People with diabetes need a sick day management plan before they fall ill, write Esther Lau and Lisa Nissen

The 2018 flu season is on track to be one of the worst flu seasons in recent decades. People living with chronic conditions such as diabetes are at high risk of serious complications if they catch the flu – even if their diabetes is usually well managed.

Hence, people living with diabetes are eligible for the free influenza vaccine under the National Immunisation Program (NIP).

Currently, only pharmacists in Victoria can access the free vaccines under the NIP for eligible patients. While that is certainly another conversation for another time, NO – this is not a turf war, and it is not about the money. It is about public health outcomes, facilitating patient access to the flu vaccine, and increasing vaccination rates.

Statistics report that people with diabetes are three times more likely to be hospitalised by the flu, and three times more likely to die from the flu and its complications compared to other people. People with diabetes also have a higher risk of developing pneumococcal pneumonia because of the flu, so pneumococcal vaccination is also recommended.

In the instance that someone living with diabetes does fall ill with the flu, then a sick day management plan needs to kick in, and a visit to the GP is urgently required.

All people living with diabetes should be informed and involved with the development for a sick day management plan after they are initially diagnosed. This plan then needs to be tailored to individual patients, and reviewed at regular intervals (at least every year) because it is important for preventing:

  • hyperglycaemic and hypoglycaemic emergencies
  • hyperosmolar hyperglycemic state
  • diabetic ketoacidosis (uncommon)

Sick day management strategies differ for type 1 and type 2 diabetes, and depending on whether or not the individual living with type 2 diabetes is managed with insulin. According to the Australian Diabetes Educators Association’s “Clinical Guiding Principles For Sick Day Management Of Adults With Type 1 And Type 2 Diabetes” (https://www.adea.com.au/wp-content/uploads/2009/10/Clinical-Guiding-Principles-for-Sick-Day-Management-of-Adults-with-type-1-and-type-2-diabetes-Review-2016.docx.pdf), a sick day management plan should generally include:

  • Recommended frequency and amount of fluids to reduce the risk of dehydration and carbohydrate containing food and fluids to reduce risk of hypoglycaemia.
  • The frequency of blood glucose monitoring and, if appropriate, blood or urine ketone monitoring.
  • Diabetes medication dose adjustment
  • Recommended additional medication useful to address clinical symptoms of illness e.g. antiemetic and anti-diarrhoea agents.
  • Clinical criteria to trigger contact with the diabetes care team.
  • Name and phone number for contact with the diabetes health care provider/department including for times outside office hours, weekends and public holidays.
  • Medical facility to which to present if the sick day management plan is not effective or if the person’s condition further deteriorates or usual health care team is not contactable.
  • Regular checking of sick day management kit e.g. expiry dates of supplies.
  • A sick day management kit which is modifiable to other situations such as travel.

Consumer resources for sick day management of adults with diabetes are available here:- Type 1 diabetes https://www.adea.com.au/wp-content/uploads/2015/12/sick-day-booklet-type-1-single-page-final.pdf

Type 2 diabetes https://www.adea.com.au/wp-content/uploads/2015/12/sick-day-booklet-type-2-single-pages-final.pdf

Pharmacists are well placed to remind patients about getting their flu shot, and checking patients have an up-to-date sick day management plan, and to referring them back to their GP or diabetes educator if required.

Dr Esther Lau and Prof Lisa Nissen are from the School of Clinical Sciences, Queensland University of Technology.