Diabetic Sick Day Guidelines

October 20, 2009

By John Crowley, Caregiver Advocate

Managing blood sugars during an illness can be very challenging. Your body’s natural reaction to an illness is to release hormones that generally cause your blood sugar to rise. Additionally, your body can become more insulin resistant. Illness can easily lead to dangerously high blood sugars, which may lead to diabetic ketoacidosis or other life threatening complications.

These guidelines will provide general rules to follow. But it is essential that every diabetic make a specific plan with his or her doctor. Don’t be caught by surprise. Be prepared by discussing your sick day plan with your doctor.

Generally during an illness, your target blood sugar level and insulin dosage (if you take insulin) must be adjusted. It is best to have your specific plan written down and kept in a convenient place. Emergency phone numbers should be written on your sick day plan.

Here are the general guidelines for diabetic sick days.

1. Always take insulin or oral medications. Often extra insulin will be required to adjust for insulin resistance. However, if vomiting and diarrhea are present, less insulin may be needed.
2. Test your blood sugar at least every four hours (for type 1) and at least twice a day (for type 2).
3. If you can, continue to eat a normal amount of carbohydrate during the day. Liquid carbohydrates (such as sports drinks) may be substituted for solid foods.
4. If you cannot eat, try to consume at least 15 grams of carbohydrates via clear juice or soda every hour.
5. If your blood sugar is over 240 mg/dL, drink extra fluids that do not contain carbs, such as water or sugar-free soda.
6. If you take insulin, check for ketones every 4 to 6 hours particularly if your blood sugar is higher than 240 mg/dL. Call your doctor if you have greater than 2+ or moderate ketones in your urine.
7. Know the symptoms of diabetic ketoacidosis: such as abdominal pain, vomiting, rapid breathing, fruity-smelling breath, or severe drowsiness.
8. Know the symptoms of dehydration: dry mouth and very yellow or dark urine.
9. If you have symptoms of diabetic ketoacidosis or dehydration, or if you have blood sugars over 240 mg/dL for longer than 24 hours, or are experiencing low blood sugars that persist, call your doctor immediately.
10. Make sure you’re not alone when you’re sick. If you live alone, arrange to have a neighbor or friend stay with you or check on you frequently.

Food Ideas to Help on Sick Days:

Clear broth soups
Gatorade
Milk
Clear Fruit Juice
Soft Drinks (be sure to avoid caffeine)

Gelatin
Saltine or Club Crackers
Oatmeal
Graham Crackers
Popsicles
Applesauce

From	Comment
jayabee52	November 8, 2009 6:18 PM How does one go about checking one's ketones? I have no idea about how to do that.
Pam S	November 8, 2009 12:44 AM When I am ill, I have to check my sugars continuously. I am all over the chart. I've had some numbers that don't even register on my meter (only 2 times that happened). Good tips....thank you.
Becki Jayne	November 2, 2009 1:37 AM Many thanks John for the information. I was diagnosed back in April with an A1C of 14.0 and blood sugar levels of 428. I was suffering from kidney issues and dehydration along with the elevated blood sugar. It is so important that people with Diabetes know exactly how to handle illnesses and DM.
ronmcgraw	October 30, 2009 8:14 PM John I want to thank you for this info very much i live alone this is very helpfull.