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Sick Days: How to Manage Your Diabetes

Written by: Melissa Herrmann Dierks , RDN, LDN, CDCES
Sick Days: How to Manage Your Diabetes

Diabetes can be challenging to control when you are sick with a cold or flu. Use the following recommendations as a guide to better manage your blood sugar when ill. To individualize this sick day plan for your specific needs, work with your healthcare team and follow their instructions.

Basics of sick day diabetes management include:

Being prepared

  • Get a yearly flu shot as recommended by the Centers for Disease Control and Prevention (CDC). Talk with your healthcare provider to see if you should receive additional vaccines, such as the pneumonia shot.
  • Work with your diabetes care team to individualize your sick day plan to include information on how to adjust your medications during illness, when to contact your healthcare provider, how to contact the office after hours, and more.
  • Ask your healthcare provider about using over the counter medications such as cough syrup or decongestants and learn about recommended brands. Stock up on approved items so that you will have them if needed.
  • Your healthcare provider may also give you a prescription for medication to treat nausea and vomiting to keep on hand and fill in case you become sick.
  • Make sure to have unexpired ketone testing supplies on hand, including ketone test strips, a compatible ketone meter (if performing a blood ketone test), and a working thermometer.

Stock your pantry

Keeping a sick day box in the pantry can be a big help. It can be especially important for those who live alone, or for times when you become sick during the night or when family members are not available to help.

Find a box or bin and stock it with:

  • Fruit juice
  • Regular soda (not diet)
  • Gatorade
  • Canned soup
  • Regular gelatin (not sugar free)
  • Regular instant pudding
  • Soda crackers
  • Unsweetened applesauce
  • Instant hot cereal
  • Clear broth or bouillon

Testing your blood sugar

Be sure to test often when you are not feeling well, to keep an eye on blood sugar levels. Based on guidelines from the American Diabetes Association (ADA), it is recommended to test:

  • For mild illness, check blood sugar at least every 6 hours. For more severe illness, check every 2-4 hours until results are within range.
  • If blood sugar remains over 250 mg/dL for more than two tests, call your healthcare provider.
  • If taking insulin, check urine ketones and notify your healthcare provider if ketones remain in the moderate to high range for over six hours. Make sure to record each ketone test on your blood sugar log.

Keeping a written blood sugar log is a good practice, especially when you are not feeling well. This will allow you to easily provide your recent blood sugar levels when you call your healthcare provider, without having to look on a meter or CGM memory. It can be hard to remember your numbers when you don’t feel well.

Taking medications as recommended

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends to not skip taking diabetes medications, even if you’re feeling ill. Do not make changes to your medication care plan without talking with your doctor.

  • Take insulin even if you are vomiting or unable to tolerate solid food. Illness can increase your insulin needs. If you are unable to tolerate your regular diet, try starting the sick day diet (discussed below). Follow the instructions that your care team has provided on how to adjust your insulin when ill.
  • Take oral medications. If you are vomiting and the pills will not stay down, call your doctor – they may instruct you to discontinue them or will provide further information on what to do.
  • Use allowed over the counter medications as instructed.

Adjusting your diet and fluid intake

Dietary recommendations

Even if you are vomiting or have diarrhea, it is important to eat and drink to prevent a low blood sugar. If you are unable to tolerate your usual diet, use the foods from your sick day box in the pantry to consume 45 grams of carbohydrate every 3-4 hours. You might want to write down what you consume to help track carbohydrate intake.

Examples of 15 gram carbohydrate portions of sick day foods include:

  • ½ cup fruit juice
  • ½ cup regular (not diet) soda
  • 1 cup Gatorade (regular)
  • 1 cup soup
  • ½ cup regular gelatin (not diet)
  • ½ cup pudding
  • 6 soda crackers (read label for other types of crackers)
  • ½ cup unsweetened applesauce
  •  ½ cup cooked cereal

You can triple the portion of one item or choose different items to equal 45 grams of carbohydrate to consume every 3-4 hours.

Fluid recommendations

In addition, it is important to consume 6-8 ounces of fluid every hour to stay hydrated. Switch between drinks that contain sugar, like regular soda, and sugar-free drinks. You may want to include drinks that contain salt, such as clear broth or bouillon.

If you are unable to tolerate 4 oz of liquid at a time due to vomiting, try a popsicle (regular, not diet),  and aim to consume 1-2 tablespoons of fluid every hour.

Seeking medical care as needed

Call your healthcare professional or visit the emergency room when:

  • You don’t know what to do
  • You can’t keep food or drink down for more than 4 hours
  • You have vomiting or diarrhea that lasts more than 6 hours
  • Blood sugar is over 250 mg/dL for two tests, or less than 70 mg/dL
  • You have a temperature over 101.5°F that lasts more than 24 hours
  • You have other symptoms, like dehydration, severe stomach pain, or trouble breathing
  • You have ketone levels in your urine that are in the moderate to high range

When visiting the emergency room, make sure to take your blood sugar and ketone test log, your medication list, and temperature log.

Being prepared and talking with your healthcare provider to understand your specific sick day guidelines can help make dealing with sick days easier.

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Written by: Melissa Herrmann Dierks , RDN, LDN, CDCES

Melissa Herrmann Dierks RDN, LDN, CDCES is a Registered Dietitian Nutritionist, Certified Diabetes Care and Education Specialist, and Licensed Dietitian Nutritionist in Huntersville, NC with over twenty-five years of professional experience in the field of nutrition and diabetes education. In addition to providing nutrition solutions for adults and children, she provides nutrition communication services to the food and beverage industry and is the owner of Supermarket Savvy. Melissa has held various sales and marketing positions for leading companies in the diabetes space including insulin pump, blood glucose monitor, and diabetes supply distribution companies.

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