Sick day plan for people with type 2 diabetes

If you have type 2 diabetes and are unwell with the flu or other infections such as gastro, urinary tract infections, skin infections or chest infections, you need to take extra care.

Key points about having a diabetes sick day plan

  1. When you have type 2 diabetes and are unwell, such as with vomiting or diarrhoea, your blood glucose levels can become more difficult to manage.
  2. Work with your doctor in advance to develop a sick day plan.
  3. Try to eat normally if you can and avoid getting dehydrated by sipping water often.
  4. Avoid taking non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen, diclofenac, naproxen or celecoxib.
  5. Seek medical help if your blood glucose levels remains higher than 20 mmol/L or lower than 4 mmol/L.  

Why does being unwell affect my diabetes?

When you are unwell, your body produces stress hormones that cause your blood glucose levels to rise, even if you are not eating. But some people who are taking medicines for diabetes may have low blood glucose (hypoglycameia) when they are unwell. This can make blood glucose levels difficult to manage. Knowing what to do in advance may help you recover faster.

Plan ahead for sick days

If you have type 2 diabetes, work with your doctor to create a sick-day plan. Here is some guidance.

  • Always let someone know you are not well. Keep your plan in a convenient place and include contact information in case you need to reach a doctor at night or on the weekends.
  • Eat normally if you can: Try to eat your normal types and amounts of food. If you find this difficult, try having light meals such as soup, dry toast or crackers.
  • Keep hydrated: Keep yourself hydrated by drinking water and avoid dehydration. Try to have at least one glass every 1–2 hours. Dehydration can happen very quickly, especially if you have vomiting (being sick) and diarrhoea (runny poos).
  • Rest well: Avoid strenuous exercise or activity.
  • Monitor your blood glucose: Measure your blood glucose levels 3–4 times a day. or immediately if you have signs or symptoms of high blood glucose (hyperglycaemia) or low blood glucose (hypoglycaemia).
  • Contact your diabetes care provider: If you are taking any medicines for diabetes, contact your diabetes care provider. Depending on the medicines you are taking, and your situation, your doctor will advise you on how best to manage this – you may need to reduce your dose or stop taking them while you are unwell. Diabetes medicines include:
    • metformin
    • empagliflozin
    • acarbose
    • insulin
    • glipizide, gliclazide or glibenclamide.
Be careful when using medicines for pain and inflammation (anti-inflammatories)

Anti-inflammatories (also called non-steroidal anti-inflammatories or NSAIDs) are often used for pain or fever. Common examples include ibuprofen (Ibugesic®, I-Profen®, Nurofen®), diclofenac (Voltaren®), naproxen (Noflam®, Naprosyn®) and celecoxib (Celebrex®).

If you have diabetic renal disease and/or are taking ACE inhibitor/ARB therapy, you must not take anti-inflammatories. These can be harmful to your kidneys. Read more about anti-inflammatories and blood pressure medicines.

If you are taking steroid tablets

If you are taking steroid tablets, especially in high doses, this will raise your blood glucose (hyperglycaemia). You may need to adjust the dose of your diabetes medicines. Contact your doctor – they will advise you on how best to manage this. Examples of steroid tablets include prednisone, dexamethasone, hydrocortisone and methylprednisolone. Read more about steroid tablets.

When to seek medical help

Contact your doctor, diabetes clinic or emergency service if you:

  • have ongoing vomiting (being sick) or diarrhoea (runny poos)
  • have blood glucose levels remains higher than 20 mmol/L  
  • have blood glucose levels that are below 4 mmol/L 
  • feel dizzy, are drowsy or confused
  • develop a fever (usually a sign of infection). 

References

  1. Sick day management in patients with diabetes Ministry of Health and Society for the Study of Diabetes, NZ, 2020
Credits: Health Navigator Editorial Team. Last reviewed: 04 Feb 2021