Diabetes Sick Days: Steps to Take

When you have diabetes, sick days often means more than a runny nose and sneezing. An illness such as a cold or the flu, or any condition resulting in nausea, vomiting or diarrhea, may cause your blood glucose to increase. An infection also can raise blood glucose levels. Therefore, it is very important to test your blood glucose when you are sick. Here are some guidelines to follow when you are ill:

• Check your blood glucose every four hours.
• Test for ketones if your blood sugars are above 240mg/dl, or as directed by your health care provider. Ketones are a form of waste often produced in the bodies of people with type 1 diabetes when they are under stress (such as during an illness). Call your doctor if ketones are found in your urine. Depending on the degree of your illness, he or she may suggest that you go to the emergency room.
• Check your temperature regularly.
• Make sure you are drinking liquids if you are unable to keep down solid food. Drink one cup of liquid every hour while you are awake to prevent dehydration. If you are unable to hold down liquids, you may need to go to the emergency room or hospital.
• Do not stop taking your insulin, even if you are unable to eat solid foods. You may need to eat or drink something with sugar in some form so that your blood glucose doesn't drop too low. People with type 2 diabetes who are on oral medicines may need to stop taking their medicines when sick. Check with your doctor if you are unsure of what to do.
• If you need an over-the-counter medicine to control symptoms such as cough and nasal congestion, ask your doctor or pharmacist for a list of sugar-free products that are available.

Diabetes Sick Days: When Should I Call My Doctor?

Call your doctor if:

• Your blood glucose stays higher than 180 mg/dL or lower than 70 mg/dL.
• You are unable to keep liquids or solids down.
• You have a fever (temperature over 101 degrees F or 38.3 degrees C).
• You have diarrhea or are vomiting.

What Foods Should I Eat When I'm Sick?

If you are sick, you should eat or drink 45 to 50 grams of carbohydrate every three to four hours to maintain your nutrition needs, to avoid ketone development and to prevent hypoglycemia.

If you can't eat foods, you could try more easily tolerated foods, such as those listed below. Each of these items equal one carbohydrate choice.

• 1 cup clear soup
• 1/2 cup regular gelatin
• 1/2 cup regular soft drink, like 7-up or Sprite
• 1/2 Popsicle
• 1/2 cup unsweetened applesauce
• 1/3 cup apple juice
• 1/2 cup sports drink, like Gatorade

Calorie-free liquids you may drink during an illness include water and 1/2 cup of broth or bouillon.

Reviewed by Certified Diabetes Educators in the Department of Patient Education and Health Information and by physicians in the Department of Endocrinology at The Cleveland Clinic.