Managing Diabetes When You Are Sick

Being sick by itself can raise your blood glucose. Moreover, illness can prevent you from eating properly, which further affects blood glucose.

In addition, diabetes can make the immune system more vulnerable to severe cases of the flu. People with diabetes who come down with the flu may become very sick and may even have to go to a hospital. You can help keep yourself from getting the flu by getting a flu shot every year. Everyone with diabetes—even pregnant women—should get a yearly flu shot. The best time to get one is between October and mid-November, before the flu season begins.

Be prepared for illness

Be prepared for illness. Make a plan ahead of time for sick days. Ask your health care team

• how often to check your blood glucose levels
• whether you should check for ketones in your blood or urine
• whether you should change your usual dose of your diabetes medicines
• what to eat and drink
• when to call your health care provider

What should I do when I am sick?

• Weigh yourself every day. Losing weight without trying is a sign of high blood glucose.
• Check your temperature every morning and evening. A fevermay be a sign of infection.

Having a cold, the flu, or an infection can raise your blood glucose levels. You can have serious health problems leading to a coma if your blood glucose levels are very high.

If You Use Insulin

• Take your insulin, even if you are sick and have been throwing up. Ask your doctor about how to adjust your insulin dose based on your blood glucose test results.

Your health care team may recommend the following:

• Check your blood glucose level at least four times a day and write down the results in your record book. Keep your results handy so you can report results to your health care team.
• Keep taking your diabetes medicines, even if you’re not able to eat.
• Drink at least 1 cup, or 8 ounces, of water or other calorie-free, caffeine-free liquid every hour while you’re awake.
• If you can’t eat your usual food, try eating or drinking any of the following:

• juice
• saltine crackers
• dry toast
• soup
• broth or bouillon
• popsicles or sherbet
• regular—not sugar-free—gelatin
• milk
• yogurt
• regular—not sugar-free—soda

If You Don’t Use Insulin

• Take your diabetes medicines, even if you are sick and have been throwing up.

Your health care provider may say you should call right away if

• your blood glucose levels are above 240 even though you’ve taken your diabetes medicines
• your urine or blood ketone levels are above normal
• you vomit more than once
• you have diarrhea for more than 6 hours
• you have trouble breathing
• you have a high fever
• you can’t think clearly or you feel sleepier than usual

Keep Taking Medicine

Be sure to keep taking your diabetes pills or insulin. Don’t stop taking them even if you can’t eat. Your health care provider may even advise you to take more insulin during sickness.

Keep Eating

Try to eat the same amount of fruits and breads as usual. If you can, eat your regular diet. If you’re having trouble doing this, use carbohydrate choices or servings: eat enough soft foods or drink enough liquids to take the place of the fruits and breads you usually eat.

• Use of trade names is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

Drink Liquids

Be sure to drink extra fluids when you're sick.

Drink extra liquids. Try to drink at least 1/2 cup (4 ounces) to 3/4 cup (6 ounces) every half-hour to hour, even if you have to do this in small sips. These liquids should not have calories. Water, diet soda pop, or tea without sugar are good choices.

Check for Changes

• Weigh yourself every day. Losing weight without trying is a sign of high blood glucose.
• Check your temperature every morning and evening. A fever may be a sign of infection.
• Every 4 to 6 hours, check how you’re breathing and decide how alert you feel. Having trouble breathing, feeling more sleepy than usual, or not thinking clearly can be danger signs.

Keep Records

Use "Records for Sick Days." Ask a family member or friend to help if you need it.

Call for Help

Ask your health care provider when you should call. During your sick times, you may need to call every day for advice. Call your health care provider or go to an emergency room if any of the following happen to you:

• You feel too sick to eat normally and are unable to keep down food for more than 6 hours.
• You're having severe diarrhea.
• You lose 5 pounds or more.
• Your temperature is over 101 degrees F.
• Your blood glucose is lower than 60 mg/dL or remains over 300 mg/dL.
• You have moderate or large amounts of ketones in your urine.
• You're having trouble breathing.
• You feel sleepy or can't think clearly.