Diabetes management during sick days

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. Poorly managed 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:

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
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 Medications
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.