Get Sick

Being sick can make your blood glucose (sugar) level go up very high. It can also cause serious conditions that can put you in a coma.

When you’re sick, you’re under stress. To deal with this stress, your body releases hormones that help it fight disease. But these hormones have side effects. They raise blood glucose levels and interfere with the blood glucose-lowering effects of insulin.

As a result, when you are sick, it is harder to keep your blood glucose in your target range. Ketoacidosis leading to a diabetic coma can develop, particularly in people with type 1 diabetes. People with type 2 diabetes, especially older people, can develop a similar condition called hyperosmolar hyperglycemic nonketotic coma. Both conditions are dangerous and can be life-threatening.

So, every diabetic patient should make a Sick-Day Plan in advance

The plan includes

How often to measure blood glucose and urine ketones?

What medications to take

How to eat

When to call your diabetes team

Check your blood sugar every 4 hours, especially, if you’re taking insulin at meals or long-acting insulin once a day — before each meal and before bed.

If your blood sugar goes over 13.9 mmol/L, check your urine for ketones, which are produced when your body has difficulty processing blood sugar.

Eating and drinking can be a big problem when you’re sick. But it’s important to stick to your normal meal plan if you can. In addition to your normal meals, drink lots of non-caloric liquids to keep from getting dehydrated. These are liquids like water and diet soft drinks. It’s easy to run low on fluids when you are vomiting or have a fever or diarrhea. Extra fluids will also help get rid of the extra glucose (and possibly, ketones) in your blood.

So, Drink liquids if you can’t keep solid food down. Have one cup of liquid every hour while you’re awake to prevent dehydration. If you can’t hold down liquids, you may need to go to the emergency room or hospital.

Avoid erratic meals

When you’re not able to eat as much as normal or don’t have an appetite, meal replacement drinks are often helpful. things you can eat or drink when you aren’t feeling well.

Regular soda pop or juice(to prevent low blood sugar)

Broth-based soups

Gelatin (regular,not sugar-free)


Electrolyte-supplemented beverages

To prepare for sick days, have on hand at home a small stock of non-diet soft drinks, broth, applesauce and regular gelatin.

When sick, you will still need to continue medications for your diabetes. Even if you are throwing up, don’t stop your medications. You need them because your body makes extra glucose (sugar) when you are sick.

If you have type 1 diabetes, you may have to take extra insulin to bring down the higher blood glucose levels. If you have type 2 diabetes, you may be able to take your pills, or you may need to use insulin for a short time. In either case, work with your diabetes team to develop your sick-day plan.

Don’t stop taking insulin

“If you’re taking long-acting insulin, which is typically given at bedtime, we usually recommend you continue with the same dose, as long-acting insulin is mainly responsible for insulin needs not related to food intake

If you’re taking insulin before meals (also called rapid-acting insulin, fast-acting insulin, or mealtime insulin) your doctor may need to reduce your dose, depending on what you’re eating at breakfast, lunch and dinner.

“If you skip a meal, skip the mealtime insulin,”

Your doctor also may adjust your oral medication.

Some diabetes medications, such as metformin, SGLT-2 inhibitors or DPP4- inhibitors, rarely cause low blood sugars and will likely not need adjusting. “These medications usually bring down blood sugar from high to normal, but very rarely drop blood sugar too low,”

On the other hand, sulfonylureas or acarbose may cause your blood sugars to drop if you are eating less. “These medications should be adjusted based on blood-sugar readings,”

Always check the label of over-the-counter medicines like cough and nasal congestion before you buy them to see if they have sugar. Small doses of medicines with sugar are usually okay. But to be on the safe side, ask the pharmacist or your team about sugar-free medicines.

Many medications you take for short-term illnesses can affect your blood glucose levels, even if they don’t contain sugar. For example, aspirin in large doses can lower blood glucose levels. Some antibiotics lower blood glucose levels in people with type 2 diabetes who take diabetes pills. Decongestants and some products for treating colds raise blood glucose levels.

If you must go to the emergency room or see a different doctor than usual, be sure to say you have diabetes, or have your identification bracelet in plain view. List all the medications that you are taking.

Your blood glucose level can also be affected by medications you take for chronic or long-term conditions.

Contact your diabetes team if:

Your blood sugar stays higher than 13.9 mmol/l or lower than 3.9 mmol/L.

You have moderate to large amounts of ketones in your urine.

You can’t keep liquids or solids down.

You have a temperature over 38.3 C.

You’ve been sick or have had a fever for a couple of days and aren’t getting better.

You have symptoms that might signal ketoacidosis or dehydration or some other serious condition (for example, your chest hurts, you are having trouble breathing, your breath smells fruity, or your lips or tongue are dry and cracked)

You aren’t certain what to do to take care of yourself

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