Guidelines for Sick Days

"Sick" refers to anytime that you have a cold, the flu, an infection, feel nauseous, are vomiting, having surgery, or an injury. When a person with diabetes gets sick, the blood glucose will often be higher than usual, even if you are eating less food. This is because insulin is often less effective during illness. Also, keep in mind that during illness the liver is still releasing glucose even when one cannot eat, so insulin is still needed. The following steps should be taken to keep blood glucose under control and prevent more serious problems. Be sure to ask your healthcare provider about these guidelines and any special recommendations they have for you.

1.  Take your diabetes medication. Always take your usual diabetes medication, unless your healthcare provider instructs you differently. Even if you cannot eat your usual meals, you need to take your medication. In some cases, additional medication is required. Check with your healthcare provider or diabetes educator.

2.  Check blood glucose and ketones.

1. Check your blood glucose every 3 to 4 hours all day and all night. Have someone do it for you if you are too sick to do it yourself.
2. If you take insulin, check for ketones if your blood glucose is 250 or higher, unless otherwise instructed by your healthcare team.
3. Write the results of your blood glucose and ketone checks down and have them ready if you need to call your healthcare provider.

3.  Drink plenty of fluids — about 6 to 8 ounces every hour you are awake.

1. If you are able to eat your meals, drink fluids that are sugar-free and caffeine-free, such as: water, decaffeinated tea, broth, and diet gingerale.
2. If you are unable to eat, alternate sugar-free fluids one hour with fluids containing sugar the next hour. Examples of fluids containing sugar include: 7-Up or Sprite (6 ounces), apple juice (4 ounces), Gatorade (4 ounces), regular gelatin (1/2 cup). Liquids with salt in them, such as bouillon or clear soup, are also important to include.

4.  Rest. Stay warm. Ask someone to help take care of you.

5.  Call your healthcare provider for any of the following reasons:

1. Vomiting or diarrhea for more than 2 hours.
2. If you have a fever.
3. Blood glucose values that remain above 250 for at least two blood glucose checks or that do not decrease with extra insulin. Do this whether you have ketones or not.
4. If you have moderate or large ketones.
5. If you have stomach pains that won't go away.
6. If you have questions or concerns.