When you’re sick, your body is also stressed. To deal with this stress, your body releases hormones that help you fight the illness. But these hormones also counteract the effect of insulin in lowering blood glucose and cause blood glucose levels to go up. Sickness can cause your diabetes to go out of control. Extremely high blood glucose levels caused by illness can also lead to diabetic ketoacidosis in people with type 1 diabetes and to hyperosmolar hyperglycemic syndrome (HHS) in people with type 2 diabetes.
Blood glucose monitoring is especially important during any bout of sickness. Even if you have type 2 diabetes and only monitor once a day, you may want to keep a closer check during times of illness. Be sure to talk to your health care team before you get ill about what you should do in the event of illness. You and your health care team can work together to come up with a plan to help you handle common illnesses such as colds or the flu.
Along with eating chicken soup and drinking lots of liquids, here are a few things you can do when you are feeling under the weather:
If you have type 1 diabetes, continue to take your insulin—even if you can’t eat. You may even need extra insulin to take care of the excess glucose your body releases when you are sick. Ask your provider about what blood glucose levels call for a change in your insulin dose.- Monitor your blood glucose and ketone levels about every 3 to 4 hours. If the levels are too high or you are pregnant, you may need to monitor more often.
- Make substitutions for your usual food if nausea and vomiting are making it difficult to eat. Try to eat or drink your usual amount of carbohydrates. Talk to your dietitian about ways to cover your basic eating plan. Prepare a sick-day plan before you even become sick. Try to keep some comforting foods like soup or frozen fruit bars on hand, especially during the cold and flu season.
- Drink plenty of caffeine-free liquids. If you are losing fluids by vomiting, from fever, or from diarrhea, you may need non-diet soft drinks or sports drinks with sugar or carbohydrate. This can help prevent the hypoglycemia caused by not eating or taking extra insulin. If vomiting or diarrhea is severe, try sipping 3 to 6 ounces an hour to keep your blood glucose even.
- Keep a thermometer on hand and a small supply of common sick-day medications that are safe to take. Be sure to read the labels.
Some cold medicines sold over-the-counter to treat colds and flu can affect your blood glucose level. Many cough and cold remedies labeled “decongestant” contain ingredients (such as pseudoephedrine) that raise blood glucose levels and blood pressure. Talk to the pharmacist or your provider before you take any over-the-counter medication.
In addition, some cough and cold remedies contain sugar and alcohol. Make sure you read the label and find out exactly what “active ingredients” as well as “inactive ingredients” any medication contains. A small amount of sugar or alcohol is probably fine, as long as you are aware you are taking it. If you will be taking frequent or high doses of a particular medicine, try to find a sugar-free version. Alcohol is a common ingredient in nighttime cold medications, but alcohol-free alternatives are available.
Pain medications are also usually safe in small doses. You don’t have to worry about taking an occasional aspirin for a headache or fever. Also, many people with diabetes take a daily coated “baby” aspirin to protect against cardiovascular disease. This is safe for people with diabetes. Ibuprofen is not safe for anyone with kidney disease. People with diabetes should not take ibuprofen unless a provider advises it. This drug could cause acute renal failure in people with kidney problems.
It’s Time to Call Your Provider.
Call your diabetes care provider if you experience any of the following:
- You have been sick for 1 or 2 days without improvement.
- You have had vomiting or diarrhea for more than 6 hours.
- You have moderate to large amounts of ketones in your urine.
- You are taking insulin and your blood glucose levels continue to be over 250 mg/dl or the level determined by you and your provider.
- You have type 2 diabetes, you are taking oral diabetes medication, and your pre-meal blood glucose levels are 250 mg/dl or higher for more than 24 hours.
- You have signs of extreme hyperglycemia (very dry mouth or fruity odor to the breath), dehydration, or loss of mental competence (confusion, disorientation).
- You are sleepier than normal.
- You have stomach or chest pain or any difficulty breathing.
- You have any doubts or questions about what you need to do for your illness.
When you call, you need to have some information ready. Keeping records during your illness will make it easier to figure out how sick you are. This will also help you and your provider keep track of your progress in getting well. Tell your provider the following information:
- your blood glucose level and your urine ketone results, starting when you first realized you were ill
- what insulin doses and diabetes pills you have taken and when you took them
- other medications you have taken
- how long you have been sick
- your temperature
- how well you can take foods and fluids
- if you have lost weight while sick
- any other symptoms you may have
- your pharmacist’s phone number
Sick-Day Action Plan
Before your next illness, decide on an action plan with your health care team. Include the following:
- When to call the doctor.
- How often to monitor your blood glucose.
- Whether you should test your urine for ketones. Ketones are produced when fats instead of glucose are used for energy. Most commonly, this is a sign that not enough insulin is available to help your body break down glucose. (Less commonly, when carbohydrates are very restricted, ketones can appear in the blood. This is called starvation ketosis.) When blood glucose levels are high during illness, ketones can appear if extra insulin is not given.
- Medication changes that might be needed. You need to know how much extra insulin to take to bring down unusually high blood glucose levels. If you take oral diabetes medications, you need to know whether you should continue taking them or increase or decrease the dose.
- Whether you need to have anti-nausea suppositories or over-the-counter cold or flu or cough medications on hand, which ones are good choices, and when to take them.
- How to choose foods and fluids during your illness.
