Managing Diabetes On Sick Days

When you have diabetes, it’s a little more difficult to manage an illness. Even something as simple as a cold can make your routine feel harder to follow. But when you know what to do when illness hits, you can stay safe, recover faster and avoid serious complications. Here’s what to keep in mind for your next sick day.

Key Takeaways: Diabetes Sick Days

• If you have diabetes, it’s important to monitor your glucose levels frequently during illness.
• Be aware of the signs and symptoms of diabetic ketoacidosis (DKA) and seek treatment if they occur.
• Work with your care provider to develop a customized sick-day treatment plan.

How Sickness Impacts Diabetes Management

If you have diabetes or have a loved one with diabetes, you know that sickness can make it more challenging to maintain target blood sugar (glucose) levels.

Illness causes the body to release stress hormones to fight the infection. These hormones can cause blood sugar levels to rise, which makes it difficult for those with diabetes to keep their blood sugar within target range.

At the same time, blood sugar levels can drop too low if symptoms like nausea, vomiting or loss of appetite disrupt normal eating routines.

As a result, people with type 1 diabetes or type 2 diabetes may experience unpredictable blood sugar levels during illness. If you have diabetes or care for someone who does, you should carefully monitor blood sugar levels while sickness symptoms persist.

“I encourage patients with diabetes to check their blood glucose levels every two to four hours while they’re under the weather,” said Adelina Priscu, MD, an Indianapolis endocrinology, diabetes and metabolism specialist with Franciscan Physician Network. “That way, they can stay on top of any fluctuations in their glucose levels and respond to them promptly with appropriate sick-day management strategies.”

What To Eat And Drink On Sick Days If You Have Diabetes

If you have diabetes and feel unwell, focus on gentle-to-digest foods and drinks that can help stabilize your blood sugar. Prioritize staying well-hydrated, but avoid caffeinated beverages, since those can promote dehydration.

If you aren’t able to eat full meals, the Centers for Disease Control recommends getting at least 50 grams of carbohydrates every four hours to keep your blood sugar levels from falling too low. That equates to roughly 1½ cups of unsweetened applesauce along with five ritz crackers every four hours.

Do enjoy:

• Water or other clear liquids, like ginger ale or herbal tea
• Low-sugar sports drinks or electrolyte replacement drinks
• Soups or broths
• Crackers or plain bread
• Unsweetened applesauce

Skip:

• High-sugar beverages
• Heavy, fatty foods
• Highly processed foods
• Caffeinated beverages

To help keep blood sugar levels within target range, the American Diabetes Association recommends following the 15-15 rule while sick. This approach suggests that you eat 15 grams of carbs, then check your blood sugar 15 minutes afterward.

Understanding Diabetic Ketoacidosis (DKA)

When your body doesn’t make enough insulin, cells can’t turn glucose (blood sugar) into energy. In response, your body will start to break down fat as fuel. This process can cause a harmful buildup of acids (ketones) in the blood. Dangerous levels of ketones can cause the blood to become acidic. This creates a life-threatening medical emergency known as diabetic ketoacidosis (DKA).

DKA most commonly affects people with type 1 diabetes. But the condition can occur in people with type 2 diabetes who have a severe illness or infection.

Signs of DKA

If you have diabetes, or are a caregiver for someone with diabetes, it’s important to know how to spot the signs of DKA. If you notice the following symptoms, seek medical attention promptly:

• Confusion
• Elevated blood glucose levels
• Excessive thirst
• Fatigue or weakness
• Frequent urination
• Fruity-smelling breath
• Nausea, vomiting and abdominal pain
• Seizures
• Shortness of breath or difficulty breathing

Most people recover fully from DKA with treatment. Typically, cases of DKA resolve following administration of IV fluids and insulin to restore hydration and regulate blood sugar levels. However, without proper treatment, DKA can lead to severe dehydration, loss of consciousness and even death.

Checking for ketones

To help monitor for DKA, test your urine for elevated levels of ketones when you feel sick. You can find over-the-counter ketone test strips at area pharmacies. The CDC recommends testing for ketones anytime you’re sick, especially if your blood sugar is 240 mg/dL or above. If your blood sugar remains elevated above 240 mg/dL, monitor your ketones every 4-6 hours.

Ketones can develop not only during DKA, but also during periods of poor appetite, reduced food intake, or starvation, when your body begins breaking down fat for energy instead of carbohydrates.

If you detect ketones in your urine, get in touch with your healthcare provider right away for guidance on how to manage them. In the meantime, stay well-hydrated, as drinking fluids helps flush ketones from your system and may prevent them from reaching dangerous levels.

If you can’t get in touch with your provider promptly, can’t keep fluids down or your ketone levels stay high, call 911 or go to the nearest emergency room for immediate medical treatment, since this can quickly develop into diabetic ketoacidosis (DKA).  

Self-Care Or Call A Doctor?

If you have diabetes and a mild or moderate sickness, you can generally manage your illness with self-care. Be sure to:

• Continue taking your basal insulin
• Monitor your temperature often

• Prioritize rest
• Take medications as directed by your provider
• Test blood glucose levels frequently
• Try to maintain normal eating and drinking routines
• Watch for signs of DKA

Ask your diabetes care team about how to adjust your insulin dose when you are sick. If you are unable to keep liquids or food down for more than 24 hours due to severe vomiting or diarrhea, call your provider for guidance. Also, call your provider if you have a temperature of 101°F or higher for 24 hours.

Call 911 or head to the emergency room immediately if you experience confusion, seizures, trouble breathing or shortness of breath.

Create a personalized sick day plan

Work with your provider to develop a sick day plan during a routine wellness visit. Ask about any changes you should make to your usual medications when you have an illness. Your doctor may recommend you take some medications as usual and adjust others.

“An individualized, sick care plan can help alleviate much of the anxiety that stems from managing illness alongside diabetes,” said Dr. Priscu. “If you create a comprehensive system for sick day management, you’ll feel equipped to handle most common illnesses successfully at home.”

Sick day management plans should include details such as:

• Monitoring guidelines: How often to check blood glucose and when to test for ketones
• Insulin or medication adjustments: Guidelines for changing doses based on blood sugar readings
• Carbohydrate targets: How many grams to consume and how frequently
• Fluid intake goals: Minimum amounts to drink hourly or daily
• Emergency contacts: When and how to reach your doctor — and when to go directly to the ER
• Over-the-counter medication guidance: Which cold and flu remedies are safe to use

If you prepare in advance for sick days, recognize the warning signs of DKA and know when to seek help, you can successfully navigate common illnesses and manage your diabetes effectively.

Franciscan Health’s diabetes care team is ready to work with you to ensure you feel confident to manage your condition every day — even when you’re under the weather.