketones are activated by illness, they lead to nausea and vomiting which makes things worse. One could get severely dehydrated so get help and call the doctor urgently or go to the nearest emergency room facility if the blood sugar levels are staying over 300 mg/dl (16.67 mmol/l) or if you feel any signs of ketoacidosis which may include nausea and vomiting, excessive thirst and urinating often, feeling weak and unusually tired, pain in the abdominal region, and confused.

Rising blood sugar levels come before ketones become abnormally high so once the blood sugar goes higher than 300 mg/dl (some even say at 240/dl), check the urine for ketones and begin proper action right away. It can spell the difference between staying in the ICU or at home. Treatment of ketoacidosis is done in the hospital and usually includes replacement of electrolyte and fluid and insulin therapy.

Stock up the medicine supply and snacks. You should have supplies for testing ketone, medications for vomiting and diarrhea in addition to the glucose meter. Request the doctor to give you recommendations.

Ask the doctor when to call him. Find out at what point of the blood glucose reading should you call him or if you can't keep the food down due to vomiting and at what specific symptoms should you call him.

Take both oral medications and/or insulin regularly. Call the doctor if these are not lowering your glucose properly. The dosage may need to be adjusted anyway when you are sick.

2. Must-Reads from Around the Web

Flu Shot Cost High But Should the Diabetics Get It?

Diabetics Should Get Their Flu Shots and Get Rid of Stuffy Nose

When You’re Sick, Which is Better: Exercise or Rest?

Prepare Yourself for those Sick Days

3. Sick Days in Public Service in Canada Takes Centre Stage

Sick days are things the diabetics are aware of. The constant challenges they have to meet in order to manage their diabetes is quite known by all those concerned. And now, just when things seem to work out well for them due to regulations that help them with what they need, along came this furor. It was after all just the calm before the storm.

So I thought I'd write about this to let it be known that we have to guard against giving up what the diabetics have gained in terms of getting access to sick days when their blood sugar levels go on a roller coaster ride. For this is just not making excuses; this is very real and I challenge anyone who could do better than what the courageous diabetics are doing to survive every single day of their lives.

The federal government just announced it would overhaul the rules about sick days, whatever that means. They will also do so for the disability leave. Announcing the changes with few details while we are supposed to celebrate the national public service week is bizarre, to say the least. Instead of appreciating the important work the public employees do, they are accused of milking the system.

The union responded to the government’s proposal by saying not so fast. The statistics for one thing are problematic and there are no details in the announcement. Even Canada’s Public Service Alliance maintained that the current plan works. Besides, putting together both the paid and unpaid leave could be misleading for the latter are usually on long term disability that is paid for by private insurance companies.

One commented that those on long term disability were included in the statistics on absenteeism so naturally, the statistics will favor the government’s stand on overhauling the system. The trouble is, there were very few details in the announcement and so when they finally make the details, someone could be left in the dust. And it better not be the diabetics.

Besides, why change the plan that is working when the claim is that it costs the government a lot of money when the most of the workers who are out on sick days are not even replaced? The president of the Professional Institute of the Public Service of Canada, Gary Corbett, said the attitude of the government is making the public service morale to dip. This was shown by the union boycotting the public service week.

The proposal will not improve employee performance. Neither will it reduce absenteeism. What it will do is create a wedge between management and the employees. The employees feel targeted now.

When asked if the employees are going to lose the number of sick days they now have, Treasury Board President, Mr. Clement appears evasive and said he will be talking to the unions. Thank heavens for that. At least we will have the unions on our side. Mr. Clement added the active case management will follow-up the workers to make sure they are getting support and at the same time will be able to track the ones who may be cheating the system.

So I ask, who will be this active case management? Will they not cost as much as what they are trying to take away from the employees? And now they want a system to track those who may be abusing the system. This only makes me ask more questions. Who will be tracking the trackers? Are they going to remove the sick days that many employees now have and give the proceeds to another group? Is this a case of what they call robbing Peter to pay Paul, in this case people they will hire to track the system?

Besides, this is probably less than a tenth of 1% of the federal budget. Compare that to how much they are spending to eliminate these sick days and how much it will cost to hire the active case management to track this change, and the savings to the government will probably be a dollar.

Do these employees have to go to court so that the benefits will not be taken from under them? Will they follow what the doctors in New Brunswick did just so the government will honour what these doctors already got in their last negotiation? Well they did and they won. The whole thing just got played out in the headlines rousing up strong feelings that only distracted attention away from real problems of government excess and waste.

These employees should not be the first on the chopping block. Why not get rid of the senate who someone said if you know people in high places, you can get appointed, receive twice the salary for not working. Or cut down the size of the PMO, and go after the higher paid employees like the ministers and senators and eliminate some institutions. They say we could raise a billion dollars right there. Someone who really got mad about this said, he did not fail to notice that they announced this just before they go on their three-month vacation or six?

4. A Success Quotation of the Month

To all you guys and dolls, working hard to take care of yourselves, here is a quote: "You don’t have to be great to get started, but you have to get started to be great." Les Brown

5. And here's the dessert recipe we promised you.

Strawberries and Cream Cheese Crepes

6. Some Humour - Let's laugh together at this joke even if it's not funny. And we want to help the cells that kill tumor and disease in our body to do their job. Those hard working cells in our body like the T - cells and the Gamma-interferon will thank us for that help. Laughing can also reduce how many times we catch a cold - by immunoglobulon in saliva.

A Wheel Chair for a Discharged Patient

There are regulations in the hospital that a discharged patient should use a wheel chair. But a student nurse found an old man all dressed up sitting on a chair with a suitcase near him.

Student Nurse: Oh, you're ready, let me get the wheel chair.

Old Man: I don't need help to leave the hospital.

Student Nurse: Sir, there are rules we have to follow. (She left and got a wheel chair.

Old Man: Yes, but I'm telling you I don't need a ...

Student Nurse: Yes, you do. (She helped the man sit on the wheel chair.)

Old Man: You'll be sorry for this.

Student Nurse: You're going to sue me? Will your wife meet you?

Old Man: She's still upstairs in the bathroom.

Student Nurse: What is she doing there?

Old Man: Changing out of her hospital gown.

7. Do you have a question or comment for the team?

Drop us a line at our contact form and write your questions or comment there.

You may see your question answered in an upcoming issue of Diabetes Positive Approach like this one below.

7. What to Tell Your Doctor When You're Sick


Here's a perspective from a doctor. Sometimes we have the wrong notion that doctors don't want us to bother them with our questions. Let me give you an example of one who actually wants you to ask questions and he gives some sort of guide to set the stage for asking questions and getting answers.

He shared with us a professional secret among the doctors. He said they depend on us as much as we depend on them to get the best possible care. They love seeing smart patients with questions on new treatment. They are happy to get articles from the patients because you keep them on their toes and the informed consumer is healthier as a result.

He gives the following suggestions for our next doctor's visit:

Make a list of the reasons why you are visiting your doctor.

Write down all the details when describing your symptoms. How often do you feel the symptoms, when and where do you feel them? Is there something that makes them worse or better? Are there people at work and at home who have the same symptoms? Write down all the past and present conditions with the medications and dates.

When the doctor prescribes a test, ask why and what happens if you don't take the diagnostic test.

When you get the prescription, ask for clarification as to what the scribbles mean. Find out if there is a generic cheaper version that does a similar job. And finally ask if there is contraindication with the vitamins and supplements you take and food and drink you consume.

8. Got something to say? Please write down your questions and comments in the contact form in our website.

Just go to the contact form and write your questions there. Also go to the disclaimer.

Thank you for being a subscriber of Diabetes Positive Approach, !

Regarding our smile and praise club, I have to tell you that I smiled at someone and she didn't smile back. Did that make me feel bad? No, oh okay, a little bit but thinking that the poorest person in the planet is the one without a smile made me feel wealthy by giving her my smile.

The same thing happened when I complimented a mother with a baby, I could tell she instantly felt better. It is true that complimenting someone makes him feel better and when that happens, it is impossible not to feel better yourself. Wow, I must do more of these because I feel so much richer and happier doing this all week.

Warm Regards,

Roger and Evelyn Guzman

Did you like this newsletter? If so, please recommend it to your friends. If you have any questions or tips, please leave a comment at our contact form and write your questions or comment there. This newsletter is copyright 2013 Roger Guzman, M.D.

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Did you miss the following back issues of this newsletter? Here are two of them:
Diabetes Positive Approach Newsletter 805

Diabetes Positive Approach Newsletter 806

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