Diabetes sick day management

An illness, injury or surgery can impact your diabetes management. When you are not feeling well your blood glucose (sugar) may fluctuate and be unpredictable. It is important to pay special attention to nutrition, medication and testing your blood glucose levels every 2-4 hours.

Type 1 Diabetes

What should I do if I become sick?

An illness can cause the release of stress hormones which will stimulate the body to release stored glucose into the blood stream. A severe illness when you have type 1 diabetes can also result in the production of ketones in your blood. It is important to have a plan and be prepared in the event that you become sick.  Frequent monitoring of your blood glucose and blood/urine ketones is necessary. Monitoring should continue if:

• your blood glucose is less than 4.0 mmol/L;
• your blood glucose is greater than 14.0 mmol/L; 
• ketones are present; or
• you are unable to eat regular meals.

An illness may also be accompanied by dehydration which will need careful monitoring. If you are vomiting and/or have diarrhea or fever, you will be more prone to become dehydrated. If you vomit twice or more within a 12 hour period, see your family physician / nurse practitioner or go to the emergency department.

Should I continue to take my insulin or medication?

Yes, insulin and diabetes medication should always be taken. An increase in the dosage of insulin is usually required. However, some people may have blood glucose that is too low and may need a reduction in their insulin dosage.

What if I do not feel well enough to eat?

If you cannot eat as usual, replace solid foods with fluids containing sugar. You can take 10-15 gram of carbohydrate per hour. For example: 4-6 oz regular juice, pop, ½ popsicle, or a regular freezie.

You should also drink sugar-free fluids, especially if your blood glucose is high. For example: water, sugar-free Kool-Aid, or diet pop.

When should I seek medical attention?

See your family physician / nurse practitioner or go to the emergency department if you:

• have persistent nausea, vomiting or diarrhea;
• have continuous blood glucose levels below normal;
• have urine or blood ketones above normal; or
• are unable to care for yourself.

Type 2 Diabetes

What should I do if I become sick?

An illness can cause your body to release more glucose into the blood stream. Having an illness when you have type 2 diabetes can cause your blood glucose levels to rise. It is important have a plan and be prepared in the event that you become sick. Frequent monitoring of your blood glucose (at least 4 times a day) is necessary. Be sure to record your blood glucose levels [PDF | 228 KB]. 

Monitoring should continue if:

• your blood glucose is greater than 14.0 mmol/L; 
• your blood glucose is less than 4.0 mmol/L;
• ketones are present; or
• you are unable to eat regular meals.

An illness may also be accompanied by dehydration. It is important that you drink a glass of liquid (½ – 1 cup) every hour while awake. Depending on your blood glucose levels, you may also drink sweetened or unsweetened fluids such as water, sugar-free drinks, broth or tea.

Should I continue to take my insulin or medication?

Yes, insulin and diabetes medication should always be taken. An increase in the dosage of medication is usually required. Keep a record of your diabetes medication and any over the counter medication you have taken. 

What if I do not feel well enough to eat?

If you are unable to eat, depending on your blood glucose levels you can have either sweetened or unsweetened fluids or snacks every 1-2 hours. For example: diet pop, gelatin regular or diet, juice, crackers, dry toast, soup, broth, popsicles, sherbet or applesauce.

Keep a record of your fluid and food intake, as well as any vomiting or diarrhea you experience.

You should also drink sugar-free fluids especially if your blood glucose is high. For example: water, sugar-free Kool-Aid, or diet pop.

When should I seek medical attention?

See your family physician / nurse practitioner or go to the emergency department if you:

• have persistent nausea, vomiting or diarrhea;
• have continuous blood glucose levels above normal;
• have urine or blood ketones above normal; or
• are unable to care for yourself.