Sick-day management - diabetes; Diabetes - sick day management; Insulin resistance - sick day management; Ketoacidosis - sick day management; Hyperglycemic hyperosmolar syndrome - sick day management
Waiting too long to get medical care when you are sick can lead to getting much sicker. When you have diabetes, a delay in getting care can be life threatening. Even a minor cold can make your diabetes harder to control. Uncontrolled diabetes can lead to more serious health problems.
When you are sick, insulin does not work as well in your cells and your blood sugar level can be higher. This can happen even if you are taking the normal doses of your medicines, including insulin.
When you are sick, keep a close watch on diabetes warning signs. These are:
If you have any of these warning signs and cannot treat them yourself, call your health care provider right away. Make sure your family members also know the warning signs.
Check your blood sugar more often than usual (every 2 to 4 hours). Try to keep your blood sugar at less than 200 mg/dL (11.1 mmol/L). There may be times when you need to check your blood sugar every hour. Write down all your blood sugar levels, the time of each test, and the medicines you have taken.
If you have type 1 diabetes, check your urine ketones every time you urinate.
Eat small meals often. Even if you are not eating as much, your blood sugar can still get very high. If you use insulin, you may even need extra insulin injections or higher doses.
Do not do vigorous exercise when you are sick.
If you take insulin, you should also have a glucagon emergency treatment kit prescribed by your doctor. Always have this kit available.
Drink plenty of sugar-free fluids to keep your body from getting dried out (dehydrated). Drink at least twelve 8-ounce (oz) cups (3 liters) of fluid a day.
Feeling sick often makes you not want to eat or drink, which, surprisingly, can lead to a higher blood sugar.
Fluids you can drink if you are dehydrated include:
If your blood sugar is less than 100 mg/dL (5.5 mmol/L) or falling quickly, it is OK to drink fluids that have sugar in them. Try to check their effect on your blood sugar in the same way you check how other foods affect your blood sugar.
Fluids you can drink if your blood sugar is low include:
If you throw up, do not drink or eat anything for 1 hour. Rest, but do not lie flat. After 1 hour, take sips of soda, such as ginger ale, every 10 minutes. If vomiting persists call or see your provider.
When you have an upset stomach, try to eat small meals. Try carbohydrates, such as:
Many foods have the right amount of carbohydrates (about 15 grams) for your sick-day diet. Remember, on sick days it is OK to eat some foods you might not normally eat, if you cannot eat your regular foods. Some foods to try are:
When you are sick, you should try to eat the same amount of carbohydrates that you normally do. If possible, follow your regular diet. If you are having a hard time swallowing, eat soft foods.
If you have already taken your insulin and are sick to your stomach, drink enough liquids with the same amount of carbohydrates that you would normally eat. If you cannot keep food or liquids down, go to the emergency room for treatment. You will receive intravenous (IV) fluids.
If you have a cold or fever, talk with your provider.
Most of the time, you should take all of your medicines as you usually do. Do not skip or double up on any medicine unless your provider tells you to.
If you cannot eat your normal amount of carbohydrates, call your provider. You may need to make a change in your insulin dose or in the dose of your diabetes pills or other injections. You may also need to do this if your illness is making your blood sugar higher than normal.
Being sick increases the risk of more serious emergencies seen with diabetes.
Call your provider if you have:
If your provider does not call back right away, you may need to go to the emergency room. This is particularly important if you are vomiting or have diarrhea for more than 4 hours.
American Diabetes Association. 4. Comprehensive medical evaluation and assessment of comorbidities: standards of medical care in diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S37-S47. PMID: 31862747 pubmed.ncbi.nlm.nih.gov/31862747/.
Atkinson MA, Mcgill DE, Dassau E, Laffel L. Type 1 diabetes mellitus. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ , eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 36.
Centers for Disease Control and Prevention website. Diabetes: managing sick days. www.cdc.gov/diabetes/managing/flu-sick-days.html. Updated March 31, 2020. Accessed July 9, 2020.BACK TO TOP
Review Date: 5/13/2020
Reviewed By: Brent Wisse, MD, board certified in Metabolism/Endocrinology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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