How To Manage Diabetes When You Are Sick

How To Manage Diabetes When You Are Sick

SICK IS AN ATTITUDE, Living WELL With Diabetes

When most people are sick with a cold or the flu, they usually rest, drink tea or eat chicken soup. If they do not start to feel better in a couple of days, they will usually call their doctor.

When you have diabetes, not feeling well affects your eating patterns and how your blood sugar reacts to your usual dose of insulin or diabetes pills.

When you are sick, your body will release hormones that work to help your body fight against your illness, but they will also make your blood sugar levels rise.

This means that your diabetes will be more difficult to control when you are sick. That is why it is so important to plan ahead and be prepared in case of illness.

Sickness can include: a cold, flu-like symptoms such as vomiting, diarrhea, sore throat, and infections such as ear, teeth or bladder, or more serious illnesses like pneumonia or a foot infection.

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Maintaining good control of your diabetes is not easy. It requires motivation, discipline, and an understanding of how diabetes affects your body.

Sometimes, however, no matter how hard you try, things go wrong. Infection or an illness such as a cold or the flu, for instance, can cause high blood sugars, loss of diabetes control, and if you have type 1 diabetes may result in a condition known as ketoacidosis.

Infection causes a stress response in the body by increasing the amount of certain hormones such as cortisol and adrenaline.

These hormones work against the action of insulin and, as a result, the body’s production of glucose increases, which results in high blood sugar levels.

When your blood sugar is high, the white cells in your body are unable to “mop up” bacteria because they cannot move around at their normal speed and do not reach the infection site quickly enough to engulf and kill the bacteria.

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In people without diabetes, when the liver releases sugar to help the body fight against the illness, the pancreas also makes extra insulin.

This allows the body to use the sugar for energy and the blood sugar remains within a normal range.

However, if you have diabetes, your body cannot make the extra insulin needed and your blood sugar will go up.

The stress hormones also work against insulin.

Together, the sugar produced from your liver and the stress hormones act to make your blood sugar rise .

You can see how illness can cause blood sugar levels to go out of control.

If not treated quickly, high blood sugar levels caused by illness can lead to more serious problems like Diabetes Ketoacidois (DKA) or Hyperosmolar Hyperglycemic Non-ketotic Syndrome (HHNK).

If you have type 2 diabetes, ketoacidosis is rare but you may experience very high blood sugars and you should know how deal with these events.

What is Ketoacidosis(DKA)?


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Ketoacidosis is a condition in which the body breaks down fat for energy rather than using sugar. When you are ill or stressed your blood sugar levels rise.

A person with Type 1 diabetes does not have an insulin supply to deal with this elevation and begins to break down fats for fuel.

When fat is burned for fuel, chemicals called ketones are released. Ketones are poisonous to the body. The kidneys usually remove ketones via the urine.

However, if the blood sugar levels remain too high for a period of time the kidneys are unable to remove the ketone build up and they begin to accumulate in the body. This can become a life-threatening situation, resulting in a diabetic coma or death.

Ketoacidosis is more common in individuals with Type 1 diabetes because of their inability to produce insulin.

Individuals with Type 2 diabetes are less likely to develop ketoacidosis because they do produce some insulin, even though it may not work as well as it should.

High blood sugar levels and ketoacidosis may develop as a result of an illness or omission of insulin.

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People with type 2 diabetes are at risk for a problem called hyperosmolar hyperglycemic nonketotic syndrome (HHNS).

It is very rare in people with type 1 diabetes.

Your risk of developing diabetic hyperosmolar syndrome might be higher if you:

1.Have type 2 diabetes. If you don’t monitor your blood sugar or you don’t yet know you have type 2 diabetes, your risk is higher.

2.Are older than age 65.

3.Have another chronic health condition, such as congestive heart failure or kidney disease.

4.Have an infection, such as pneumonia, a urinary tract infection or a virus, which causes your blood sugar levels to rise.

5.Take certain medications. Some drugs — such as corticosteroids (prednisone), diuretics (hydrochlorothiazide and chlorthalidone) and the anti-seizure medication phenytoin (Dilantin).

HHNS is an emergency caused by very high blood sugar, often over 600 mg/dL. Your kidneys try to get rid of the extra blood sugar by putting more sugar into the urine. This makes you urinate more and you lose too much body fluid, causing dehydration.

As you lose fluids, your blood becomes thicker and your blood sugar level gets too high for the kidneys to be able to fix.

With the high blood sugar and dehydration there is also an imbalance of minerals, especially sodium and potassium in the blood.

The imbalance of fluids, glucose, and minerals in the body can lead to severe problems, such as brain swelling, abnormal heart rhythms, seizures, coma, or organ failure. Without rapid treatment, HHNS can cause death.

You will need to stay in the hospital in order to bring your blood sugar level under control and treat the cause of the HHNS.

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What do you do if you become Sick When You Have Diabetes?

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The key to dealing with your diabetes when you’re sick is preparation. You should have already come up with a plan BEFORE you experience a sick day.

Working with your diabetes educator or doctor, develop a plan that includes how often to measure blood glucose and urine ketones, which over-the-counter medicines to take, what and how often to eat, and when to call your diabetes team.

It’s also helpful to put together a contacts list that includes daytime and evening phone numbers for your doctor, diabetes educator, and dietitian.

It can be difficult to manage your diabetes on your own when you are sick.

Let a family member or friend know that you are sick and ask them to check in on you.

Be sure someone knows how to test your blood sugar and give your insulin if you need help when you are unwell.

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If you have Type 1 diabetes:

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1. Continue to take your insulin. Even if you are not eating, it is essential that you continue to take your insulin. As skipping the dose will result in a further elevation of your blood sugar with the resultant production of ketones.

When you’re sick, it is extremely important to continue your diabetes medications. Even if you’re throwing up, don’t stop taking your medicines. You need them because your body makes extra glucose when you’re sick. When taking any over-the-counter medications, read the labels carefully. Cough syrup, for example, often contains alcohol or sugar, which can throw off your glucose levels even more. Key words to look for in the list of ingredients for any over-the-counter medication include: dextrose, glucose, fructose. These are all sugars. If in doubt about whether to take a particular medication, consult your pharmacist.

As a general rule, if you have Type 1 diabetes, you may need to take extra insulin to bring down your higher blood glucose levels while you’re sick.

2. Monitor your blood glucose levels every 2-4 hours.

3. If your blood glucose level is over 250, test your urine for ketones.

4. If your blood glucose levels are high and ketones are present, you will need to increase your insulin. Contact your doctor for advice or follow the guidelines your healthcare provider has given you.

5. If you are unable to eat normally, substitute meals with easily digestible foods or liquids of a similar carbohydrate value. Drink plenty of fluids as you can quickly become dehydrated.

If you’re having a hard time swallowing, eat soft foods with the same amount of carbohydrates as your regular foods. If you’re sick to your stomach or vomiting, drink enough liquids to equal the amount of carbohydrates that you’d normally eat.

Use the list below as a guide:

Food Normal Carbo-
hydrate grams
Apple or pineapple juice 1/2 cup 15
Cereal, cooked 1/2 cup 15
Coffee, tea, bouillon, broth 1 cup 0
Cream soup, made with milk 1 cup 27
Cream soup, made with water 1 cup 15
Gelatin, regular 1/2 cup 20
Grape or prune juice 1/3 cup 15
Ice cream, vanilla 1/2 cup 15
Milk 1 cup 12
Non-diet soft drink 1/2 cup 15
Orange juice 1/2 cup 15
Popsicle ® 1 24
Pudding, regular 1/2 cup 30
Pudding, sugar-free 1/2 cup 15
Sherbet 1/2 cup 30
Soup, thick chunky 1 cup 20
Soup, thin creamy 1 cup 15
Sugar 1 tsp 24
Yogurt, fruit flavored 1 cup 40-60
Yogurt, plain or artificially sweetened 1 cup 17

As a rule of thumb, try to take in 50 grams of carbohydrates every four hours.

6. If you feel nauseous, take about 15 gm of carbohydrates hourly in the form of juice or soda (not diet) ,applesauce, fruit juice bar, frozen yogurt , toasted brown bread .

Glucose is absorbed if taken slowly in small amounts.

7. Sickness and diarrhea can cause dehydration. It is very important to prevent this, so replace lost fluids with hourly drinks.

8. If vomiting occurs and is continuous, you must seek medical advice as you can rapidly become dehydrated and very ill.

If you have Type 2 diabetes:

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1. Monitor your blood glucose levels every 4 – 6 hours.

2. Continue taking your medication or insulin and, if your blood glucose levels remain high for more than 48 hours, seek medical advice as you may require an increase in your dose or additional treatment.

3. Continue to eat, but substitute normal food with easily digestible nourishing fluids if necessary. Drink plenty of fluids.

4. If you feel nauseous, take carbohydrates in the form of  juice or soda (not diet) ,applesauce, fruit juice bar, frozen yogurt , toasted brown bread.

Glucose is absorbed if taken slowly in small amounts.

5. Sickness and diarrhea can cause dehydration. It is very important to prevent this, so replace lost fluids with hourly drinks.

6. If vomiting occurs and is continuous, you must seek medical advice as you can rapidly become dehydrated and very ill.

Sick Day Insulin Adjustment


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When you are sick, you may need to increase your rapid or short acting insulin doses or even take an extra injection to lower high blood sugars and get rid of ketones.

The following section on insulin adjustment is a guideline only. Check with your health care team before using these guidelines.

1. When your blood sugar is higher than 14 mmol/L, you need extra rapid or short acting insulin.

2. Insulin adjustments are based on your total daily dose (TDD) of insulin. To get your TDD, add your usual unit doses of pre meal and basal insulin.

For example, if you usually take 10 units rapid at breakfast, 8 units rapid at lunch, 12 units rapid at supper and 24 units of long acting insulin at 10 pm, your TDD is 10 + 8 + 12 + 24 = 54 units.

3. Your sick day adjustment will then be a percentage of your TDD.

The adjustment could be 10%, 15% or 20% of your TDD, based on your blood sugar and ketone levels.

Blood glucose less than 13 mmol/L – continue with current dosage.

Blood glucose 13-22 mmol/L – patient should increase by two units each injection, even if unable to eat.

Blood glucose greater than 22 mmol/L – patient should increase by four units each injection, even if unable to eat.

Return dose to normal when blood glucose returns to normal.

4..The suggested extra rapid or short acting insulin can be taken either by:

1. Adding the suggested extra units to your usual dose at the usual time or

2. Taking an extra insulin injection

Remember to record all insulin injections, including any extra ones, in your log book.

Rapid acting insulin can be taken every 3 to 4 hours.

Short acting insulin can be taken every 4 to 6 hours.

5.If your blood sugar is:

4 to 13 mmol/L: take your usual basal and rapid or short acting insulin doses and use your usual correction factors.

less than 4 mmol/L: treat as hypoglycemia with fast acting carbohydrate; you may need to reduce your insulin doses slightly.

Coping With Morning Sickness When You Have Diabetes

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Nausea and vomiting in pregnancy (also known as morning sickness – although it can occur at any time of day) is very common in early pregnancy. It’s unpleasant, but it doesn’t put your baby at any increased risk, and usually clears up between weeks 12 and 14 of pregnancy. Unfortunately, for some women, it can have a significant adverse effect on their day-to-day activities and quality of life.

Managing your diabetes if you suffer from morning sickness may be especially difficult. You may find that making adjustments to your insulin doses – both in amount and timing – may help you with this.

Often you will need less insulin during this stage. However, it is very important that you discuss this first with your Diabetes Specialist Nurse or Midwife or other healthcare professional.

If you do suffer with morning sickness, your healthcare professional may also recommend that you try a number of changes to your diet and lifestyle to help you cope better.

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Sick Day Key Points


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1.Have a Blood glucose record sheet to monitor your blood glucose every 2-6 hours

2.Have a Ketone record sheet to monitor your ketones every 3-4 hours.

3. Ketone strips, blood glucose strips, check expiration dates regularly.

4. Buy a Thermometer.

5. Contact information for your doctor

6. Over the counter medicines (discuss with your pharmacist)

7.Acetaminophen (Tylenol®): for pain and fever

Ibuprofen (Advil®): for pain

Sugar free cough drops and syrup: for cough and sore throat

Dimenhydrinate (Gravol®): for nausea and vomiting

Loperamide (Imodium®): for diarrhea

Glucose or dextrose tablets (eg. Dex 4®): for low blood sugars

8.Continue taking your medication or insulin.

9.Always monitor your blood sugar during illness.

10. If your sugar levels are high, test for ketones and DO NOT STOP taking your medication or insulin.

11. If you have moderate to large ketones after taking additional insulin contact your health care provider.

12.If you are unsure what to do, call your healthcare provider.

13. If persistent vomiting occurs, call your healthcare provider.

14. Request sick day guidelines from your healthcare provider.

15.If you have to go to the hospital or emergency room, immediately tell doctors and nurses you have diabetes.

Always wear your diabetes identification bracelet or necklace in case you’re not able to talk to the doctors or nurses.

16.Physical activity is not always advised when you are sick, as it can increase blood sugar and ketone levels.

17.Hand sanitizer at home

18. Fruit juices such as orange juice at home

19.Soup, crackers, and other foods that are easy on your stomach

20. Glucagon (ask your doctor for a prescription)

To help you remember the important steps of looking after your diabetes just think of the word S-I-C-K:

Sick Notes

S= Blood Sugar Testing

Check your blood Sugar every 2 to 3 hours when blood sugars are high (above 14 mmol/L) or more often if needed.

Record the blood sugar and ketone results, insulin used, food eaten and fluid intake . Have it handy if calling your health care professional for help.

I = Insulin

Continue to take your Insulin. Often extra rapid acting or short acting insulin is needed especially if glucose levels are elevated or ketones are present.

If you are having low blood sugars you may need to reduce your insulin dose(s). Never omit your basal insulin as it is needed to stop ketones from forming.

C =Carb and Fluid

Try to keep Carb (carbohydrate) intake as normal as possible when you are sick. Your body needs carb for energy and to balance with your insulin. If you can only eat a small amount, focus on eating carb containing foods.

You may need to eat small amounts of lighter foods or sip on carb containing fluids throughout the day to get the carb you need. Also increase your fluid intake to prevent dehydration.

K =Ketone Testing

Check for blood or urine Ketones. Test for ketones every 2 to 3 hours or every time you use the bathroom. Ketones are produced when your body burns fat instead of sugar for energy. This can happen even when blood sugars are not high if your food intake has been poor. Record the results.

Check the expiry date on your strips. Urine ketone strips are only good for six months after opening.

Forgetting to check for ketones when sick is a common and serious mistake. Ketones are a sign your body is lacking insulin and burning too much fat for energy. Having large amounts of ketones and high blood sugar can lead to DKA. 

Remember to get a flu shot every year and pneumonia shot every five years.

Everyone gets sick, but if you plan ahead, take proper precautions and stay in touch with your diabetes team, you will get better, just like everyone else.

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2 thoughts on “How To Manage Diabetes When You Are Sick”

  1. what a informative article on diabetes management, I never realized diabetes took so much to manage it to feel as healthy as possible. So much information would overwhelm someone new to managing diabetes, you have done a fine job in this article helping someone new manage their diabetes much better.

    How expensive is the cost to manage your diabetes?

    • The estimated lifetime medical spending for people with diabetes is now more than 211,000 euros.

      The visits you have to make to your doctor, the blood glucose meters that you require to check your level, and the prescription medications that most people with diabetes need are only a small part of the economic costs of diabetes.

      Diabetes starts to get very expensive when you dont manage it and have to be hospitalized or need to go into a nursing home or residential facility.

      Uncontrolled diabetes can be one of the most expensive diseases anybody can get.

      The price of good diabetes control is high, but the long-term cost of not staying healthy is higher!


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