Sick Days

As a person with diabetes, you know how important it is to take good care of yourself. It may be harder to do when you're sick, but that's when you need to pay special attention to nutrition, medication and testing your blood and urine.

Whether it's a sore throat, the flu or surgery, illness puts your body under extra stress. To help you fight an illness, your body releases hormones that cause your liver to release glucose. As a result, your blood glucose rises, sometimes to dangerously high levels. This can lead to Diabetic Ketoacidosis (DKA) or Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) in people, especially seniors, with type 2 diabetes.

Avoid a risky situation. Make a sick-day plan and talk about it with your doctor before you become ill. Your plan should cover eating and drinking, taking medication and testing both blood glucose and ketones.

The Sick-Day Plan:

Testing

Check your blood glucose every four hours around the clock, especially before meals and at bedtime. Check your urine for ketones using strips. You can buy strips at the pharmacy. You may want to try Ketostix® Reagent Strips, which are for testing only ketones in your urine. If you don't have a meter, you can test your urine for both glucose and ketones using Keto-Diastix® Reagent Strips.

Continue testing your blood and urine as long as:

  • Your blood glucose is greater than 14 mmol/L.
  • Your ketone numbers are moderate to large.
  • You cannot follow your regular meal plan.
  • You are not feeling well.

If your ketones are moderate to large, you should contact your doctor or diabetes educator right away. See Ketone Testing section for more information.

For more information about testing, please see the Testing section.

Medication

Even if you are feeling sick, do not change your medication schedule. Continue taking your insulin and other prescribed medications as usual. Depending on how ill you are, and on your blood glucose and ketone values, you may need to take an extra dose of short*- or rapid-acting insulin every three to four hours. To find out how much to take, call your doctor or diabetes educator or use the extra-dosage scale given to you by your doctor or diabetes educator.

Liquids

Drinking enough fluids is extremely important, since dehydration can make your illness worse. You are at risk of becoming dehydrated if you are:

  • Losing fluids due to diarrhea, fever or vomiting.
  • Drinking less than usual.
  • Urinating more than usual.

As a general rule, drink eight ounces of liquid every hour while you're ill, and avoid drinks that contain caffeine.

Your choice of liquids should be guided by your blood glucose. If your blood glucose is over 14 mmol/L, drink calorie-free liquids such as:

  • Water
  • Broth
  • Sugar-free, caffeine-free soft drink

If you have low blood glucose, drink:

  • Regular soda
  • Milk
  • Fruit juices

Food

You may not be able to eat according to your usual meal plan while you're ill, but it's important to eat carbohydrates regularly to keep your blood glucose from going too low. If you are unable to eat solid foods, you should try to consume 10-15 grams of carbohydrate in liquid from every hour.

Blood Glucose Level Amount of Carbohydrate and When
Less than 10 mmol/L 15 grams/hour
From 10 to 14 mmol/L 15 grams at meal, or within one hour
More than 14 mmol/L 8 ounces calorie-free liquid/hour plus at least 150 grams of carbohydrate per day to prevent starvation

Examples of liquids that contain 15 grams of carbohydrate:

  • 500 mL (2 cups) chicken soup
  • 250 mL (1 cup) cream soup, made with water
  • 125 mL (1/2 cup) cooked cereal
  • 125 mL (1/2 cup) vanilla ice cream
  • 125 mL (1/2 cup) regular Jell-O®
  • 125 mL (1/2 cup) ginger ale (not diet)
  • 75 mL (1/3 cup) grape juice
  • 125 mL (1/2 cup) apple juice
  • 200 mL (3/4 cup) orange juice
  • 200 mL (3/4 cup) regular soft drinks (not cola as it contains caffeine)
  • 125 mL (1/2 cup) cranberry juice

Call Your Doctor or Health Care Professional When:

  • You've been vomiting or had diarrhea for more than six hours.
  • You've been unable to eat or drink for more than four hours.
  • Your illness has not improved after two days.
  • You've had high blood glucose for longer than 24 to 48 hours, with or without urine ketones.
  • You've taken extra short*- or rapid-acting insulin as suggested by your doctor.
  • You're not sure what to do.
  • You have any of the following signs of ketoacidosis:
    • Stomach pain
    • Nausea or vomiting
    • Rapid breathing or heart beat
    • Fruity-smelling "ketone breath"
    • Thirst and frequent urination
    • Weakness or tiredness
    • Visual disturbances
    • Sleepiness, difficulty staying awake
    • Cracked lips or dry mouth (signs of dehydration)

Be Prepared!

Create a special box that contains the following items. Keep it somewhere handy and out of the reach of your children. Note any expiry dates on your household calendar, so you can replace items when they become outdated. When you are ill, tell a family member or friend, so that someone can check on you every four to six hours.

  • Blood glucose and ketone strips (Check expiration dates!).
  • Lancets.
  • Record book and pen for test results.
  • Information from your doctor, diabetes educator or pharmacist showing dosage adjustment for insulin and oral diabetes medication according to blood glucose and ketone values.
  • Over-the-counter medications for sore throat, cough, nasal congestion, fever, headache, upset stomach, diarrhea and vomiting, as recommended by your doctor or pharmacist.
  • Liquids with and without calories.
  • List of 15-gram carbohydrate foods and fluids that are usually on-hand (Talk about them with your dietitian).
  • Thermometer.
  • Important telephone numbers (e.g., family members, doctor, diabetes educator, taxi, hospital emergency room, etc.).
  • Money for taxi fares.

*Short-acting insulin is referred to as Fast-Acting in the 2003 CDA Guidelines.