The information contained in the leaflets below are for adults only and does not apply to children with diabetes who should follow the guidance given by the paediatric hospital team looking after their care.

On behalf of your GP Surgery

k WHY IS THIS LEAFLET FOR YOU?

Everyone has days when they are not well. If you have diabetes, being unwell can affect your blood glucose control so it is important that you know how to manage this. This leaflet will give you essential information on:

• How illness affects your blood glucose levels• Looking after yourself• What to eat and drink• Managing your medication• When to seek help

LIFESTYLE

The content of this leaflet was generated independently by TREND-UK. Printing and distribution was funded by Napp. Napp have reviewed the content for factual accuracy only.

TYPE 2 DIABETES:WHAT TO DO WHEN YOU ARE ILL

UK/DIA - 18080(1)March 2020

Passing more urine than

usual

Symptoms of high blood glucose may include:

Thirst

Tiredness

k HOW DOES ILLNESS AFFECT YOUR BLOOD GLUCOSE LEVELS?

When you are ill, especially if you have an infection and high temperature, your body is less responsive to the insulin you produce naturally or may be injecting. Insulin is a hormone which controls your blood glucose. Being unwell therefore usually makes your blood glucose levels rise, even if you are eating less than usual.

� It is possible to manage your diabetes effectively during illness and keep your blood glucose levels in or near to target by following the simple advice given in this leaflet

2

k LOOKING AFTER YOURSELF

( Rest: avoid strenuous exercise

( Prevent dehydration by drinking plenty of sugar-free fluids. Sip gently throughout the day (at least 2 ½ to 3 ½ litres or 4 to 6 pints in 24 hours)

( Treat symptoms such as a high temperature or a cough with basic over-the-counter medicines such as painkillers and cough syrups. These do not have to be sugar-free varieties as they contain very little glucose and are taken in small quantities. Ask your pharmacist for advice

( Contact your GP if you think you have an infection as you may need antibiotics

( If you are able to monitor your blood glucose, check at least 4 times daily while you are unwell

( You may need to adjust your diabetes medication while you are ill

( Seek medical help if your readings remain higher than usual, you feel very unwell and you are not sure what to do

3

k WHAT CAN YOU EAT AND DRINK?

Your body uses a lot of energy when you are unwell, even if you are resting. Try to eat as normal but if you cannot manage your usual meals, replace these with light and easily digested foods such as soups and milky puddings. See the table below for a list of alternative food options. Each portion is equal to approximately 10 gram carbohydrate (e.g. an egg-size potato, a small slice of bread or a tablespoon of cooked rice or pasta):

Fruit juice 100 ml

Milk 200 ml

Plain vanilla ice-cream 1 large scoop

Tomato soup 200 gram (half a large tin)

Low fat yoghurt 150 gram (1 small pot)

2 Rich tea or malted milk biscuits

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k MANAGING YOUR DIABETES MEDICATION

If you take diabetes tablets or a non-insulin injection and feel unwell:

Continue to take your tablets even if you are not eating. However:

• If you are taking metformin or an SGLT2 inhibitor and you are vomiting or have diarrhoea, you should stop this medication immediately as you may be at risk of dehydration. You will need a check for ketones if you take an SGLT2 inhibitor until you have recovered.

• If you take a tablet which helps your body to produce more insulin, such as gliclazide, you may need to increase the dose or even need insulin injections for a short time while you are ill. You will need meal replacements if you are unable to eat normally

• Contact your GP if you feel like your symptoms are prolonged or getting worse and are able to check your blood glucose levels and find they are constantly higher than 15 mmol/L

• If you are injecting a non-insulin glucose-lowering medication and develop acute abdominal pain, nausea and vomiting, stop the injections immediately and seek urgent medical attention

If you take insulin:

• Monitor and record your blood glucose levels at least four times a day (at mealtimes even if you are not eating your usual meals, and at bedtime)

• If your blood glucose readings are higher than usual, you may need to increase your insulin dose (see table on page 6). Contact your GP or diabetes nurse if you are not sure how to do this

If your blood glucose levels are lower than usual (because you are eating less than usual) you may need to reduce your insulin or any tablet you are taking which helps your body produce more insulin.

5

k MANAGING YOUR INSULIN DOSES DURING ILLNESS

If your blood glucose is persistently greater than 11 mmol/L, you will need to increase your insulin dose

Blood glucose level Additional insulin

11.1 to 17 mmol/L Add 2 extra units to each dose

17.1 to 22 mmol/L Add 4 extra units to each dose

Over 22 mmol/L Add 6 extra units to each dose

If you are taking more than 50 units in total daily, you should double the adjustments. All adjustments are incremental and should be reduced gradually as the illness subsides. Contact your doctor, practice nurse or diabetes specialist nurse for advice if you feel unsure about adjusting your insulin doses.

If your blood glucose levels are dropping down to 4 mmol/L or less, reduce your insulin dose by 10% (i.e. if your dose is usually 20 units, reduce by 2 units, if it is usually 40 units, reduce by 4 units). Make sure you have suitable “hypo” treatments available such as dextrose tablets, glucojuice or jelly babies

6

k WHEN TO SEEK HELP

Call your GP or diabetes specialist nurse for immediate help:

� If you are pregnant

� If you have persistent vomiting and are unable to keep fluids down

� If you become drowsy and breathless

� If you have acute abdominal pain

� If your condition worsens despite following the advice given in this leaflet

If you need to go to hospital, remember to take a list of all your medications and insulin safety card (if injecting insulin) with you

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k BEING PREPARED:

� Make sure you always have plenty of tablets/insulin and monitoring equipment especially in winter time, when people around you are unwell or you are travelling and may become ill

� Keep a few simple medicines such as painkillers and cough syrup in a safe place in the house

� Discuss how to manage your diabetes when you are unwell with your practice nurse or doctor so you know what to do if you become ill and when to seek help

k USEFUL RESOURCES:

A number of useful leaflets are available on the TREND-UK website including information about low blood glucose (hypoglycaemia), driving and diabetes, Type 2 diabetes and steroid treatment, diabetes and travel, and Type 2 diabetes and diabetic ketoacidosis.

TREND-UK: www.trend-uk.orgDiabetes UK: www.diabetes.org.ukDiabetes UK: 0345 123 2399

TM TREND-UK Limited. Content to be reviewed March 2022

k WHY IS THIS LEAFLET FOR YOU?

You have been prescribed a treatment which may cause hypoglycaemia. This leaflet will give you essential information on:

• What is a “hypo”?• Symptoms• Who gets a hypo?• How do I treat my hypo?• How do I avoid a hypo?• Driving and hypos• What else do I need to know?

DIABETES: WHY DO I SOMETIMES FEEL SHAKY, DIZZY AND SWEATY?HYPOGLYCAEMIA EXPLAINED

LIFESTYLE

The leaflet was developed by TREND UK in collaboration with MSD. This leaflet was

initiated, funded and distributed by MSD.GB-DIA-00342 Date of preparation: May 2018Reviewed: January 2020

k WHAT IS A “HYPO”?

Glucose is a sugar carried in the bloodstream that your body uses for energy. If you have diabetes and take certain treatment, your blood glucose levels can sometimes become too low. This is called hypoglycaemia (or a “hypo”) and occurs when your blood glucose level drops below 4 mmol/L.

k SYMPTOMS

Early signs and symptoms of a hypo include:

Tingling of the lips

Hunger

Palpitations

Trembling and shaking.

Becomingpale

Sweating heavily

Feeling anxious

Symptoms may vary from person to person, but you will feel “different” very quickly.

If you miss these early signs, the symptoms may get worse and include:

� Slurring your words.

� Behaving oddly

� Being unusually aggressive or tearful.

� Having difficulty in concentrating.

If you do not treat your hypo at this stage, you may become unconscious.

2

k WHAT CAUSES HYPOS?

A number of situations can cause a hypo:

Drinking toomuch alcohol

or drinkingalcohol without

food

Too much insulin or too many diabetes tablets.

Delayed or missed meals

Eating less starchy foods than usual

Unplanned orstrenuous activity

Incorrect insulin injection technique

Sometimes there is no obvious cause, but treatment should always be carried out immediately, as advised.

k WHO GETS A HYPO?

• If you are injecting insulin or taking diabetes tablets that make your body produce more insulin, then you may be at risk of hypos.

• If you are not sure how your diabetes tablets work, discuss this with your local pharmacist.

3

k HOW TO TREAT HYPOS

As soon as you notice the symptoms of a hypo or if a blood glucose test shows that your level is too low (4 mmol/L or less), you should treat it immediately with something that will raise your blood glucose quickly. Suitable quick-acting glucose treatments to provide 15g to 20g carbohydrate are:

( 200ml (a small carton) of smooth orange juice

( 60 ml Glucojuice or Lift

( 5 glucotabs ( 6 dextrose tablets ( 5 jelly babies

� Be aware that some soft fizzy drinks which you may have used for hypo treatments in the past may now have a lower sugar content.

If you do not feel better after 10 to 15 minutes (or your blood glucose level is still less than 4 mmol/L) repeat ONE of these treatments.

When you start to feel better, and if you are not due to eat a meal, eat some starchy food, like 2 plain biscuits or a small banana.

If you are not able to treat your hypo yourself, but you are still conscious and able to swallow, someone can give you glucose gel if you have this available.

k HOW TO AVOID HYPOS

( Eat regularly and include a small portion of starchy carbohydrate at each meal, such as bread, rice or potatoes.

( You may need to eat more carbohydrate before and after physical activity. ( Keep to sensible alcohol limits and do not drink on an empty stomach. ( Take your medication at the recommended dose and times. ( If you are testing your blood glucose levels, and notice your readings are

regularly dropping, discuss this with your diabetes team as you may need a change in medication or your insulin regimen adjusted.

( Always carry glucose with you to treat hypos quickly.

� If you become unconscious, you will need immediate emergency treatment. Someone should dial 999 for an ambulance. You should be put on your side with your head tilted back. Glucose treatments should NOT be put in your mouth.

4

k DRIVING AND HYPOS

• Keep glucose treatments in the car within easy reach at all times• Check your blood glucose before driving and every 2 hours if it is a

long journey .• Your blood glucose level should be more than 5 mmol/L to drive.

If you have a hypo while driving, stop the car as soon as possible. Remove the keys to demonstrate you are not in charge of the car, and move into the passenger seat if safe to do so. Treat the hypo as advised.

You should not drive for at least 45 minutes after recovery because your response rates will be slower.

The DVLA has guidance in place for reporting episodes of hypoglycaemia. It is important you notify them in line with this guidance. The latest Medical Standards of Fitness to Drive can be found on the DVLA website. For a patient-information leaflet, see the TREND-UK website on the back page.

5

k REMEMBER:

� Having a hypo means that your blood glucose level is too low. � Act IMMEDIATELY by eating or drinking something that will raise your blood

glucose quickly. � Never ignore the warning signs. � Make sure other people know what to do when you are having a hypo. � Always carry glucose and diabetes identification.

Consequences of frequent hypos:

� You may feel more tired than usual for some time following a hypo. � You may not experience the usual warning symptoms. � You may be fearful and anxious about having further hypos. � It could affect your employment and ability to drive.

If you are concerned about anything within this leaflet please discuss thiswith your healthcare professional.

k USEFUL RESOURCES:

TREND-UK: www.trend-uk.orgDiabetes UK: www.diabetes.org.ukDiabetes UK: 0345 123 2399Driver and Vehicle Licensing Agency: www.gov.uk/diabetes-drivingDisclaimer: These links will take you to an external website for which MSD does not review or control the content.

LIFESTYLE

TM TREND-UK Limited. Content to be reviewed January 2022

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