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Sick Day Plan

Diabetes and Illness

Illness or injury can make managing your diabetes more difficult. When you are sick your body is in a state of stress and produces stress hormones. These hormones help your body fight the illness or injury, but they also cause your blood sugar to increase.

Your blood sugar can increase when you are sick even if you are unable to eat or drink. Untreated high blood sugar can lead to Diabetic Ketoacidosis (DKA) or Hyperosmolar Hyperglycemic Syndrome (HHS). DKA and HHS are health emergencies and require treatment in the hospital.

These problems can be avoided by having a sick day plan which you should develop with your doctor.

Illness and Blood Sugar Control

Just about any type of illness can make controlling your blood sugar more difficult including:

  • Colds
  • Stomach bugs that cause vomiting and diarrhea
  • Infections of the ear, sinuses, throat, teeth or bladder
  • Pneumonia
  • Infected sores including those on the feet

Sick Day Tips

  • Always take your long acting insulin.
  • Generally, you will need more insulin when you are sick. Your doctor will decide how much insulin you will need to take while sick or if you should continue your diabetes pills.
  • If you are taking a type of diabetic pill called an insulin secretagogue such as glyburide, glipizide, glimepiride replaglinide or nateglinide and are unable to keep food down-call your doctor to decide if you should take it.
  • Check your blood sugar every 2 to 4 hours.
  • Urine should be checked for ketones if your blood sugar is above 240 or you have been vomiting or having diarrhea.
  • Discuss with your doctor any other instructions that are specific to your condition.

Frequently Asked Questions

When should I call the doctor?

  • Call if you have been sick for 24 hours or more
  • Your temperature is greater than 101.5 degrees
  • You have been throwing up or had diarrhea for more than 6 hours
  • There are moderate to large amounts of ketones in your urine
  • Your blood sugar is greater than 240 or less than 70 for 2 checks in a row
  • You have symptoms of infection such as pain with urination or wounds with drainage
  • You are dehydrated
  • You have chest pain or abdominal pain
  • You have difficulty breathing
  • You have any question or are unsure what you should do

What should I eat and drink while I am sick?

When you are ill you may not be able to eat as you normally do because you are sick to your stomach and vomiting or because you don’t feel like eating. You might not have the energy to go shopping or to prepare food. You will probably be less active than you are when you feel good.

  • Drink at least 8 ounces of caffeine-free fluid every hour. Caffeine increases urination and can lead to further dehydration when you are already vomiting or have diarrhea.
  • Eat 50 grams of carbohydrate (3 carbohydrate servings) every 3 to 4 hours. Even if your blood sugar is high, it is important to continue to take in carbohydrates.
  • If you are vomiting, eat foods that are easy on the stomach like toast, crackers, broth and soups. Include fluids that have calories such as fruit juice, regular caffeine free soda, gelatin and popsicles.

What things do I need to have on hand to be prepared for a sick day?

  • Foods that are easy on the stomach such as applesauce, crackers, and soup
  • Liquids that provide calories such as juices, regular caffeine free soft drinks, reduced sugar sports drinks, regular gelatin and popsicles
  • Liquids that are calorie free such as water, diet sodas, sugar free gelatin, herbal teas
  • Thermometer
  • Diabetic medications and/or insulin
  • Glucose meter, glucose strips and supplies for checking your blood sugar
  • Ketone sticks (especially for type 1 diabetics)
  • List of emergency telephone numbers. If you live alone it is important that you let a friend know that you are sick.
  • Over the counter medicines such as Tylenol for fever and pain, Lomotil (generic: loperamide) for diarrhea, sugar free cough drops and syrups for cough and sore throat. You should discuss the use of over the counter medicines with your doctor before using them. Some over the counter medications can increase your blood sugar.

Should I exercise when I am sick?

  • You should not exercise when you are sick. Exercise during illness can increase your blood sugar and ketones.
In a medical emergency, call 911.