Diabetes: los días de enfermedad

Los días de enfermedad pueden hacer que los niveles de azúcar de los diabéticos se alteren. Te explicamos cómo evitarlo

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Las enfermedades pueden hacer que aumente mucho el nivel de glucosa en la sangre. La mejor manera de prevenir que una enfermedad leve se convierta en un gran problema es tener un plan de acción en caso de enfermedad. Así, cuando se enferme, se sentirá tranquilo y seguro. Ya sabrá qué hacer y tendrá a mano los recursos para hacerlo.

¿QUÉ DIFERENCIA HACE EL QUE YO TENGA DIABETES, CUANDO ESTOY ENFERMO?

Cuando usted tiene diabetes, el no sentirse bien afecta a su rutina de comidas, y la forma en que el azúcar en su sangre reacciona a su dosis usual de insulina o de la medicación oral para su diabetes.

Cuando se enferma, está sometido a estrés. Para lidiar con el estrés, el cuerpo libera hormonas que ayudan a combatir la enfermedad. Pero estas hormonas tienen efectos secundarios. Aumentan el nivel de glucosa en la sangre e interfieren con los efectos de la insulina para reducir el nivel de glucosa, por lo que  es más difícil mantener el nivel deseado de glucosa en la sangre.

La enfermedad puede incluir: un resfriado, gripe, vómitos, diarrea, dolor de garganta e infecciones tales como en los oídos, los dientes o la vejiga, o enfermedades más serias, tales como la neumonía o infecciones en los pies.

HAGA UN PLAN PARA LOS DÍAS DE ENFERMEDAD… ¿EN QUÉ CONSISTIRÍA?

Este plan debe incluir  con qué frecuencia debe medirse el nivel de glucosa en la sangre, qué medicamentos tomar y qué comer y  cuándo llamar a su médico/enfermero, en caso necesario.

Ingiera comidas pequeñas con frecuencia. Aun cuando no esté comiendo mucho, su nivel de azúcar en la sangre todavía puede llegar a estar muy alto. Si utiliza insulina, puede incluso necesitar inyecciones adicionales.

No haga ejercicio vigoroso cuando esté enfermo.

Si toma insulina, también debe tener un equipo para tratamiento de emergencia con glucagón recetado por el médico. Tenga siempre este equipo disponible.

 

REGLAS PARA DÍAS DE ENFERMEDAD

1.-Tome mucho líquido

Usted tiene que reponer los fluidos que ha perdido su cuerpo a causa de los azúcares elevados en su sangre, la fiebre, el vómito y la diarrea. Cuando usted está enfermo o no se siente bien, puede que beba menos que cuando se siente bien. Necesita ingerir líquidos para prevenir la deshidratación (pérdida de agua). Se recomienda que usted beba líquidos cada hora, mientras esté despierto. Todos los líquidos deben ser libres de cafeína porque la cafeína actúa como un diurético (elimina agua). Las bebidas que contienen cafeína ocasionarán que la deshidratación sea aún mayor. Lo que debe hacer es:

  • Coloque un vaso de 240mL al lado de su cama.
  • Cada hora, beba medio litro de alguna bebida que no contenga azúcar ni cafeína. Los mejores líquidos para beber cuando se encuentre enfermo son: el agua, refrescos que no contengan azúcar, té verde o té negro sin leche.
  • Cada tres horas: beba medio litro de caldo o bien sopas (para proveerle a su cuerpo sodio y otros minerales que éste necesita).
  • Si el azúcar en su sangre se encuentra bajo, puede que usted necesite beber líquidos que contengan carbohidratos o azúcar.

2.- Revise el azúcar de su sangre

Debe controlar el azúcar en la sangre con más frecuencia de lo normal (cada 2- 4 horas) y trate de mantenerlo en menos de 200 mg/dl. Puede haber períodos en que necesite mirarlo cada hora. Anote todos sus niveles, la hora de cada prueba y los medicamentos que ha tomado.

3- Nunca omita su inyección de insulina o sus medicamentos, cuando se encuentre enfermo

Cuando se enferma, debe seguir tomando sus medicamentos para la diabetes. No deje de tomar sus medicamentos, ni siquiera si está vomitando. Los necesita porque el cuerpo produce glucosa adicional cuando está enfermo.

4.- Revise su temperatura; la fiebre le puede causar deshidratación. 

El tener fiebre puede ser una señal de infección.

 fiebre

¿QUÉ ALIMENTOS PUEDE COMER CUANDO ESTÁ ENFERMO?

Cuando está enfermo, puede ser difícil comer y beber. Pero es importante seguir su plan regular de alimentación, de ser posible. Además de las comidas usuales, tome muchas bebidas sin calorías para evitar deshidratarse.

Cuando tenga malestar de estómago, trate de ingerir comidas pequeñas. Pruebe con estos hidratos de carbono:

  • Roscas de pan y panes
  • Cereal cocido
  • Puré de patata
  • Sopa de fideos o arroz
  • Galletas saladas
  • Gelatinas
  • Galletas integrales

Muchos alimentos tienen la cantidad correcta de hidratos de carbono (aproximadamente 15 gramos) para la dieta en sus días de enfermedad. Recuerde, en los días en que esté enfermo, está bien comer algunos alimentos que normalmente no podría comer. Algunos alimentos para probar son:

  • ½ taza de jugo de manzana
  • ½ taza de refresco (no dietético, descafeinado)
  • 1 rodaja de tostada seca
  • 6 galletas de sal
  • ½ taza de yogur helado
  • ½ taza de helado no dietético (si no está vomitando)
  • 1 taza de yogur (no helado), sin azúcar o natural
  • Malteada (½ taza de leche baja en grasa y ¼ de taza de helado mezcladas en la batidora) si usted no está vomitando

Cuando esté enfermo, debe tratar de comer la misma cantidad de hidratos de carbono que consume normalmente. Si es posible, siga con su alimentación habitual. Si está teniendo dificultad para deglutir, coma alimentos blandos.

Si ya tomó la insulina y tiene malestar de estómago, beba líquidos suficientes con la misma cantidad de hidratos de carbono que comería normalmente. Si no puede retener alimentos o líquidos, acuda a urgencias para recibir tratamiento.

CUÁNDO LLAMAR A SU EQUIPO DE CONTROL DE LA DIABETES

No es necesario que llame a su médico cada vez que se resfría. Pero debe llamarlo cuando suceden ciertas situaciones, por ejemplo:

  • Desde hace un par de días está enfermo o tiene fiebre y no está mejorando.
  • Desde hace más de seis horas está vomitando o tiene diarrea.
  • Tiene un nivel de glucosa de más de 240 a pesar de haber usado la insulina adicional que indica su plan para enfermedades.
  • Toma pastillas para la diabetes y su nivel de glucosa en la sangre sube a más de 240 antes de las comidas y se mantiene en ese nivel durante más de 24 horas.
  • Tiene síntomas de deshidratación (por ejemplo, le duele el pecho, tiene dificultad para respirar, el aliento le huele a fruta o tiene la lengua o los labios secos y partidos.

REGISTRO PARA DÍAS DE ENFERMEDAD

Lista de cotejo para usarla durante su enfermedad

Cuándo revisar Resultados

¿Cuál es el peso de hoy?

Todos los días ……….kg

¿Cuánto líquido tomó  hoy?

Todas las noches

……….vasos

¿Cuál es su temperatura? Todas las
mañanas y noches

……….ºC

¿Qué medicamento usó para la diabetes (insulina, antidiabéticos orales)?

Cada 4 horas

o antes de cada comida

Medicina/ hora/ dosis

¿Qué otro medicamento

tomó usted?

Medicina/ hora/ dosis

¿Cuál es su nivel de azúcar en la sangre?

Cada 2-4 horas

Hora/ Azúcar en la sangre

¿Cómo está respirando?

Cada 4-6 horas

Hora/Condición

Cualquier dolor de estómago, respiración acelerada, diarrea,
Vómito, aliento con olor a frutas.
Temperatura superior a 38ºC.
Todos los días o noches

Hora/Síntoma

María López Villar
Enfermera Residente, EFyC, Centro de Salud Arturo Eyries, Valladolid


REFERENCIAS:

American Diabetes Association. Standards of medical care in diabetes — 2014. Diabetes Care. 2014;37:S14-S80.

Revisado: abril 2016

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