How to Manage Your Diabetes When You’re Sick

This information has guidelines for managing your diabetes when you aren’t feeling well. It also explains what to do ahead of time so you have everything you need when you’re sick.

Follow these guidelines if you have:

• A cold
• The flu (influenza)
• An infection
• Any illness, condition, or side effects that make it hard to eat or drink like usual

What to Do Before You’re Sick

It’s very important to plan ahead. Getting ready before you get sick will make it easier to care for yourself when you don’t feel well.

Make a sick day plan

Talk with your diabetes healthcare provider about what to do if you get sick. This is the provider who manages your blood glucose (blood sugar) levels. They can give you a more detailed sick day plan. The plan for when you’re sick should have instructions for:

• When you should contact them.
• How often to check your blood glucose levels.
• How to take your diabetes medications.
• Which over-the-counter medications (medications you buy without a prescription) you can use. Some can raise your blood glucose or affect your usual medications.
• If and when you should test your urine (pee) for ketones.
• When to seek emergency medical help.

Keep a list of all your healthcare providers and their phone numbers. Make sure to include how to contact them after business hours.

Stock up on medications and other supplies

Your blood glucose levels may be higher than usual when your body is under stress, including being sick. You’ll need to manage your diabetes even more carefully than usual.

You may need more medication than usual to keep your blood glucose in your target range, even if you can’t eat or drink. Make sure you always have enough medications and supplies for several weeks or longer. Examples are listed below.

• Diabetes medications and supplies, such as:
  • Oral diabetes medications (diabetes medications you swallow).
  • Injectable diabetes medications (diabetes medications you take as a shot).
  • Insulin pen needles.
• Monitoring supplies, such as:
  • Blood glucose test strips.
  • Lancets.
  • Ketone test strips. You’ll need these if you’re at high risk for diabetic ketoacidosis (DKA) or your diabetes healthcare provider tells you to test for ketones.
• Other medications and supplies, such as:
  • A thermometer.
  • Medications for nausea (feeling like you’re going to throw up) that your care team prescribes.
  • Medications for pain and fevers, such as acetaminophen (Tylenol®) or ibuprofen (Advil® and Motrin®).
  • Medications for diarrhea (loose or watery poop), such as loperamide (Imodium®) or bismuth subsalicylate (Pepto-Bismol® and Kaopectate®).
  • Medications for constipation (having fewer bowel movements than usual), such as milk of magnesia (Phillips’® Milk of Magnesia), polyethylene glycol (MiraLAX®), or bisacodyl (Dulcolax®).
  • Medications for heartburn or upset stomach, such as antacids (Mylanta® or Maalox®).
  Talk with your healthcare provider before taking any over-the-counter medications. Some can affect the way your usual medications work.

Stock up on foods and drinks

You should also have some quick and easy foods or meals. Examples are listed below.

• Saltine crackers or pretzels
• Unsweetened applesauce
• Instant cooked cereals, such as oatmeal or Cream of Wheat®
• Canned soups
• Regular or low-sodium broth from a box, can, or packet
• Instant pudding or premade pudding cups
• Regular gelatin (not sugar-free), such as Jell-O®
• Regular soft drinks, such as ginger ale or Sprite®
• Diet soft drinks (soft drinks without calories), such as diet ginger ale or Sprite Zero Sugar
• Electrolyte drinks with calories, such as Gatorade® or vitaminwater®
• Electrolyte drinks without calories, such as G-Zero or vitaminwater Zero
• Juice boxes or small cans of fruit juice
• Tea
• Nutritional drinks for people with diabetes, such as Glucerna® or BOOST Glucose Control®

What to Do When You’re Sick

• Follow your diabetes healthcare provider’s instructions for how often to test your blood glucose levels.
• Follow your diabetes healthcare provider’s instructions for taking your diabetes medications.
• Get plenty of rest.
• Tell a family member or friend that you’re sick. They can check in with you to make sure you’re OK and help you if needed. Make sure they know where to find the list of your healthcare providers and their phone numbers.

Eating and drinking

Try to keep eating and drinking plenty of calorie-free liquids when you’re sick. If you can’t eat normal meals, take small bites of food and sips of liquids often.

Aim to eat or drink about 50 grams of carbohydrates every 3 to 4 hours when you’re awake. You can see how many carbohydrates are in a serving of a food or drink by checking the Nutrition Facts label (see Figure 1). Nutrition Facts labels can also help you compare the nutritional information for different products.

Preventing dehydration

Dehydration is when there aren’t enough fluids in your body. Being dehydrated, even for less than 24 hours, can lead to kidney failure.

Drinking lots of liquids is one of the most important things to do when you’re sick. Aim to drink around 8 to 10 (8-ounce) glasses (about 2 liters) of liquids every day.

If you have any of the following signs of dehydration, contact your healthcare provider right away. If you’re a patient at MSK and you need to reach a healthcare provider after 5:00 p.m., during the weekend, or a holiday, call 212-639-2000.

• Dizziness, especially when you stand
• Urinating (peeing) less than usual
• Dark, amber-colored urine
• Feeling more thirsty than usual
• Headache
• Muscle cramps
• Dry mouth or cracked lips
• A fast, irregular heartbeat
• Loss of appetite

When to Call Your Healthcare Provider

Call your healthcare provider if:

• You have any signs of dehydration listed above.
• Your blood glucose is less than 70 milligrams per deciliter (mg/dL). For information about managing low blood glucose, read the resource About Hypoglycemia (Low Blood Sugar).
• Your blood glucose is consistently over 250 mg/dL, even after you’ve taken higher doses of medication following your diabetes healthcare provider’s instructions.
• You have a fever above 100.4 °F (38 °C).
• You’ve vomited every time you drank something in the past 4 hours.
• You’ve had vomiting, diarrhea, or both for more than 6 hours.
• You’ve vomited every time you ate something in the past 24 hours.
• You don’t think you can take care of yourself and don’t have anyone to help you.

If you take metformin (Glucophage^®), an SGLT-2 inhibitor medication (Invokana^®, Jardiance^®, Farxiga^®, or Steglatro^®), or a medication that contains metformin or an SGLT-2 inhibitor, call your diabetes healthcare provider if:

• You have vomiting, diarrhea or both that won’t stop.
• You’re eating and drinking much less than usual.
• You’re scheduled for any type of surgery.
• You have an infection.
• You’re taking much less insulin than usual.

When to Go to the Emergency Room

Along with calling your healthcare provider, go to the emergency room if:

• You can’t stay awake or think clearly. If this happens, someone should take you to the emergency room and call your healthcare provider for you.
• Your blood glucose goes too low (less than 70 mg/dL) and you can’t eat or drink to bring it back to a normal level.
• You have any signs of DKA, such as:
  • Fruity-smelling breath with fast breathing or trouble breathing.
  • Abdominal (belly) pain.
  • Confusion.
  • Moderate to high ketone levels in your urine.