What to do when you are Sick and Have Diabetes

Adapted from the American Diabetes Website ADA.org

Being sick can make your blood glucose (sugar) level go up very high. It can also cause serious conditions that can put you in a coma. The best way to prevent a minor illness from becoming a major problem is to work out a plan of action for sick days ahead of time. Then when you become sick, you will feel safe and secure. You will already know what to do and you will have the supplies on hand to do it.

What Happens When You're Sick

When you're sick, you're under stress. To deal with this stress, your body releases hormones that help it fight disease. But these hormones have side effects. They raise blood sugar levels and interfere with the blood sugar-lowering effects of insulin.

As a result, when you are sick, it is harder to keep your blood sugar in your target range. Ketoacidosis (DKA) leading to a diabetic coma can develop, particularly in people with type 1 diabetes. People with type 2 diabetes, especially older people, can develop a similar condition called hyperosmolar hyperglycemic nonketotic coma. Both conditions are dangerous and can be life-threatening.

Making a Sick-Day Plan

Prepare a plan for sick days in advance. Work with your doctor, or a diabetes educator. The plan will include when to call your diabetes team, how often to measure blood sugar and urine ketones, what medicines to take, and how to eat. You can buy urine ketone test strips at any local pharmacy.

When to Call Your Diabetes Team

You do not need to call your team every time you have a sniffle. But you will probably want to call if certain things happen. For example:

  • you've been sick or have had a fever for a couple of days and aren't getting better
  • you've been vomiting or having diarrhea for more than 6 hours
  • your sugars are higher than 240 even though you've taken the extra insulin your sick-day plan calls for
  • you take pills for your diabetes and your blood sugar level climbs to more than 240 before meals and stays there for more than 24 hours
  • you have symptoms that might signal ketoacidosis or dehydration or some other serious condition (for example, your chest hurts, you are having trouble breathing, your breath smells fruity, or your lips or tongue are dry and cracked)
  • you aren't certain what to do to take care of yourself

Be ready to tell what medicines you've taken and how much, how long you've been sick, whether you can eat and keep food down, whether you've lost weight, and what your temperature and blood sugar level are. To be prepared, keep written records of all these things as soon as you become sick.

Diabetes Medicines

When sick, you will still need to continue medicine for your diabetes. Even if you are throwing up, don't stop your medicines. You need them because your body makes extra glucose (sugar) when you are sick.

If you have type 1 diabetes, you may have to take extra insulin to bring down the higher blood sugar levels. If you have type 2 diabetes, you may be able to take your pills, or you may need to use insulin for a short time. In either case, work with your diabetes team to develop your sick-day plan.

Food

Eating and drinking can be a big problem when you're sick. But it's important to stick to your normal meal plan if you can. In addition to your normal meals, drink lots of non-caloric liquids to keep from getting dehydrated. These are liquids like water and diet soft drinks. It's easy to run low on fluids when you are vomiting or have a fever or diarrhea. Extra fluids will also help get rid of the extra sugar (and possibly, ketones) in your blood.

But what if you can't stick to your normal meal plan? Your sick-day plan should contain a meal plan. Try to take in your normal number of calories by eating easy-on-the-stomach foods like regular (non-diet) gelatin, crackers, soups, and applesauce.

If even these mild foods are too hard to eat, you may have to stick to drinking liquids that contain carbohydrates. Aim for 50 grams of carbohydrate every three to four hours. Your sick-day plan may include regular (not diet) soft drinks. Other high-carbohydrate liquids and almost-liquids are juice, frozen juice bars, sherbet, pudding, creamed soups, and fruit-flavored yogurt. Broth is also a good choice.

To prepare for sick days, have on hand at home a small stock of non-diet soft drinks, broth, applesauce, and regular gelatin.

Medicines to Watch Out For

You may want to take extra medicines when you are sick. For example, if you have a cold, you may want to take a cough medicine. Always check the label of over-the-counter medicines before you buy them to see if they have sugar. Small doses of medicines with sugar are usually okay. But to be on the safe side, ask the pharmacist or your team about sugar-free medicines.

Many medicines you take for short-term illnesses can affect your blood sugar levels, even if they don't contain sugar. For example, aspirin in large doses can lower blood sugar levels. Some antibiotics lower blood sugar levels in people with type 2 diabetes who take diabetes pills. Decongestants and some products for treating colds raise blood sugar levels.

If you must go to the emergency room or see a different doctor than usual, be sure to say you have diabetes, or have your identification bracelet in plain view. BRING all the medicines that you are taking. BRING your glucose log as well.

Handy Sick-Day Snacks

These foods contain between 10 and 15 grams of carbohydrates.

Fluids
  • 1 double-stick popsicle
  • 1 cup Gatorade
  • 1 cup milk
  • 1 cup soup
  • 1/2 cup fruit juice
  • 1/2 cup regular soft drink (not diet)
Foods
  • 6 saltines
  • 5 vanilla wafers
  • 4 Lifesavers
  • 3 graham crackers
  • 1 slice dry toast (not light bread)
  • 1/2 cup cooked cereal
  • 1/3 cup frozen yogurt
  • 1/2 cup regular ice cream
  • 1/2 cup sugar-free pudding
  • 1/2 cup regular (not sugar-free) Jell-O
  • 1/2 cup custard
  • 1/2 cup mashed potatoes
  • 1/4 cup sherbet
  • 1/4 cup regular pudding

From "Diabetes Care When You're Sick," by Rachel Gifford, RN, MSN, CDE, and Belinda P. Childs, ARNP, MN, BC-ADM, CDE, Diabetes Forecast, February 2005, page 46