Diabetes sick day plan

If you have 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. In these situations blood glucose levels can become more difficult to manage.

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. You may also feel thirsty and pass urine (pee) more often than usual, which can make you dehydrated. 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 or a child you care for have diabetes, work with your doctor to make a sick-day plan. Questions to discuss with your doctor include:

  • What your target blood glucose level should be during an illness?
  • How often to check your blood glucose and your ketone levels?
  • If you take insulin, how you should adjust your insulin dose and timing?
  • When to contact your doctor for help?  

Here are examples of sick day plans:

Keep your plan in a convenient place and include contact information in case you need to reach your doctor at night or on the weekends.

Sick day tips

  • Try to eat your normal types and amounts of food. If you find this difficult, try having light meals such as soup, dry toast, crackers.  
  • Avoid dehydration – keep yourself hydrated by drinking water. Try to have at least one glass every 1 to 2 hours. Dehydration can happen very quickly, especially if you have vomiting and diarrhoea.
  • Avoid strenuous exercise or activity.
  • Always let someone know you are not well.

Type 1 diabetes

Checking your blood glucose and ketone levels frequently is the only way to monitor the effect of illness on your diabetes. 

  • Measure your blood glucose levels every 3 hours.
  • Test your blood ketones every 1 to 2 hours. 
  • Follow your sick day plan if your blood glucose levels or ketone levels are high.
  • Keep taking your insulin. Do not stop using your insulin. You can adjust your dose up or down as outlined in your sick day plan. Contact your diabetes care provider if you are unsure about how to adjust your insulin dose.
  • If your blood glucose levels are high (above 12 mmol/L) avoid foods and drinks with too much carbohydrate. Have sugar-free drinks such as for water (soda water, mineral water).
  • If your blood glucose levels are below 8 mmol/L and provided you do not have diarrhoea or vomiting, drink fruit juice, fizzy drinks left to go 'flat' (ginger ale, lemondade etc). If you are unable to eat your usual diet try egg custards, fruit yoghurt, 1 scoop of ice-cream or half a cup of normal jelly. This is to help prevent blood glucose becoming too low (hypoglycaemia).

If your blood glucose levels or ketone levels are consistently high, you are at risk of diabetic ketoacidosis. If your blood glucose levels are too low, you are at risk of hypoglycaemia. Both these conditions can be harmful. Contact your doctor, diabetes clinic or emergency service if you have any of the following symptoms.

When to seek medical help

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

  • Have ongoing vomiting or diarrhoea.
  • Have raised blood ketone levels above 1.5 mmol/L.
  • Have high blood glucose levels, above 15 mmol/L, despite taking extra doses of insulin
  • Have difficulty keeping your blood glucose levels above 4 mmol/L.  
  • Feel dizzy, are drowsy or confused.
  • Develop a fever (usually a sign of infection). 

Type 2 diabetes

  • Measure your blood glucose levels 3 to 4 times a day.   
  • Continue to take your usual diabetes medication, including insulin, even if you are not eating regular meals. If you are taking metformin, and have vomiting or diarrhoea, contact your diabetes care provider about continuing metformin. 
When to seek medical help

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

  • Have ongoing vomiting or diarrhoea.
  • Have high blood glucose levels, continually higher than 15 mmol/L.
  • Have difficulty keeping your blood glucose levels above 4 mmol/L.  
  • Feel dizzy, are drowsy or confused.
  • Develop a fever (usually a sign of infection).

Learn more

The following links provide further information on sick day planning in people with diabetes. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.

Sick days Diabetes Info NZ
Diabetes: Sick-day Plan American Diabetes Association, US 
Sick days & type 1 diabetes Diabetes Australia
Managing sick days for type 2 diabetes NDSS Australia

References

  1. Sick day management for Type 1 and Type 2 in primary care Pharmac
  2. Sick day management General practice management of type 2 diabetes RACGP