When you are living with diabetes, sick days are more than not feeling well and taking it easy. Sick days mean closer monitoring of your condition as any illness whether it is the common cold, flu, COVID, stomach bug or other infections, can cause major swings in your blood sugar. When your body fights an infection, it releases stress hormones. These hormones can raise blood sugar even when you are eating less, increase insulin resistance, and can trigger ketone formation in type 1 diabetes and insulin dependent type 2 diabetes. Also of concern are episodes of vomiting, diarrhea and decreased appetite which can cause low blood sugar. This combination is often unpredictable, and having a sick day plan in place is important in managing your disease.
Your Sick Day Checklist
Monitor blood sugar more often
Blood sugar should be monitored every 2-4 hours to ensure blood sugars are within normal limits and to be proactive with treating blood sugar if it is not in range. If using a continuous glucose monitor (CGM), be sure you have alerts set and consider tighter monitoring during sick days.
Monitor ketones
For those on insulin, monitoring ketones is important when blood sugar is high; you are nauseous, vomiting, unusually tired or thirsty. High ketone levels can turn your blood acidic, leading to diabetic ketoacidosis (DKA), a serious condition that requires immediate medical attention. Monitoring ketones allows for early detection and prevention of this life-threatening condition, especially when blood sugar is consistently high above 240 mg/dL. High ketones may require additional insulin, fluids, or urgent medical care depending on severity.
Continue to take diabetes medications
When you are sick and eating less, it may seem like it is best to stop taking insulin, but usually insulin should be continued as your body is still managing the stress response. For non-insulin medications, some may need to be adjusted if you cannot eat or are dehydrated. You will want to follow your healthcare providers’ guidance for medication adjustments for sick days. Be sure to discuss with your provider the best plan for your medication and any adjustments during sick days.
Stay hydrated and consume carbohydrates
Being sick often leads to dehydration, which can make blood sugar worse. You will want to aim to stay hydrated by consuming plenty of fluids – water, broth, and sugar-free drinks. If you are unable to eat, be sure to consume carbohydrate-containing fluids such as juice, regular sports drinks, or even a small amount of regular soda. If you can eat, choose bland carbohydrate-rich foods that are easy to tolerate, such as toast, crackers, rice, soup, bananas, applesauce, and yogurt.
Get your rest but stay alert to any warning signs
Fatigue is normal when you are not feeling well but be alert to any warning signs that you may need medical attention: dehydration, persistent vomiting or diarrhea, not being able to keep down fluids, blood sugars consistently over 240mg/dl, presence of ketones, difficulty breathing, confusion or dizziness.
Have a sick day kit ready to go for any sick days
Prepare a sick day kit in advance so you have the supplies you need when you’re not feeling well. Your kit should include extra glucose and ketone strips, back up insulin and if on a pump, additional supplies. Add a thermometer to monitor your temperature, juice, glucose gel, electrolyte drinks, easy to eat foods (crackers, apple sauce, can fruit) and contact information for your healthcare provider.
When to call your healthcare provider
It is best to reach out to your healthcare provider anytime you are in doubt and need to discuss your plan. Important times to reach out would also include any episodes of vomiting or diarrhea lasting more than 6 hours, moderate to large ketone levels, fever lasting more than 24 hours, blood sugar levels >240mg/dl that will not come down, or you have signs of dehydration (dry mouth, decrease urine output or dark colored urine, dizziness). Early intervention with your healthcare team can prevent DKA or dangerously low blood sugar levels.
When you have diabetes, sick days can seem very overwhelming, so having a plan in place can help to keep things under control while you and your body are under stress. The key things to remember as part of your plan are frequent monitoring, staying hydrated, and knowing when to seek medical help.