Managing Diabetes During Sick Days

WHAT YOU SHOULD KNOW:

When you have diabetes and you get sick, your body releases hormones that cause your blood sugar levels to rise. This may happen if you have a cold, the flu, surgery, an injury, or emotional stress. It may be harder for you to manage your blood sugar levels while you are sick. You will need to follow a special plan to manage your blood sugar levels. This plan is sometimes called a sick day plan. This plan will help you to manage your blood sugar levels and prevent dehydration (loss of too much body fluid) and other serious health conditions. Tell family or friends who help you when you are sick about your sick day plan. Put your sick day plan in a place that is easy for you or someone else to find.

AFTER YOU LEAVE:

Medicines:

• Keep using your diabetes medicine or insulin. Do not change your usual dose. Diabetes medicine and insulin are needed to lower your blood sugar levels. If you normally do not use insulin, you may need to use it while you are sick. If you already use insulin, you may need extra insulin while you are sick. Your primary healthcare provider will tell you if you need to make changes to how you use your diabetes medicine or insulin.
  
  
• Take your medicine as directed: Call your primary healthcare provider if you think your medicine is not working as expected. Tell him if you are allergic to any medicine. Keep a current list of the medicines, vitamins, and herbs you take. Include the amounts, and when, how, and why you take them. Take the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine lists.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

What to do during sick days:

• Check your blood sugar more often than usual. If you have type 2 diabetes, check your blood sugar levels at least 4 times each day. If you have type 1 diabetes, check your blood sugar every 4 hours.
  
  
• Check your urine or blood for ketones. Ask your primary healthcare provider which type of ketone testing is best for you. Ketone urine test kits are sold in pharmacies and some stores. You can also buy a meter to check the amount of ketones in your blood. To check for ketones, follow the instructions that come with the ketone test kit or meter. Ask when and how often to check ketones.
  
  
• Drink plenty of liquids. Drink 8 ounces (1 cup) of liquid each hour. Drink sugar-free liquids such as water, diet soda, or sugar-free powders mixed with water.
  
  
• Follow your usual meal plan as closely as possible. If you cannot follow your meal plan, eat other foods that are easy for your body to digest. If you are eating less food than normal or cannot eat any foods, drink liquids with calories in them.

What to drink and eat while you are sick:

It may be hard for you to follow your usual meal plan when you are sick. If you feel sick to your stomach or are throwing up, the following may be easier to drink and eat. Keep these items ready for sick days. Each of the items has about 10 to 15 grams of carbohydrate.

• Liquids:
  
  
  • 1/3 to 1/2 cup of fruit juice
    
    
  • 1/2 cup of regular soda
    
    
  • 1 cup of milk
    
    
  • 1 double-stick popsicle
    
    
  • 1 cup of a sports drink
  
  
• Foods:
  
  
  • 1/2 cup of regular gelatin or cooked, hot cereal
    
    
  • 1/2 cup of sugar-free pudding or 1/4 cup of regular pudding
    
    
  • 1/2 cup of mashed potatoes, macaroni, or noodles
    
    
  • 1/4 cup of sherbet
    
    
  • 1/2 cup of regular ice cream
    
    
  • 1 slice of dry toast, 6 saltine crackers, or 3 graham crackers

Risks of not having a sick day plan:

• High blood sugar levels can lead to a buildup of chemicals called ketones in the blood and urine. Ketone build-up leads to a serious condition called diabetic ketoacidosis (DKA). DKA may happen to people with type 1 or type 2 diabetes. If left untreated, DKA can lead to coma and death.
  
  
• High blood sugar levels can also lead to dehydration, and to a serious condition called hyperosmolar hyperglycemic state (HHS). HHS usually happens in older people with type 2 diabetes. However, it can happen in people of any age and in people with type 1 diabetes. HHS is also very serious and can cause other health problems and lead to death if left untreated.

Contact your primary healthcare provider if:

• You are throwing up frequently.
  
  
• You are having frequent diarrhea.
  
  
• You have a fever.
  
  
• Your ketone levels are higher than what your primary healthcare provider has told you they should be.
  
  
• Your blood sugar levels are higher than what caregivers have told you they should be.

Seek care immediately or call 911 if:

• You cannot keep food and liquids down at all for a few hours.
  
  
• You have trouble breathing.
  
  
• You have one or more of the following:
  
  
  • Drowsiness or confusion
    
    
  • Dry eyes or mouth
    
    
  • Irregular or fast breathing, fast or pounding heartbeat, and low blood pressure
    
    
  • Leg cramps
    
    
  • Weakness or dizziness

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Managing Diabetes During Sick Days (Discharge Care)