If you have nausea, vomiting, fever, diarrhea, or any other symptoms of an infectious disease, you should immediately consult a doctor. Infectious disease and type 1 or type 2 diabetes are a killer combination. Why - we will explain in detail below in the article. Do not delay the time, call an ambulance or get to the hospital. In case of diabetes type 1 or 2, if there is an infection in the body, then it is very important to get qualified medical assistance quickly.
Do not hesitate to bother doctors, because if a vicious circle of dehydration arises due to an infectious disease in diabetes, then both you and doctors will not be bored.
Why infections for diabetics are especially dangerous
In diabetes type 1 or 2, infectious diseases cause dehydration, and it is deadly, many times more dangerous than for adults and children who do not have diabetes. Feel free to call an ambulance every time a diabetic patient has nausea, vomiting, fever or diarrhea. Why are infectious diseases in diabetes so dangerous? Because they cause dehydration. And why is dehydration deadly? Because dehydration and elevated blood sugar form a vicious circle. This quickly - within a few hours - can lead to kidney failure, coma, death or disability.
There is also a danger that after an infectious disease, if it is started to be treated late, the remaining beta cells of your pancreas will die. From this, the course of diabetes will worsen. In the worst case scenario, type 2 diabetes can turn into severe and incurable type 1 diabetes. Let's take a closer look at how infectious diseases affect blood sugar and how to properly treat them. After all, who warned, he is armed.
A good example from medical practice
To highlight the importance of quick access to an ambulance, Dr. Bernstein tells this story. One Saturday, at 4 pm, a diabetic woman called him, who was not his patient. Her doctor turned off the phone for the weekend and did not leave instructions on who to contact in difficult situations. She found Dr. Bernstein's phone number in the city directory.
The patient was alone at home with an infant, and she continuously vomited from 9 am. She asked - what to do? Dr. Bernstein said that she was probably so dehydrated that she would not be able to help herself, and therefore she urgently needed to be in the hospital in the emergency room. They will be able to compensate for the lack of fluid in the body with the help of intravenous drips. Having finished the conversation with her, Dr. Bernstein called the local hospital and warned that they need to wait for this patient and prepare to inject intravenously her liquid against dehydration.
The patient had enough strength to bring the baby to her grandmother, and then on her own to get to the hospital. 5 hours after that, Dr. Bernstein received a call from the emergency department. It turned out that the diabetic woman had to be admitted to the hospital “in full”, because they could not help her in the emergency room. Dehydration was so severe that the kidneys completely failed. It is good that the hospital had a dialysis unit, where she was miraculously dragged from the other world, otherwise she would have died. As a result, this patient spent 5 “not dull” days in the hospital, because she immediately underestimated the danger of her condition.
What is the vicious cycle of dehydration and high sugar
If you have vomiting or diarrhea, then you most likely have an infectious disease. The cause may still be poisoning with some poisons or heavy metals, but this is unlikely. Next, we will assume that the cause is an infection. Wherever there is an infection in the body - in the mouth, in the gastrointestinal tract, the finger is swollen or something else - the blood sugar is likely to go up. So, the starting point: the infection itself raises blood sugar.
As a result of vomiting and / or diarrhea, the body loses its water supply. The fluid content in the gastrointestinal tract falls below normal. The lost fluid must be urgently replaced, and for this the body uses water from the bloodstream. This does not mean that internal bleeding occurs in the stomach or intestines. It is just that cells absorb water from the blood into themselves, and give it back much less. But when this happens, the cells do not absorb additional glucose from the blood. As a result, water in the blood becomes less, and glucose remains the same. Thus, blood sugar rises even more. If vomiting or diarrhea occurs several times in a row, then due to high sugar and dehydration, the blood of a patient with diabetes becomes viscous, like sugar syrup.
The human body is permeated with a dense network of blood vessels. The farther away these vessels are from the center, the narrower they are. The most distant and narrow vessels are called “peripheral”, i.e. remote from the center. At any moment a lot of blood is in the peripheral vessels. Unfortunately, if the blood thickens, then it becomes harder to squeeze into the narrow peripheral vessels. As a result, peripheral tissues are worse supplied with oxygen and nutrients, including insulin and glucose. This is despite the fact that the concentration of glucose in the blood rises. In fact, due to the fact that glucose and insulin from the thick blood do not penetrate into the peripheral vessels, strong insulin resistance develops.
Peripheral tissues begin to absorb less glucose, because of which its concentration in the blood rises even more. The higher the blood sugar, the stronger the insulin resistance. And insulin resistance, in turn, increases blood sugar. Also, the kidneys are trying to remove excess glucose from the urine, which causes frequent urination, and this increases dehydration. This is one of the scenarios for the development of the vicious cycle of dehydration and high blood sugar, and another one is connected to this scenario, which we describe below.
Glucose and insulin from the blood do not reach the peripheral tissues. The cells have a difficult choice - to die of hunger or begin to digest fats. They all choose the second option in unison. However, in the process of fat metabolism inevitably, by-products appear, which are called ketones (ketone bodies). When the concentration of ketones in the blood rises dangerously, the urge to urinate is even stronger, and dehydration goes to a higher level. The double vicious circle ends with the patient losing consciousness, and his kidneys fail.
The main thing is that the events that we have described above can develop very quickly, as a result of coma and kidney failure occur within a few hours. The example of a diabetic woman that we gave at the beginning of this article is actually typical. For emergency doctors it is not unusual. Unfortunately, in such cases it is difficult for doctors to restore the patient’s normal vital activity. Mortality reaches 6-15%, and subsequent disability - even more often.
Severe dehydration is treated only in the hospital with the help of intravenous droppers. Putting these droppers start in the ambulance. But we can do a lot to prevent such an extreme development of events. Suppose you woke up in the middle of the night or early in the morning because you have vomiting or diarrhea. What should be done? First, if you have “your” doctor, then call him and let him know, even at 2 am. Vomiting or diarrhea in a diabetic patient is how serious an event that it is possible to break the propriety. Secondly, if there is an infection in the body, you may temporarily need insulin shots, even if you do not usually treat your type 2 diabetes with insulin.
Infectious diseases usually increase blood sugar in patients with diabetes. Even if you do not usually use insulin, when the body is fighting an infection, it is advisable to temporarily start to do it. The goal is to reduce the load on the beta cells of your pancreas that are still working and to keep them alive. Insulin shots also help keep blood sugar under control and thus prevent the development of a vicious cycle of dehydration and high sugar.
Beta cells of the pancreas massively die as a result of high blood sugar, this is called glucose toxicity. If during an infectious disease to prevent their death, then type 2 diabetes can turn into type 1 diabetes, or the course of type 1 diabetes will worsen. Therefore, all (!) Patients with diabetes need to master the technique of painless insulin injections and be ready to use it when you are being treated for infection.
We list the main causes of dehydration in diabetes:
- diarrhea or vomiting several times in a row at short intervals;
- very high blood sugar;
- high fever, a person sweats a lot;
- forgot to drink enough liquid in hot weather or during exercise;
- thirst center in the brain is affected by atherosclerosis - in elderly diabetics.
One of the main symptoms of the fact that blood sugar is very high is a strong thirst, along with frequent urination. In such a situation, problems arise, even if a person drinks water, because he loses electrolytes. However, there are simple measures that can be taken at home to prevent the development of a vicious cycle of dehydration and high blood sugar.
Acute complications of diabetes due to high sugar
Diabetic ketoacidosis and hyperosmolar coma are two acute conditions that can develop due to a combination of dehydration and high blood sugar.
Diabetic ketoacidosis occurs in people whose pancreas does not produce their own insulin. These are patients with type 1 diabetes as well as type 2 diabetes who have almost completely lost the activity of their beta cells. In order for diabetic ketoacidosis to occur, there must be a very low concentration of insulin in the blood serum plus insulin resistance due to high blood sugar and dehydration.
In such a situation, the uptake of glucose by cells, which usually stimulates insulin, stops. To survive, cells begin to digest fats. Fat metabolism by-products, ketones (ketone bodies), accumulate. One of the types of ketone bodies is acetone, a popular solvent and the main component of nail polish remover. Ketones can be detected in the urine using special test strips, as well as the smell of acetone in the exhaled air. Because of this smell of acetone, people who have lost consciousness because of diabetic ketoacidosis are often mistaken for drunkards who have become numb.
If ketone bodies accumulate in the blood in high concentrations, it is toxic to tissues. The kidneys try to rid the body of them by excreting them in the urine. Because of this dehydration is still increasing. Signs of diabetic ketoacidosis:
- test strips show that there are a lot of ketones in the urine;
- intense thirst;
- dry mouth;
- frequent urination;
- deep breathing difficulties;
- high blood sugar (usually higher than 19.5 mmol / l).
All these signs usually appear simultaneously. If ketones are found in the urine, but the blood sugar is normal - do not worry. Fat metabolism to form ketone bodies is a normal, healthy, natural process. In type 2 diabetes, we even specifically cause it with a low-carbohydrate diet, so that the patient burns his fat reserves and grows thin. There is no need to take emergency measures if the concentration of ketones in the urine is low or medium, while the blood sugar does not increase, the person drinks enough liquid and his health is normal.
Another acute condition that occurs due to dehydration and high blood sugar is hyperosmolar coma. This is a potentially more dangerous complication of diabetes than ketoacidosis. It happens to diabetics, whose pancreas still produces insulin, although not enough. “Hyperosmolar” means that the concentration of glucose, sodium and chlorides is increased in the blood, because of the dehydration there is not enough water to dissolve these substances. Patients who develop hyperosmolar coma usually maintain sufficient beta-cell activity so that the body does not begin to digest fats. But while insulin is not enough to keep blood sugar from a very strong recovery.
Hyperosmolar coma differs from ketoacidosis by the fact that ketone bodies are not detected in the urine of a diabetic or in the air exhaled by it. As a rule, it occurs in elderly patients with diabetes, whose thirst center in the brain is affected by age-related atherosclerosis. Such patients do not feel thirsty, so at the time of hospitalization they have dehydration even more than with diabetic ketoacidosis. The early symptoms of hyperosmolar coma are drowsiness, clouding of consciousness. If you do not take urgent measures, then the person will fall into a coma. Blood sugar in patients is usually higher than 22 mmol / l, but it can also be fantastically high. Cases of up to 83 mmol / l were noted.
Treatment of diabetic ketoacidosis and hyperosmolar coma - fluid replacement using intravenous droppers, as well as intravenous insulin. The activities are the same, but the recommended protocols for their conduct are slightly different. Read more about the treatment of diabetic ketoacidosis and the treatment of hyperosmolar coma. Termination of dehydration by fluid replacement lowers blood sugar by itself, regardless of intravenous insulin. Because the liquid dissolves sugar in the blood, and also allows the kidneys to remove excess glucose and ketone bodies in the urine.
Diabetic ketoacidosis and hyperosmolar coma occur with patients who are too lazy to properly manage their diabetes. The frequency of deaths is from 6 to 25%, depending on the age and how weak the diabetic's body is. If you study our site, then most likely you are a motivated patient and these complications are unlikely to threaten you, except during an infectious disease. Treatment of diabetic ketoacidosis and hyperosmolar coma is carried out only in a medical hospital. Our task is to carry out measures to prevent them, without taking matters to the extreme. This means to quickly consult a doctor at the first symptoms of infection, as well as take home measures to keep normal blood sugar and prevent dehydration.
Nausea, vomiting and diarrhea
Nausea, vomiting and diarrhea are most often caused by bacterial or viral infections. Sometimes they are accompanied by flu-like symptoms. If you have nausea, vomiting and / or diarrhea, then the main means is to stop eating. Moreover, there is usually no appetite in such situations. You will surely be able to survive a few days without food. At the same time it is necessary to continue to drink water and other liquids that do not contain carbohydrates. The question arises - how do the doses of insulin and diabetes pills change during fasting?
Patients who perform a type 1 diabetes treatment program or a type 2 diabetes treatment program use extended insulin only to maintain normal fasting blood sugar. We control sugar in the blood after eating with short or ultrashort insulin.When switching to fasting mode during the infection, fast insulin shots are canceled, which were before a meal, and extended insulin in the morning and / or evening continues as usual. It is assumed that you do not exceed the amount of prolonged insulin that is needed to keep normal sugar on an empty stomach. To do this, you need to calculate in advance its correct dosages according to the method described here.
With diabetes pills is the same. Pills that you take at night or in the morning to control sugar on an empty stomach - continue. Pills that are taken before a meal - temporarily cancel with a meal. Both tablets and insulin, which control fasting blood sugar, should continue to be taken in full doses. This will not allow blood sugar to “scale off” and develop diabetic ketoacidosis or hyperosmolar coma - deadly acute complications of diabetes. So, for patients who perform a type 1 diabetes treatment program or a type 2 diabetes treatment program, it is easy to correctly change their treatment regimen to the time of an infectious disease and fasting. Diabetics, who are treated by standard methods and splitting huge doses of insulin, have many problems.
Infection and dehydration are known to cause an increase in blood sugar. The danger of the development of a vicious cycle of dehydration and high sugar persists, despite starvation. If blood sugar rises, then it must be immediately restored to normal with the help of injections of fast insulin. This is the reason why we insist that all diabetics master the technique of painless insulin shots, even if under normal conditions they are not treated with insulin. During an infectious disease, temporary insulin shots are a useful and even vital measure.
Injections of insulin during infection can reduce the load on the beta cells of the pancreas and thus keep them alive. It depends on whether the course of diabetes worsens when you recover from an infection. If you have not prepared yourself temporarily injecting insulin while you are being treated for an infection, then immediately contact your doctor to draw up an insulin regimen and teach you to give yourself injections. If you ignore this measure, then there is a high probability that the course of diabetes will worsen, because the beta cells “burn out”. In the worst case, diabetic ketoacidosis or hyperosmolar coma may develop.
Briefly describe how to normal blood sugar with injections of fast insulin during infectious diseases. You need to measure your sugar with a glucometer in the morning after waking up, and then every 5 hours. Prick a sufficient dose of ultrashort or short insulin to bring the sugar back to normal if it is elevated. Measure blood sugar and, if necessary, inject fast insulin every 5 hours, even at night! To do this, set the alarm to wake up in the middle of the night, quickly complete all the activities and sleep further. If you are so weak that you are not able to measure your sugar and prick insulin, then you need someone else to do it. This could be your relative or medical professional.
What pills need to stop taking
Many popular drugs increase dehydration or even temporarily weaken kidney function. During infectious diseases in diabetes, their reception should be stopped, at least temporarily. The black list includes pressure pills - diuretic drugs, ACE inhibitors, angiotensin II receptor blockers. Also, do not take non-steroidal anti-inflammatory drugs - ibuprofen and others. In general, discuss all the medicines you take with the doctor who prescribed them.
How to control vomiting
In order to prevent dehydration, you need to drink liquid, including saline solutions. But if you have continuous vomiting, the fluid will not have time to digest. If vomiting stops after 1-2 episodes, then it is not so bad, but still notify your doctor. If vomiting continues, call an ambulance immediately to be hospitalized. Delay is deadly! At the hospital, experts will figure out how to stop vomiting, and most importantly - with the help of droppers, they will inject you with liquid and vital electrolytes. We absolutely do not recommend taking any antiemetic drugs at home.
When vomiting is stopped, you should immediately begin to drink liquid to replace the loss of water in the body and prevent dehydration. Drink all the time, but gradually, so as not to stretch the walls of the stomach and not to provoke repeated vomiting. It is desirable that the liquid had a temperature close to that of the body — so it will immediately be absorbed. What is the best liquid in this situation? How much to drink? The liquid suitable for you should meet three conditions:
- it should not be something that you do not like;
- only carbohydrate-free liquids are suitable, while no high-calorie sweeteners are allowed;
- the liquid must contain electrolytes — sodium, potassium, and chlorides — to compensate for their losses that occurred during episodes of vomiting or diarrhea.
You can drink herbal tea, plain or mineral water, and if it is time to start eating, then strong meat broth that does not contain carbohydrates. All these fluids can and are recommended to be “strengthened” with additional electrolytes. For each liter, add 0.5-1 teaspoon without a heap of table salt, and you can also ¼ teaspoon of potassium chloride. This is a salt substitute that is sold in a pharmacy. Table salt provides the body with sodium and chlorides, and potassium chloride - also with the valuable mineral potassium. If vomiting has stopped after 1-2 episodes, then the electrolytes to the liquid and you can not add. Do not use ready-made electrolyte powders if they contain glucose.
During fasting, daily fluid intake should be 48 ml per 1 kg of body weight. For a person weighing 62 kg, this is about 3 liters per day. For larger people, much more. If there is a loss of fluid and electrolytes due to diarrhea or vomiting, then an additional few liters should be drunk within 24 hours to replace these losses. In general, during infectious diseases in diabetes, you need to drink not just a lot, but a lot. If you could not or simply forgot to drink in time, you will have to enter the hospital with the help of intravenous droppers to cure dehydration.
If you or your diabetic child are hospitalized to treat dehydration with intravenous droppers, the following problem may occur. Medical staff will want to inject intravenously electrolyte solutions containing glucose, fructose, lactose, or some other sugar that is harmful in diabetes. Do not let them do this. Insist that doctors inject electrolyte solutions without glucose or other sugars. In case of anything, contact the administration, and also threaten to complain to the Ministry of Health. Intravenous administration of fluids and electrolytes is a very important, useful and vital measure ... but still for those who treat diabetes with a low-carbohydrate diet, it is desirable that the solution does not contain glucose or other sugars.
Diarrhea and how to treat it properly
First of all, we point out that diarrhea with blood and / or in combination with high temperature requires immediate medical attention. Trying to be treated at home is possible only if there is neither blood nor fever. Treatment consists of three components:
- blood sugar control;
- control of diarrhea to avoid further loss of fluid and electrolytes;
- replacement of already lost fluids and electrolytes to prevent the vicious cycle of dehydration and high blood sugar.
Blood sugar control is carried out in the same way as with vomiting, and we have already described it in detail above. With the replacement of fluid and electrolytes - the same thing, only with diarrhea, you can still add 1 teaspoon without a slide of soda for every liter of fluid. The main treatment for diarrhea, just like vomiting, is to stop eating. If you take any medication for diarrhea, then only those that are agreed with your doctor. Read “Medications for the treatment of diarrhea (diarrhea) for diabetes.”
If diarrhea is accompanied by fever or stools with blood, do not even think about taking any medication, but go to a doctor right away.
High fever causes severe dehydration because a person sweats profusely. The exact amount of these losses is difficult to estimate, so we just recommend drinking 1-2 liters of fluid per day more than usual. Increased body temperature helps to neutralize viruses or bacteria that cause an infectious disease. If at the same time a person sleeps more than usual, then this also speeds up recovery. But with diabetes, drowsiness can be dangerous, because it interferes with performing the necessary activities - every 5 hours to measure blood sugar, if necessary, make insulin injections, drink liquid, call up with a doctor. Set an alarm to wake up at least once every 5 hours.
We treat fever-reducing drugs with great care. Significant doses of aspirin or nonsteroidal anti-inflammatory drugs (ibuprofen and others) can cause severe hypoglycemia. It is especially undesirable to use drugs of these groups at high temperatures in children. Combining nonsteroidal anti-inflammatory drugs with dehydration can cause kidney failure. Non-steroidal anti-inflammatory tablets are categorically inappropriate for people with diabetic kidney damage.
At high temperatures, you need to control blood sugar and drink the liquid just as we described above in the sections on the treatment of vomiting and diarrhea. There is one nuance. When sweating electrolyte loss is very slight. Therefore, if there is no vomiting and / or diarrhea, then it is possible not to add salt solutions in liquids that the patient drinks. If you do not feel hunger, then do not eat. If you get hungry - maybe you will be enough ¼ or 1/2 of your normal portion of food. Colitis, respectively, 1/4 or ½ of your usual dose of fast insulin before meals.
Dehydration in diabetes: findings
Like hypoglycemia, dehydration can be life-threatening for a diabetic. Therefore, family members of a diabetic patient should carefully study this chapter. The stocks that are mentioned in the article “Diabetic First Aid Kit. What a person with diabetes needs to have at home and with them ”should be purchased in advance and be in a convenient and accessible place. Once again we urge all patients with type 2 diabetes to master the technique of painless insulin injections and to check how different doses of insulin act on you. This must be done in advance, even if you control your sugar well with diet, exercise and pills.
Call your doctor at the first sign of fever, vomiting, or diarrhea. The sooner a diabetic receives medical care, the more likely it is to prevent dehydration, diabetic ketoacidosis or a hyperosmolar coma. When dehydration has already developed, the treatment becomes very difficult. The doctor knows this well, so he will not mind if you disturb him once more and call him in advance.
The doctor will probably ask if there are ketones in the urine and, if so, in what concentration. Therefore, it is advisable to check the urine with the help of test strips for ketones before calling your doctor. If you do not eat anything, then surely the test strips will show that there are ketones in the urine in small or medium concentrations. If the ketones in the urine are combined with normal blood sugar, then there is nothing to worry about. Diabetic ketoacidosis should be treated only when blood sugar is raised to 10 mmol / l or more. If you took aspirin for 24 hours, you need to tell your doctor about it, because aspirin can cause fake positive results of detecting ketones in the urine.
Infections that do not cause dehydration
Many infections do not carry the threat of dehydration, but almost all of them increase blood sugar. Infectious diseases cause symptoms that are easily distinguishable. If you have a urinary tract infection, there will be a burning sensation during urination. Bronchitis is manifested by coughing, and so on. All these are clear signals from the body that immediate medical attention is required. Because if you have type 2 diabetes or type 1 diabetes in a mild form, then you probably don’t want your few remaining beta cells to die.
A typical scenario - a patient with type 2 diabetes feels that he has a urinary tract infection. But he postpones the visit to the urologist and is not treated. As a result, his blood sugar rises so much that the remaining beta cells “burn out”. After that, type 2 diabetes goes into type 1 diabetes, and now the patient will have to make 5 insulin shots every day for life. In the worst case, an urinary tract infection without careful treatment will also give kidney complications, and then a black box is just around the corner.
Often there are hidden infections that cause no symptoms other than inexplicably high blood sugar. If sugar stays high for several days and insulin acts worse than usual, then this is a reason to consult a doctor. In such situations, it most often turns out that the diabetic has deteriorated insulin due to improper storage or reuse of syringes, or an infection has developed in the oral cavity.
Prevention and treatment of dental problems
Infection in the oral cavity is the most frequent case of latent infection. Bacteria in the mouth infect the gums, root canals of the teeth and even the jaw bones. If diabetes is poorly controlled and blood sugar is elevated, this creates favorable conditions for bacteria in the mouth. And then, infections in the oral cavity increase blood sugar and lower the body's insulin sensitivity. This is another example of a vicious cycle.
So, if blood sugar stays inexplicably elevated for several days, then the first possible reason is insulin, especially because of the reuse of disposable syringes. If the insulin is exactly normal, then the diabetic needs to quickly go to the dentist. In search of the source of infection, the doctor will examine the gums, and also blow a stream of cold air on each tooth. If the pain shows that the tooth is sensitive to cold, then there is definitely an infection and inflammation in it. Then the dentist will cure a bad tooth by himself or send the patient to a gum specialist.
Keep in mind that dentistry in Russian-speaking countries - by world standards is very cheap and at the same time high-quality, almost better than in the West. Smart people from there travel here specifically to treat their teeth. Therefore, you and I are just ashamed to walk with rotten teeth. It is also assumed that the infection that lives in the mouth spreads through the blood vessels to the entire body and increases the risk of heart attack, destroying the walls of the vessels from the inside. This theory has not yet been definitively proven, but more and more experts are confirming it. Not to mention the fact that dental problems interfere with diabetes control.
Conclusion: find yourself a good dentist, and it is better to advance, slowly, while your teeth do not hurt. You need a dentist who:
- well owns the technique of his craft;
- uses quality materials for fillings;
- does not save painkillers;
- before prick painkiller in the gums, makes a test for allergies;
- has a kind nature by nature.
All people are advised to visit the dentist every 6 months prophylactically. In diabetes, it is advisable to do this every 3 months.During these visits, the plaque and the stone that had formed on them are removed from the teeth. This is the best way to prevent oral infections. You also need to brush your teeth twice a day, after breakfast and at night, and after each meal, use dental floss.