Diabetes and Chikungunya: What you need to know
The recent chikungunya epidemic in the Caribbean has severely affected many persons with diabetes. With the severe pain and fever, persons may lose their appetite and have difficulty with many diabetes self-management tasks, such as taking medications and checking their blood sugars. This has resulted in many persons with diabetes having to be treated in the emergency room or being hospitalised for high or low blood sugar levels.
Hyperglycaemia (high blood sugars)
The stress of any illness in a patient with diabetes will increase their blood sugar levels. Hyperglycaemia can cause dehydration, affect electrolyte levels in the blood, produce drowsiness and make the patient more ill.
For patients with type 1 diabetes (where the body is not able to make any insulin), there is also the risk of ketoacidosis from the build-up of ketones, an acidic substance produced when the body is not able to use sugar for energy. Hyperglycaemia is made worse if the patients stops taking their medications or if they become dehydrated.
Hypoglycaemia (low blood sugars)
Several of the medications used to treat diabetes can result in hypoglycaemia, particularly when not eating. If unable to eat, it is important for the patient to have fluids that contain carbohydrates (sugar) to prevent hypoglycaemia.
It is also important to monitor blood sugar levels to be sure that the readings do not become too low.
Patients with diabetes, when ill with chikungunya or other illnesses, should not stop their diabetes medications, unless instructed to do so by their doctor. It is very important to be able to monitor blood sugar, as the choice of foods or drinks will depend on how high or low the blood sugar readings are.
If you have diabetes and are affected by chikungunya, here are some things you should remember to do:
n Let your doctor know that you are ill and when you do not feel well.
n Get plenty of rest.
n Do not stop taking your medications - especially your insulin - unless instructed to do so by your doctor.
n Check your blood sugar readings every four hours when ill.
n Check your blood sugar every two hours if the readings are above 10mmol/L (180mg/dl) or below 5mmol/L (90 mg/dl).
n Drink calorie- (sugar-) free drinks such as diet soda, broth (soup with no food) or eat carbohydrate- (starch-) free foods (such as sugar-free Jello) if your blood sugars are above 10mmol/L (180mg/dl).
n Drink small amounts of regular juice, oral rehydration fluids, sports drinks if you are unable to eat and your blood sugars are less than 10mmol/L (180mg/dl)
Go to hospital if you:
n cannot monitor your blood sugar at home
n have blood sugar higher than 15mmol/L (250mg/dl) that are not coming down
n have ketones in your blood or urine
n start vomiting and you are not able to keep anything down
n become short of breath or have difficulty breathing
n experience pain in the stomach
n become confused or
n cannot get to a health-care facility easily in case of an emergency
n The Caribbean Endocrine Society (CARES), founded in 2006, is a non-profit organisation that promotes the advancement and practise of disease of the endocrine system in the Caribbean. We can be contacted at firstname.lastname@example.org.