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Managing Diabetes During Sick Days

What is sick day management?

Sick day management is a plan to control your blood sugar levels while you are sick. You develop this plan with your healthcare providers.

Why do I need a sick day plan?

Your blood sugar levels can increase because of stress from illness, surgery, or injury. Your plan will help prevent high blood sugar levels and other serious health conditions such as the following:

  • Diabetic ketoacidosis (DKA) is a medical condition that forces your body to use fat instead of sugar for fuel. DKA happens when your body does not have enough insulin and your blood sugar levels get very high. As fats are broken down, they leave chemicals called ketones that build up in your blood. Ketones are dangerous at high levels. DKA can lead to coma, and can be life-threatening if not treated.

  • Hyperosmolar hyperglycemic syndrome (HHS) is another medical condition that occurs when your blood sugar gets too high. Your body gets rid of the extra sugar through your urine. This leads to severe dehydration.

What steps should I follow during sick days?

  • Continue to take your medicines as directed. Your healthcare provider will tell you if you need to make any changes. 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 to increase the amount you take. Talk to your healthcare provider before you take any over-the-counter medicines.

  • Check your blood sugar level more often than usual. If you have type 2 diabetes, check at least 4 times each day. If you have type 1 diabetes, check every 4 hours.



  • Check your urine or blood for ketones. Ask your 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. Ask when and how often to check ketones. Do not exercise if you have ketones in your urine or blood.

  • Drink liquids as directed. You may need to drink about 8 ounces (1 cup) of liquid each hour. Drink liquids that do not contain sugar or caffeine. Ask your healthcare provider which liquids are best for you.

  • 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 that contain calories.

  • Tell others about your sick day plan. Tell others who help you while you are sick about your sick day plan. Put your plan in a place that is easy to find. Your sick day plan may change over time based on your needs.

Which foods should I eat?

If your stomach is upset or you are vomiting, the following may be easier to drink and eat. Each of the foods listed below has about 10 to 15 grams of carbohydrate.

  • Liquids:

    • ⅓ to ½ cup of fruit juice

    • ½ cup of regular soda

    • 1 cup of milk

    • 1 double-stick popsicle

    • 1 cup of a sports drink

  • Foods:

    • ½ cup of regular gelatin or cooked, hot cereal

    • ½ cup of sugar-free pudding or ¼ cup of regular pudding

    • ½ cup of mashed potatoes, macaroni, or noodles

    • ¼ cup of sherbet

    • ½ cup of regular ice cream

    • 1 slice of dry toast, 6 saltine crackers, or 3 graham crackers

Call 911 for any of the following:

  • You have trouble breathing.

When should I seek immediate care?

  • You cannot keep food and liquids down at all for a few hours.

  • You are drowsy or confused.

  • You are breathing faster than normal.

  • Your heartbeat is faster than normal, or your heart is pounding.

  • You are weak or dizzy.

When should I contact my healthcare provider?

  • You have leg cramps.

  • Your mouth or eyes are dry.

  • You are vomiting or have diarrhea.

  • You have a fever.

  • Your ketone level is higher than healthcare providers have told you it should be.

  • Your blood sugar level is higher than healthcare providers have told you it should be.

  • You have questions or concerns about your condition or care.

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. 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.

© 2015 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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