How to Manage Diabetes When Things Don’t Go As Planned…


by Melinda D. Maryniuk, MEd, RD, CDE

Managing diabetes is never easy, but it can be even more challenging when someone is sick. When a person is not feeling well, their blood glucose can go high even if they are eating less then they usually do.  That’s why it’s important to have a “sick day plan” so people can be prepared for a cold, the flu, an infection, surgery or an injury. Here are six guidelines for setting up a sick day plan, and of course talk to a healthcare provider about getting suggestions for a more specific plan:

  • 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 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 medicine. 

  • 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 aren’t 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, talk to a dietitian about switching 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. 

  • 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, Have a fever of 1000 or higher, Are vomiting or unable to keep fluids down, Have constant diarrhea, Have abdominal or chest pain, Have rapid, shallow breathing or Have blood glucose levels over 250 mg/dl for more than two readings with or without ketones

  • Put together a sick day kit. Talk with your healthcare provider or diabetes educator about what should be in your kit, but a few suggestions might be: extra test strips (you’ll be checking more often), a thermometer, cold medicine, sugar-free cough drops and cough syrups and easy to digest foods.

And that’s what you need to know about managing diabetes while you’re under the weather—thanks for watching!