Sick Days and Diabetes

When you have a cold or flu, or if you have a fever for a day or two, your body needs sugar that it can use for energy to help fight the illness.

If you're feeling too sick to eat, your body will get its energy by releasing blood sugar from stored supplies in the liver, making your blood sugar level rise.

That's why you need to keep taking your insulin or diabetes medication when you're sick to control your blood glucose levels even though you may not be eating or may be eating less than normal.


Maintain Your Insulin Therapy Regimen

Unless your doctor tells you otherwise, continue taking the same number of insulin units you normally would, even if you're sick to your stomach or not eating.

Test and Monitor Your Glucose Levels

Test your blood glucose every two to four hours, unless your doctor tells you otherwise. If your blood sugar readings are well above your normal target levels for two readings in a row, call your doctor. The doctor will need accurate records of your blood sugar readings in order to give you proper treatment advice.

Test and Monitor for Ketones

Be alert for the following symptoms when you're sick:

  • Pains in the stomach

  • Fruity breath

  • Diarrhea

  • Fast breathing

  • Vomiting

These symptoms could mean that your blood sugar levels are dangerously high, which indicate that you could be progressing into a condition called diabetic ketoacidosis (DKA). DKA develops over a period of days, and is the result of the buildup of harmful waste products called ketones in the blood. DKA occurs when not enough insulin is available to break down glucose and the body breaks down only fat instead. Ketones are formed as the fat breaks down, and they climb to dangerous levels in the blood.

To be safe, check your urine for ketones every four hours and report their presence to your doctor immediately. The doctor will need accurate records of your ketone readings in order to give you proper treatment advice.

Maintain Your Diet

Try to eat your usual meals or snacks, if possible. If you can't stick to your usual diet, follow these guidelines for replacement foods:

If your blood glucose
is over 14 while you are sick...
If your blood glucose
is under 4 while you are sick...

Tea with no sugar
Instant broths
Diet drinks

Fruit juice
Ginger ale or cola (not diet)

Or eat:
Ice chips
Sugar-free Jell-O®
Sugar-free ice pops

Or eat:
BD GLucose Tablets
Ice pops (not sugar-free)
Jell-O® (not sugar-free)

If you're having a hard time swallowing, eat soft foods with the same amount of carbohydrates as your regular foods. If you're sick to your stomach or vomiting, drink enough liquids to equal the amount of carbohydrates that you'd normally eat.

Use the list below as a guide:

FoodNormalCarbohydrate grams
Apple or pineapple juice1/2 cup15
Cereal, cooked1/2 cup15
Coffee, tea, bouillon, broth1 cup0
Cream soup, made with milk1 cup27
Cream soup, made with water1 cup15
Gelatin, regular1/2 cup20
Grape or prune juice1/3 cup15
Ice cream, vanilla1/2 cup15
Milk1 cup12
Non-diet soft drink1/2 cup15
Orange juice1/2 cup15
Popsicle ®124
Pudding, regular1/2 cup30
Pudding, sugar-free1/2 cup15
Sherbet1/2 cup30
Soup, thick chunky1 cup20
Soup, thin creamy1 cup15
Sugar1 tsp24
Yogurt, fruit flavored1 cup40-60
Yogurt, plain or artificially sweetened1 cup17

Source: Life with Diabetes; A Series of Teaching Guides, 2 nd Edition

© 2000 American Diabetes Association
Reprinted with permission from The American Diabetes Association.

JELL-O is a trademark of Kraft Foods Holdings, Inc.
POPSICLE is a trademark of Conopco, Inc.

Warning Signs

If you develop any of these symptoms while you're sick, call your doctor immediately:

  • Your blood sugar is over 14 mmol/L for 24 hours.

  • Your blood sugar is over 17 mmol/L for two tests in a row (in a two-to-eight hour period).

  • You find ketones in your urine.

  • You feel sleepier than usual.

  • You have trouble breathing.

  • You can't think clearly.

  • You throw up more than once.

  • You have diarrhea.

  • You have an infection. 

If you have to go to the hospital or emergency room, immediately tell doctors and nurses you have diabetes. Always wear your diabetes identification bracelet or necklace in case you're not able to talk to the doctors or nurses.