Sick Days

As a person with diabetes, you know how important it is to take good care of yourself. It may be harder to do when you're sick, but that's when you need to pay special attention to nutrition, medication and testing your blood and urine.

Whether it's a sore throat, the flu or surgery, illness puts your body under extra stress. To help you fight an illness, your body releases hormones that cause your liver to release glucose and that get in the way of insulin. As a result, your blood sugar rises, sometimes to dangerously high levels.

Avoid a risky situation. Make a sick-day plan and talk about it with your doctor before you become ill. Your plan should cover eating and drinking, taking medication and testing both blood sugar and ketones.

The Sick Day Plan

Testing

Check your blood sugar every four hours around the clock, especially before meals and at bedtime. Check your urine for ketones using strips. You can find strips at the pharmacy. You may want to try Ketostix^® Reagent Strips, which are for testing only ketones in your urine. For testing your urine for both sugar and ketones, you may want to try Keto-Diastix^® Reagent Strips.

Continue testing your blood and urine as long as:

• your blood sugar is greater than 234 mg/dL
• your ketone numbers are moderate to large
• you cannot follow your regular meal plan
• you are not feeling well.

For more information about testing, please see the Testing section.

Medication

Although you're feeling sick, do not change your medication schedule. Continue taking your insulin and other prescribed medications as usual. Depending on how ill you are, and on your blood sugar and ketone values, you may need to take an extra dose of short- or rapid-acting insulin every three to four hours. To find out how much to take, use the extra-dosage scale given to you by your doctor or diabetes educator.

Liquids

Drinking enough fluids is extremely important, since dehydration can make your illness worse. You are at risk of becoming dehydrated if you are:

• losing fluids due to diarrhea, fever or vomiting
• drinking less than usual
• urinating more than usual

As a general rule, drink eight ounces of liquid every hour while you're ill, and avoid drinks that contain caffeine.

Your choice of liquids should be guided by your blood sugar. If your blood sugar is over 234 mg/dL, drink calorie-free liquids such as:

• water
• broth
• sugar-free, caffeine-free soda

If you have low blood sugar, drink:

• regular soda
• milk
• fruit juices

Food

You may not be able to eat according to your usual meal plan while you're ill, but it's important to eat carbohydrates regularly to keep your blood sugar from going too low. Depending on your blood sugar levels, as measured before a usual meal time, you need to drink or eat carbohydrate according to the following schedule:

Foods and liquids that contain 15 grams of carbohydrate:

• 1 cup chicken soup
• 1 cup cream soup, made with water
• 1/2 cup cooked cereal
• 1/2 cup vanilla ice cream
• 1/2 cup ginger ale (not diet)
• 1/3 cup grape juice
• 1/2 cup apple juice
• 3/4 cup orange juice
• 1/2 cup cola (not diet)
• 1/2 cup cranberry juice
   

Call your doctor or healthcare professional when:

• You've been vomiting or had diarrhea for more than six hours.
• You've been unable to eat or drink for more than four hours.
• Your illness has not improved after two days.
• You've had high blood sugar for longer than 24 to 48 hours, with or without urine ketones.
• You've taken extra short- or rapid-acting insulin as suggested by your doctor.
• You're not sure what to do.
• You have any of the following signs of ketoacidosis:

- Stomach pain
- Nausea or vomiting
- Rapid breathing or heart beat
- Fruity-smelling 'ketone breath'
- Thirst and frequent urination
- Weakness or tiredness
- Visual disturbances
- Sleepiness, difficulty staying awake
- Cracked lips or dry mouth (signs of dehydration)

Be prepared!

Create a special box that contains the following items. Keep it somewhere handy that's out of the reach of your children. Note any expiry dates on your household calendar, so you can replace items when they become outdated. When you are ill, tell a family member or friend, so that someone can check on you every 4 to 6 hours.

• Blood sugar and ketone strips (Check expiration dates!)
• Lancets
• Record book and pen for test results
• Information from your doctor, diabetes educator or pharmacist showing dosage adjustment for insulin and oral diabetes medication according to blood sugar and ketone values
• Over-the-counter medications for sore throat, cough, nasal congestion, fever, headache, upset stomach, diarrhea and vomiting, as recommended by your doctor or pharmacist
• Liquids with and without calories
• List of 15-gram carbohydrate foods and fluids that are usually on-hand (Talk about them with your dietitian.)
• Thermometer
• Important telephone numbers (e.g., family members, doctor, diabetes educator, taxi, hospital emergency room, etc.)
• Money for taxi fares