Managing Diabetes if You’re Sick

Fighting an illness is never easy, but it can be even more difficult if you’re diabetic. When you’re sick, your body fights infection by releasing hormones…

Fighting an illness is never easy, but it can be even more difficult if you’re diabetic. When you’re sick, your body fights infection by releasing hormones that raise blood sugar levels and interfere with the effects of insulin.

It’s harder to manage your blood sugar levels and urine ketones if you have a fever or experience nausea, diarrhea or dehydration. If you don’t properly manage your glucose levels, you could end up in a diabetic coma.

People with Type 1 Diabetes may be at risk to develop ketoacidosis, while those with Type 2 Diabetes, especially older adults, may be more susceptible to a similar condition called hyperosmolar hyperglycemic nonketotic coma. Both of these conditions can be life-threatening. Don’t let a minor illness turn into a major one: develop a sick day action plan and stick to it when the time comes.

Be Prepared: Make a Sick Day Plan Before You’re Sick

The best way to fight an illness when you have diabetes is to be prepared with a plan. That way, when you become sick, you will know what to do and have what you need on hand to manage your symptoms. Be sure to consult your doctor, diabetes educator and dietician for their input, and have their phone numbers handy in case you need to reach them at night or during holidays and weekends.

Your sick day action plan should include instructions regarding

  • How often to measure your blood sugar
  • How often to measure your urine ketones
  • What you should eat and/or drink and when
  • What medicines you should (and shouldn’t) take
  • When you should call your doctor

Measuring Your Blood Sugar and Ketones

Your health care professional is the most informed person with respect to the proper testing regimen for you.  However, as a good rule of thumb, if you have Type 1 Diabetes and you’re ill, you should consider measuring your blood glucose and ketones approximately every four hours. For those with Type 2 Diabetes, you should check your glucose levels at least four times a day. If your blood sugar is higher than 300, it is important to monitor your ketone levels as well.

It’s important to measure your ketones because they are more likely to build up if you’re sick, especially if you have an upset stomach. Any time you have an upset stomach, you should check your ketones. If left unchecked, the accumulation of these waste products can lead to ketoacidosis.

You can check ketone levels with urine test strips or a blood test.  The blood test is better mode of testing because urine ketones will always lag behind blood ketone levels.

Be sure to keep a record of all your glucose and ketone levels, noting the time of day and how you were feeling or what symptoms you were experiencing at the time and advise your doctor of any changes.

What to Eat and Drink

Even though you may not feel like it, it’s important to stick to your normal meal plan when you’re sick. If you need to modify meals, eat foods that are easy on your stomach, such as soup, crackers, regular (non-diet) gelatin. Be sure to eat enough so you consume your normal number of daily calories.

It’s also important to stay hydrated because fluids help to eliminate the excess glucose in your blood. If you’re able to maintain your normal meal plan, you should drink a lot of non-caloric liquids such as water and diet soft drinks.

If you’re not able to keep food down, you should drink liquids containing carbohydrates – approximately 50 grams of carbs every 3 to 4 hours. This includes juice, regular (non-diet) soft drinks and broth. Other choices include semi-liquids such as frozen juice bars, sherbet, yogurt and pudding.

Medicines You Should (and Shouldn’t) Take

Whatever you do, do NOT stop taking your diabetes medicines when you’re sick. You need your insulin or diabetes medication to counteract the increased blood sugar your body makes when you’re sick.

If you have Type 1 Diabetes, you may need to increase your insulin. If you have Type 2 Diabetes, you might need to increase your medication strength or dosage or supplement with insulin. Check with your doctor and to determine what is best for you based on your symptoms.

Before you buy or take any over-the-counter (OTC) medicines, check the label to see if they contain sugar. Small doses containing sugar may be okay, but you may want to ask your pharmacist or physician if there are any sugar-free alternatives.

Be aware, some OTC and prescription medicines that don’t contain sugar can also affect your blood sugar. If taken in large doses, aspirin can lower blood glucose levels, as can some antibiotics for those who have Type 2 Diabetes and take diabetes medication. Certain cold products, such as decongestants, can raise your blood sugars.

If you have to see a doctor other than your own, be sure to mention your Diabetes and what medicines you’re taking.

Know When to Call Your Doctor

If you have diabetes and you’re sick, call your doctor if you experience any of the following:

  • You’ve had a fever for 2 days and aren’t getting better
  • You’ve been vomiting or had diarrhea for more than 6 hours
  • You have moderate to large amounts of ketones in your urine
  • You’ve increased your insulin but your blood sugar levels are still higher than 240
  • You take pills for your diabetes and your glucose level increases to more than 240 before meals and stays there for more than 24 hours
  • You have symptoms of 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’re not sure what to do to take care of yourself

Your doctor will want to know how long you’ve been sick, what medicines and dosages you’ve taken, if you’ve been eating and keeping food down, if you’ve lost weight and what your temperature, glucose and ketone levels are, so make sure you keep an accurate journal of all the details while you’re sick.