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Diabetes - when you are sick

Waiting too long to get medical care when you are sick can lead to getting much sicker. When you have diabetes, a delay in getting care can be life threatening. Even a minor cold can make your diabetes harder to control. Uncontrolled diabetes can lead to more serious health problems.

When you are sick, keep a close watch on diabetes warning signs. These are:

  • High blood sugar that will not come down with treatment
  • Nausea
  • Vomiting
  • Low blood sugar that will not rise after you eat

If you have any of these warning signs and cannot treat them yourself, call your doctor right away.

Sick Day Plan

Check your blood sugar more often than usual (every 2 - 4 hours). Try to keep your blood sugar at less than 200 mg/dL. There may be times when you need to check your blood sugar every hour. Write down all your blood sugar levels, the time of each test, and the medicines you have taken.

If you have type 1 diabetes, check your urine ketones (use Ketostix-foil wrapped strips) every time you urinate.

Eat small meals often. Even if you are not eating as much, your blood sugar can still get very high. If you use insulin, you may even need extra insulin injections.

Do NOT do vigorous exercise when you are sick.

If you take insulin, you should also have a glucagon emergency treatment kit prescribed by your doctor. Always have this kit available.

Drink Lots of Fluids

Drink plenty of sugar-free fluids to keep your body from getting dried out (dehydrated). Drink at least 12 8-ounce cups of fluid a day.

Fluids you can drink if you are dehydrated are:

  • Water
  • Club soda
  • Diet soda (caffeine-free)
  • Tomato juice
  • Chicken broth

If your blood sugar is less than 100 mg/dL or falling quickly, it is OK to drink fluids that have sugar in them. Try to check their effect on your blood sugar, the same way you check how other foods affect your blood sugar.

Fluids you can drink if your blood sugar is low:

  • Apple juice
  • Orange juice
  • Grapefruit juice
  • Gatorade or other sports drink
  • Tea with honey
  • Lemon-lime drinks
  • Ginger ale

If you throw up, do not drink or eat anything for 1 hour. Rest, but do not lie flat. After 1 hour, take sips of soda every 10 minutes.

Eating When You Are Sick

When your stomach is upset, try to eat small meals. Try carbohydrates, such as:

  • Bagels or bread
  • Cooked cereal
  • Mashed potatoes
  • Noodle or rice soup
  • Saltines
  • Gelatin (such as Jell-O)
  • Graham crackers

Many foods have the right amount of carbohydrates (about 15 grams) for your sick-day diet. Remember, on sick days it is OK to eat some foods you might not normally eat, if you cannot eat your regular foods. Some foods to try are:

  • ½ cup apple juice
  • ½ cup regular soft drink (non-diet, caffeine-free)
  • 1 Popsicle (1 stick)
  • 5 Lifesavers candies
  • 1 slice of dry toast
  • ½ cup cooked cereal
  • 6 saltine crackers
  • ½ cup frozen yogurt
  • 1 cup Gatorade or sports drink
  • ½ cup regular ice cream (if you are not throwing up)
  • ¼ cup sherbet
  • ¼ cup regular pudding (if you are not throwing up)
  • ½ cup regular gelatin/Jell-O
  • 1 cup yogurt (not frozen), sugar-free or plain
  • Milkshake made with ½ cup low-fat milk and ¼ cup ice cream mixed in a blender (if you are not throwing up)

When you are sick, you should try to eat the same amount of carbohydrates that you normally do. If possible, follow your regular diet. If you are having a hard time swallowing, eat soft foods.

If you have already taken your insulin and are sick to your stomach, drink enough liquids with the same amount of carbohydrates that you would normally eat. If you cannot keep food or liquids down, go to the emergency room for treatment. You will receive fluids through a tube in your blood vessel (intravenous).

If you have a cold, talk with your doctor, diabetes nurse.

Diabetes Drugs

Most of the time, you should take all of your medicines as you usually do. Do not skip or double up on any medicine unless your doctor tells you to.

If you cannot eat your normal amount of carbohydrates, you may need to make a change in your insulin dose or in the dose of your diabetes pills or other injections.

When to Call the Doctor

Call your doctor if you have:

  • Blood sugars higher than 240 mg/dL for more than 1 day
  • Moderate-to-large ketones for 2 or more tests
  • Vomiting or diarrhea for more than 4 hours
  • Any severe pain
  • A fever higher than 100 °F
  • Trouble moving your arms or legs
  • Vision, speech, or balance problems

If your doctor does not call back right away, you may need to go to the emergency room. This is especially important if you are vomiting or have diarrhea for more than 4 hours.

Alternate Names

Sick-day management - diabetes

References

American Diabetes Association. Standards of medical care in diabetes -- 2012. Diabetes Care. 2012 Jan;35 Suppl 1:S11-63.

In the clinic. Type 2 diabetes. Ann Intern Med. 2010 Mar 2;152(1):ITC1-16.

Inzucchi SE, Sherwin RS. Type 1 diabetes mellitus. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011: chap 236.

Inzucchi SE, Sherwin RS. Type 2 diabetes mellitus. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011: chap 237. 

Update Date: 9/4/2012

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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