Developing A Diabetes Sick Day Plan

By Melinda D. Maryniuk, MEd, RD, CDE

When someone is not feeling well, their blood glucose can go high even if they are eating less than normal. It is important to have a plan in place to be prepared for days when someone is not feeling their best. Here are examples of situations that are considered a “sick day” and may make blood glucose go up:

  • Common cold
  • Flu
  • Nausea, vomiting, diarrhea
  • Infection
  • Surgery
  • Dental work
  • Stress
  • Injury

Sick Day Plan

During times when you feel sick or are in any of the situations listed above, it is important to pay closer attention to glucose levels as they can change unexpectedly and very quickly. Follow these guidelines and talk with your healthcare provider about a plan specific for you:

Check blood glucose often. Check it 4 times a day for mild illness (like a cold) or every 3-4 hours for a more severe illness, such as the flu. Blood glucose can rise quickly when you are sick and you cannot always tell what’s happening just by how you are feeling. If glucose is over 250 mg/dl for two readings in a row, call your healthcare provider as you may need a change in your medications. 

Ask your healthcare provider if you need to check ketones. This is always important for people with type 1 diabetes and sometimes recommended for those with type 2. You may need to check if your blood glucose goes above 250 mg/dl. 

Always take your diabetes medicine. When you are not feeling well, you may not feel like eating. However, it is important to keep taking your diabetes medicine (unless your healthcare provider tells you not to). 

Drink plenty of fluids. Drink at least 6 to 8 ounces of water or other fluids every hour while you are awake to prevent dehydration. If you are unable to eat solid food, switch back and forth each hour between sugar-free drinks (water, seltzer, tea, diet soda) and drinks containing carbohydrate (such as juice and regular soda)

Learn about easy-to-eat foods. When you don’t feel like eating your usual meals, it may still important to get some carbs to cover the medicines you’ve taken, especially insulin. Keep some special foods handy for a sick day emergency such as plain saltine crackers, oatmeal, broth based soups, applesauce, juice and popsicles. Talk with a dietitian to determine if you need a special sick day diet plan based on your diabetes medicines. 

Rest and keep warm. Don’t exercise much. Have someone help take care of you. 

Know when to call for help. Never hesitate to call if you are worried, but pay particular attention to these signs and symptoms and call your provider for advice for what to do if you:

  • Have signs of dehydration such as dry mouth, cracked lips, sunken eyes, skin that is flushed and dry or weight loss
  • Have a fever of 100° or higher
  • Are vomiting or unable to keep fluids down
  • Have constant diarrhea
  • Have abdominal pain
  • Have chest pain
  • Have rapid, shallow breathing
  • Have blood glucose levels over 250 mg/dl for more than two readings with or without ketones

Be prepared. Create a sick day supply kit. Talk with your healthcare provider or diabetes educator about what should be in your kit. This list offers some general ideas to get you started:

  • Extra glucose meter and strips (you’ll be checking more often)
  • Digital thermometer
  • Medicines to relieve symptoms of cold, flu, pain, fever or diarrhea
  • Sugar-free cough drops and cough syrups
  • Ketone strips (if neeed)
  • Telephone numbers for healthcare provider
  • Easy to digest foods such as:
    • Sugar-free and regular gelatin and popsicles
    • Low-Sodium Vegetable or Chicken Broth
    • Herbal, non-caffeinated tea
    • Soft drinks (sugar-free and regular, if needed to replace carbs)
    • Fruit juice
    • Applesauce

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