Sick day plan for people with type 2 diabetes

If you have type 2 diabetes and are unwell with the flu, gastro, or other infections (including COVID-19), you need to take extra care. Work with your healthcare provider to create a sick-day plan, so you know what to do.

Key points about having a diabetes sick day plan

  1. Be prepared have a sick day plan ready before you get unwell.
  2. Avoid dehydration –  keep drinking water and eat normally if you can.
  3. You may need to stop certain diabetes or blood pressure medicines for a few days while you are unwell (see below).
  4. Know how and when to check your blood glucose levels.
  5. Ask for help from a whānau member or a friend and seek urgent medical care if needed. 

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 eating less than usual. But some people who are taking medicines for diabetes may have low blood glucose (hypoglycaemia) when they are unwell. This can make blood glucose levels difficult to manage. Knowing what to do in advance may help you recover faster.

Always let someone know you are not well 

Reach out to a whānau member or friend, and let them know you are unwell and that you are taking medication for type 2 diabetes. Ask them to check on you regularly and tell them who they can contact for you if necessary. 

If you develop the following, call your doctor, nurse or diabetes clinic or go to your closest hospital emergency department
  • have ongoing vomiting (being sick) or diarrhoea (runny poos) especially if it lasts for more than 2 hours
  • have blood glucose levels that remain higher than 20 mmol/L
  • have blood glucose levels that are below 4 mmol/L
  • feel dizzy, drowsy or confused
  • develop a fever (usually a sign of infection).

If you are significantly unwell call 111 for help.

Stay hydrated

Keep your fluids up by drinking water to avoid dehydration (your body getting dry). Try to have at least one glass (200 mL) every 1–2 hours. Dehydration can happen very quickly, especially if you have vomiting (being sick) and diarrhoea (runny poos).

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.

Know how to manage your diabetes medicines

Your sick day plan should include specific advice about how you should manage your diabetes medicines when you are unwell. If you are not drinking and eating as usual, or have vomiting, and diarrhoea your diabetes medication may need adjustment. It is important to contact your healthcare provider for advice if you are unsure about what to do. The following is a guide.

Guidance on how to manage your diabetes medicines when you are unwell

Insulin

Never stop your insulin: If you are unable to eat or drink, call your healthcare provider to decide if you should reduce your dose. It is important that you never stop taking your insulin without advice from a health care professional.

Monitor your blood glucose: If you have access to blood glucose monitoring, measure your blood glucose levels 3–4 times a day, or immediately if you have signs or symptoms of high blood glucose levels (hyperglycaemia) or low blood glucose levels (hypoglycaemia).

If you DO NOT have access to blood glucose monitoring, look out for symptoms of high blood glucose levels. These include thirst, passing more urine (pee) than usual and tiredness.

Empagliflozin (Jardiance and Jardiamet)

Stop taking empagliflozin if you are unwell, irrespective of your symptoms. Taking empagliflozin when you are unwell increases your risk of high ketones levels, which can cause a serious but rare side effect called ketoacidosis.

If you develop symptoms of ketoacidosis such as nausea (feeling sick), vomiting (being sick) or tummy pain go to your GP, after-hours medical centre or hospital immediately for a finger prick blood test to check your ketone levels. Only restart your empagliflozin when you are well AND eating and drinking normally.

Glipizide, gliclazide and glibenclamide

If you are not eating well regardless of type of illness, stop taking glipizide, gliclazide and glibenclamide – you are at increased risk of low blood glucose (hypoglycaemia). Restart when you are well (usually after 24–48 hours of eating and drinking normally).

Metformin, vildagliptin (Galvus and Galvumet) and acarbose

Only stop metformin, vildagliptin and acarbose if you have severe gastro, such as vomiting and diarrhoea (multiple episodes, or lasting more than a few hours), and are at risk of dehydration. Restart when you are well, usually 24–48 hours after your gastro symptoms have cleared.

Dulaglutide (Trulicity)

Dulaglutide is given as a once weekly injection. It usually does not cause problems if your are slightly unwell, but if you are at risk of dehydration, with vomiting and diarrhoea and not eating and drinking as usual, you can withhold the next injection when it is due.

Take care with other medicines as well

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. 

Blood pressure medicines

Many people who have diabetes are also on blood pressure medicines. Some of these medicines (eg, cilazapril, quinapril, lisinopril, perindopril, candesartan and losartan) should be stopped for a few days if you are at risk of dehydration. Talk to your healthcare provider about what to do about your blood pressure medicines when you are sick.

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.

References

Credits: Sandra Ponen, Pharmacist. Reviewed By: Dr Ryan Paul, Endocrinologist, Hamilton Last reviewed: 14 Feb 2022