Diabetes - when you are sick

  • Alternative Names
    • Sick-day management - diabetes; Diabetes - sick day management

  • What to Expect at Home
    • Waiting too long to get medical care when you are sick can lead to getting much sicker. When you have diabetes, a delay in getting care can be life threatening. Even a minor cold can make your diabetes harder to control. Uncontrolled diabetes can lead to more serious health problems.

      When you are sick, keep a close watch on diabetes warning signs. These are:

      • High blood sugar that will not come down with treatment
      • Nausea and vomiting
      • Low blood sugar that will not rise after you eat
      • Confusion or changes in how someone normally behaves

      If you have any of these warning signs and cannot treat them yourself, call your health care provider right away. Make sure your family members also know the warning signs.

  • Sick-day Plan
    • Check your blood sugar more often than usual (every 2 to 4 hours). Try to keep your blood sugar at less than 200 mg/dL (11.1 mmol/L). There may be times when you need to check your blood sugar every hour. Write down all your blood sugar levels, the time of each test, and the medicines you have taken.

      If you have type 1 diabetes, check your urine ketones every time you urinate.

      Eat small meals often. Even if you are not eating as much, your blood sugar can still get very high. If you use insulin, you may even need extra insulin injections.

      DO NOT do vigorous exercise when you are sick.

      If you take insulin, you should also have a glucagon emergency treatment kit prescribed by your doctor. Always have this kit available.

  • Drink Lots of Fluids
    • Drink plenty of sugar-free fluids to keep your body from getting dried out (dehydrated). Drink at least twelve 8-ounce (oz) cups (3 liters) of fluid a day.

      Fluids you can drink if you are dehydrated include:

      • Water
      • Club soda
      • Diet soda (caffeine-free)
      • Tomato juice
      • Chicken broth

      If your blood sugar is less than 100 mg/dL (5.5 mmol/L) or falling quickly, it is OK to drink fluids that have sugar in them. Try to check their effect on your blood sugar in the same way you check how other foods affect your blood sugar.

      Fluids you can drink if your blood sugar is low include:

      • Apple juice
      • Orange juice
      • Grapefruit juice
      • Gatorade or other sports drink
      • Tea with honey
      • Lemon-lime drinks
      • Ginger ale

      If you throw up, DO NOT drink or eat anything for 1 hour. Rest, but DO NOT lie flat. After 1 hour, take sips of soda, such as ginger ale, every 10 minutes. If vomiting persists call or see your provider.

  • Eating When you are Sick
    • When you have an upset stomach, try to eat small meals. Try carbohydrates, such as:

      • Bagels or bread
      • Cooked cereal
      • Mashed potatoes
      • Noodle or rice soup
      • Saltines
      • Gelatin (such as Jell-O)
      • Graham crackers

      Many foods have the right amount of carbohydrates (about 15 grams) for your sick-day diet. Remember, on sick days it is OK to eat some foods you might not normally eat, if you cannot eat your regular foods. Some foods to try are:

      • One half cup (125 milliliters, mL) apple juice
      • One half cup (125 mL) regular soft drink (non-diet, caffeine-free)
      • One Popsicle (1 stick)
      • Five Lifesavers candies
      • One slice of dry toast
      • One half cup (125 mL) cooked cereal
      • Six saltine crackers
      • One half cup (125 mL) frozen yogurt
      • One cup (250 mL) Gatorade or sports drink
      • One half cup (125 mL) regular ice cream (if you are not throwing up)
      • One quarter cup (62 mL) sherbet
      • One quarter cup (62 mL) regular pudding (if you are not throwing up)
      • One half cup (125 mL) regular gelatin (Jell-O)
      • One cup (250 mL) yogurt (not frozen), sugar-free or plain
      • Milkshake made with one half cup (125 mL) low-fat milk and one quarter cup (62 mL) ice cream mixed in a blender (if you are not throwing up)

      When you are sick, you should try to eat the same amount of carbohydrates that you normally do. If possible, follow your regular diet. If you are having a hard time swallowing, eat soft foods.

      If you have already taken your insulin and are sick to your stomach, drink enough liquids with the same amount of carbohydrates that you would normally eat. If you cannot keep food or liquids down, go to the emergency room for treatment. You will receive fluids through a tube in your blood vessel (intravenous).

      If you have a cold, talk with your doctor or diabetes nurse.

  • Diabetes Drugs
    • Most of the time, you should take all of your medicines as you usually do. DO NOT skip or double up on any medicine unless your provider tells you to.

      If you cannot eat your normal amount of carbohydrates, call your provider. You may need to make a change in your insulin dose or in the dose of your diabetes pills or other injections.

  • When to Call the Doctor
    • Call your provider if you have:

      • Blood sugar higher than 240 mg/dL (13.3 mmol/L) for more than 1 day
      • Moderate-to-large ketones with your urine tests
      • Vomiting or diarrhea for more than 4 hours
      • Any severe pain or chest pain
      • A fever of 100°F (37.7°C) or higher
      • Trouble moving your arms or legs
      • Vision, speech, or balance problems
      • Confusion or new memory problems

      If your provider does not call back right away, you may need to go to the emergency room. This is especially important if you are vomiting or have diarrhea for more than 4 hours.

  • References
    • Laufgraben M, Kaufman ST. Acute diabetic emergencies, glycemic control, and hypoglycemia. In: Parrillo JE, Dellinger RP, eds. Critical Care Medicine: Principles of Diagnosis and Management in the Adult. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 58.

      Standards of medical care in diabetes - 2016: summary of revisions. Diabetes Care. 2016;39:S4-S5. PMID: 26696680