Diabetes & 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:

Let your doctor know that you are ill and when you do not feel well.

Get plenty of rest.

Do not stop taking your medications - especially your insulin - unless instructed to do so by your doctor.

Check your blood sugar readings every four hours when ill.

Check your blood sugar every two hours if the readings are above 10mmol/L (180mg/dl) or below 5mmol/L (90 mg/dl).

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).

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:

cannot monitor your blood sugar at home

have blood sugar higher than 15mmol/L (250mg/dl) that are not coming down

have ketones in your blood or urine

start vomiting and you are not able to keep anything down

become short of breath or have difficulty breathing

experience pain in the stomach

become confused or disoriented

cannot get to a health-care facility easily in case of an emergency

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 secretariat@caribbean-endo.org. Email yourhealth@gleanerjm.com.

Key facts about diabetes

World Diabetes Day is Friday, November 14, 2014.

347 million people worldwide have diabetes.

In 2012, an estimated 1.5 million deaths were directly caused by diabetes.

More than 80 per cent of diabetes deaths occur in low- and middle-income countries.

The World Health Organization projects that diabetes will be the seventh leading cause of death in 2030.

Healthy diet, regular physical activity, maintaining a normal body
weight and avoiding tobacco use can prevent or delay the onset of Type 2
diabetes.

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.

Diabetes increases the risk of heart disease and stroke. 50 per cent of
people with diabetes die of cardiovascular disease (primarily heart
disease and stroke).

Combined with reduced blood flow,
neuropathy (nerve damage) in the feet increases the chance of foot
ulcers, infection and eventual need for limb amputation.

Diabetic retinopathy is an important cause of blindness, and occurs as a
result of long-term accumulated damage to the small blood vessels in
the retina. One per cent of global blindness can be attributed to
diabetes.

Diabetes is among the leading causes of kidney failure.

The overall risk of dying among people with diabetes is at least double the risk of their peers without diabetes.

Early diagnosis can be accomplished through relatively inexpensive blood testing.

Treatment of diabetes involves lowering blood glucose and the levels of
other known risk factors that damage blood vessels. Tobacco use
cessation is also important to avoid complications.

Simple
lifestyle measures have been shown to be effective in preventing or
delaying the onset of type 2 diabetes. To help prevent type 2 diabetes
and its complications, people should:

❑ achieve and maintain healthy body weight;

❑
be physically active - at least 30 minutes of regular,
moderate-intensity activity on most days. More activity is required for
weight control;

❑ eat a healthy diet of between three and
five servings of fruit and vegetables a day and reduce sugar and
saturated fats intake;

❑ avoid tobacco use - smoking increases the risk of cardiovascular diseases.