Managing Diabetes When You’re Sick

Knowing how to manage diabetes during periods of illness, especially during cold and flu season, is critical.

Diabetes can make the immune system less able to fight the flu increasing your risk of serious complications. Also, the flu can raise blood glucose levels. Illness is stressful to the body, and the stress hormones that are released when you’re sick cause the liver to produce more glucose, resulting in elevated blood sugar levels.

When you have diabetes, a delay in getting care can be life threatening. Even a minor cold can make your diabetes harder to control. That’s why it’s important to have a plan for those sick days.The first step is to talk with your health care team so they can individualize the plan for you. Make an appointment to see your healthcare provider before you get sick.

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When you talk with your health care provider write and personalize the following:

How often to check your blood glucose and urine ketone levels. When ill, you will need to check your blood glucose and urine ketones more frequently than you normally check. If you have type 1 diabetes monitor your blood glucose and urine ketones every four hours. If you have type 2 diabetes monitor your blood glucose levels four times a day and only measure urine ketone levels if your blood glucose levels go above 240.

Whether you should change your usual dose of diabetes medicines. Even if you’re unable to eat or keep food down your blood glucose will rise just because you’re sick. You might even have to take more insulin or diabetes medication than usual to control your blood glucose.

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What to eat and drink. To keep your blood glucose steady, you should aim to get about 50 grams of carbohydrate every 3 to 4 hours. Consider foods such as saltine crackers, dry toast, soup, broth or bouillon, frozen yogurt, regular ice cream, Jello, sherbet, and applesauce—the regular versions, not sugar-free. If you can’t hold food down drink clear liquids that contain sugar.

When to call your doctor. You should call your doctor when:

• You’ve been sick or had a fever for a couple of days without getting better.
• You’ve been vomiting or had diarrhea for longer than six hours.
• You have blood glucose higher than 240 after taking your extra insulin.
• You have blood glucose higher than 240 for more than 24 hours, though you’ve taken your oral diabetes medications.
• You have moderate to large amounts of ketones in your urine.
• You have any symptoms of diabetic ketoacidosis (DKA) or dehydration such as feeling sleepier than usual, having trouble breathing, fuzzy thinking, fruity odor on your breath, or dry tongue and lips.

Your sick day plan should also include important phone numbers so you can reach your healthcare team members quickly if illness strikes. Important phone numbers—daytime and after hours include doctor, diabetes educator, emergency room, pharmacy, family or friend.