Diabetes: Preparing for Sick Days


It’s cold and flu season! If you are a newly diagnosed diabetic and/or are unfamiliar with what to do when you are sick, keep reading. This is important information if you want to keep your blood sugar in check as it can lead to serious complications if not managed appropriately.

When you are sick there are a set of guidelines that can help you manage your blood sugars so that a minor illness does not turn into a hospital visit. Even a minor cold can put the body under stress which raises blood sugar levels. When the body is under stress, hormones are released to help fight off the illness and these hormones raise blood sugar even when we don’t consume carbohydrates. When blood sugar gets too high and insulin cannot keep up, this can result in diabetic ketoacidosis (DKA). This happens more often in type 1 diabetics. In this case, the body’s cells are unable to take in the glucose due a lack of insulin and start to use fat as energy. The breakdown of fat creates ketones and in excess is toxic to humans. You should test for ketones in the urine when blood sugar is over 250 mg/dL, and/or if you are ill, every 4 to 6 hours. If your ketone levels are elevated, you should seek medical assistance as this can be fatal. A more common, but similar, condition that can occur in type 2 diabetics is called hyperosmolar hyperglycemic nonketotic syndrome (HHNS). This happens when blood sugar levels increase and your body attempts to get rid of the excess by dumping it through your urine. This results in frequent trips to the restroom and then you may not go for a long period of time causing you to have very dark urine. Blood sugar levels can reach up to 600 mg/dL in this case. It’s important to consume water even if you don’t feel thirsty to avoid dehydration. To avoid HHNS when you are sick, check your blood sugar more often than scheduled and call your diabetes care team if your blood sugar is above your target range.

Just as your blood sugar can go too high, it can also go too low if you have trouble consuming food. If you are only consuming liquids, make sure some of them have sugar such as fruit juice or regular soft drinks. Alternate between sugar containing beverages and water while continuing to check your blood sugar frequently to make sure you are not going too high or low. When you are sick, symptoms of a high or low blood sugar can oftentimes be masked by the symptoms of being sick.

Be prepared ahead of time and create a plan of action:

  • Keep a journal specifically for sick days where you can write down your blood sugars, ketone levels, carbohydrate intake, and your symptoms. Write down times checked/foods consumed as well.
  • In this same journal, keep phone numbers (including after-hours numbers) of your diabetes care team (endocrinologist, primary care physician, diabetes educator, hospital, etc.).
  • Make sure you have enough diabetic supplies (test strips, ketone strips, batteries for your meter, enough medication/insulin). Keep in mind test strips do expire.
  • Have appropriate non-perishable foods and liquids available (Gatorade, fruit juice, water, crackers, soup).
  • Talk to your diabetes team about adjusting your medication/insulin for when you are sick and when to call in an emergency.
  • Stay up to date on your vaccinations including your annual flu shot!

One more thing to keep in mind. If you are looking for a cough syrup, purchase one that is low in sugar or sugar-free. Your pharmacist will be able to let you know options available. Discussing sick day guidelines with your diabetes team and planning ahead will allow you to rest easy knowing you are prepared when you come down with a cold or the flu.