Managing Diabetes During Sick Days

What is sick day management?

When you have diabetes and you get sick, your body releases hormones that cause your blood sugar levels to rise. Your blood sugar levels may rise when you have a cold or the flu. They may also rise because of other conditions such as surgery, injury, and 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 and it is developed by you and your caregiver. 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.

Why do I need a sick day plan?

• You may develop other serious health conditions if you do not take certain steps to control your blood sugar. Very high blood sugar levels that are not controlled can cause your body to produce chemicals called ketones. Ketones build up in your blood and urine, leading to a condition called diabetic ketoacidosis (DKA). If left untreated, DKA can lead to a coma and death. DKA may happen to people with type 1 or type 2 diabetes.
  
  
• Very high blood sugar levels can also lead to dehydration. Dehydration may lead to a condition called hyperosmolar hyperglycemic state (HHS). HHS is very serious and can cause other health problems and lead to death if it is not treated. 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.

What steps should I follow during sick days?

• Do not stop using your diabetes medicine or insulin or 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 caregiver will tell you if you need to make changes to how you use your diabetes medicine or insulin. Talk to your caregiver before you take any over-the-counter medicines.
  
  
• 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 caregiver 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 about 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 foods may be easier for me to tolerate while I am 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 are foods may be easier to eat. Keep these foods ready for sick days. Each of the foods listed below 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 one-quarter 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

What is my sick day plan?

Your sick day plan may change over time based on your needs. Tell family or friends who help you while 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.

When should I contact my caregiver?

Contact your caregiver if:

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

When should I seek immediate care?

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

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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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.

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