Sick-Day Guidelines for People With Diabetes

What happens when you are sick

When you are sick, your body reacts by releasing hormones to fight infection. But these hormones raise blood sugar levels and at the same time make it more difficult for insulin to lower blood sugar. When you have diabetes, even a minor illness can lead to dangerously high blood sugar. This may cause life-threatening complications, such as diabetic ketoacidosis or a hyperosmolar state.

Plan ahead

Work with your doctor to make a sick-day plan for you or your child with diabetes. Discuss your target blood sugar goal during an illness, how you should adjust your insulin dose and timing (if you take insulin), and when you need to contact your doctor for help. Also, make sure you know how often to check blood sugar and urine ketone levels. Keep your plan in a convenient place, and include contact information in case you need to reach your doctor at night or on the weekends.

Steps to take during an illness

Here are some general sick-day guidelines:

• Continue taking your pills for diabetes (if you have type 2 diabetes) or insulin, even if you are vomiting and having trouble eating or drinking. Your blood sugar may continue to rise because of your illness. If you cannot take your medicines, call your doctor and discuss whether you need to adjust your insulin dose or other medicine.
• Try to eat your normal types and amounts of food and to drink extra fluids, such as water, broth, carbonated drinks, and fruit juice. Encourage your child to drink extra liquids to prevent dehydration.
  • If your blood sugar level is higher than 240 milligrams per deciliter (mg/dL), drink extra liquids that do not contain sugar, such as water or sugar-free cola.
  • If you cannot eat the foods in your regular diet, drink extra liquids that contain sugar and salt, such as soup, sports drinks, or milk. You may also try eating foods that are gentle on the stomach, such as crackers, gelatin, or applesauce. Try to eat or drink 50 grams (g) of carbohydrate every 3 to 4 hours. For example, 6 saltine crackers, 1 cup (8 fl oz) of milk, and ½ cup (4 fl oz) of orange juice each contain approximately 15 g of carbohydrate.
• Check your blood sugar at least every 3 to 4 hours, or more often if it is rising quickly, even through the night. If your blood sugar level rises above 240 mg/dL and your doctor has told you to take an extra insulin dose for high blood sugar levels, take the appropriate amount. If you take insulin and your doctor has not told you to take a specific amount of additional insulin, call him or her for advice.
• If you take insulin, do a urine test for ketones every 4 to 6 hours, especially if your blood sugar is higher than 300 mg/dL. Call your doctor if you have more than 2+ or moderate ketones in your urine. Check your child's urine for ketones at least every 6 hours, even through the night.
• Weigh yourself and check your temperature, breathing rate, and pulse frequently if your blood sugar is higher than 300 mg/dL. If you are losing weight and your temperature, breathing rate, and pulse are increasing, contact a doctor. You may be getting worse.
• Don't take any nonprescription medicines without talking with your doctor. Many nonprescription medicines affect your blood sugar level.

When to call your doctor

Minor illnesses in people with diabetes—especially children with type 1 diabetes—can lead to very high blood sugar levels and possible emergencies. When children are sick, watch them closely for signs that they need immediate medical attention. Call 911 or other emergency services if you or your child has:

• Symptoms of diabetic ketoacidosis (DKA), such as abdominal pain, vomiting, rapid breathing, fruity-smelling breath, or severe drowsiness.
• Symptoms of dehydration, such as a dry mouth and very yellow or dark urine. Dehydration is particularly dangerous in children and may be caused by vomiting and diarrhea.
• A low blood sugar level that continues.

It may not be necessary to call your doctor every time you or your child with diabetes has a mild illness, such as a cold. But it is a good idea to call for advice when you are sick and:

• Your blood sugar level is higher than 240 mg/dL after taking the adjusted amount of insulin in your sick-day plan.
• You take oral diabetes medicine and your blood sugar level is higher than 240 mg/dL before meals and stays high for more than 24 hours.
• You have more than 2+ or moderate ketones in your urine.
• You still have a fever and are not feeling better after a few days.
• You are vomiting or having diarrhea for more than 6 hours.

When you are sick, write down the medicine(s) you have been taking and whether you have changed the dosage of your diabetes medicines based on your sick-day plan. Also note changes in your body temperature, weight, blood sugar, and urine ketone levels. Have this information handy when you talk to your doctor.

Credits

By	Healthwise Staff
Primary Medical Reviewer	John Pope, MD - Pediatrics
Specialist Medical Reviewer	Stephen LaFranchi, MD - Pediatrics, Pediatric Endocrinology
Last Revised	December 7, 2010