Step-by-Step: Your Diabetes Sick Day Plan

If you have diabetes, you need a sick day plan. It can help stop a mild illness from turning into a major health problem.

You don't feel like doing much of anything when you're sick. This is your body's way of telling you to take it easy. But even though you may not feel up to it, you still need to follow your diabetes care plan.

If you don't carefully manage your blood sugar when you're ill, you could end up with a much more serious health condition. Following a diabetes sick day plan may help prevent complications.

Diabetes and illness

When you're sick, your blood sugar is often higher. This is because the body releases hormones to help cope with the stress of illness. Sometimes these hormones can reduce the effectiveness of insulin and cause blood sugar and possibly ketone levels to spike.

When you are ill, you are at increased risk of getting:

• Diabetic ketoacidosis. This occurs most often in people with type 1 diabetes. It can also rarely happen in someone with type 2 diabetes. When you are sick or your blood sugar is high for some other reason, dangerous compounds called ketones can build up in your body. It can come on quickly, within hours.
• Hyperosmolar hyperglycemic state (HHS). This happens more frequently in people with type 2 diabetes. HHS is dangerously high blood sugar levels without the presence of ketones. It usually takes days or weeks to develop.

These conditions are caused by having too little insulin in your body. You develop very high blood sugar levels and become severely dehydrated quickly. This can lead to seizures, shock, coma and even death.

Benefits of having a plan

It can be a challenge to keep blood sugar levels under control when you're sick. Having a plan in place to manage your diabetes on sick days will help you:

• Keep blood sugar and ketone levels under control.
• Spot signs of a blood sugar emergency early so you can get prompt medical care.
• Ease your mind when you become sick. The stress of being sick adds to difficultly to control blood sugar.

1. The plan
   Create your personal sick day plan before you get sick. Meet with your doctor to outline the specifics of your plan as soon as you're diagnosed with diabetes. The plan will include such things as how often to check blood sugar and if and when to check for ketones. Consider these factors when developing a plan with your doctor:
   • Check your blood sugar levels often. You will have to monitor your blood glucose levels more closely when you are sick. Check blood sugar every four hours or as frequently as your doctor suggests.
   • Test for ketones as directed by your doctor. Some doctors advise testing when blood glucose levels are above 240 mg/dL. Check for ketones using urine testing products that are made for measuring ketones.
   • Keep taking your insulin and medication as prescribed. Do not stop taking your insulin or diabetes medicines when you're sick — even if you are vomiting — unless your doctor instructs you to do so. You may actually need to take extra insulin when you're fighting illness. Do not take more unless your doctor tells you to do so, though.
   • Eat regularly, even if you have no appetite. Try to eat as closely to your normal eating times as possible. Aim for 50 grams of carbohydrates every three to four hours. This will help keep your blood sugar levels stable. Soup may be a good option if you feel queasy.
   • Take in plenty of fluids, especially if you're vomiting or have diarrhea or a fever. You can easily become dehydrated if you do not drink enough liquids. If you have an upset stomach, sip fluids slowly.
   • Be wary of over-the-counter (OTC) medicines. Some medicines you might take for an illness can affect blood sugar levels. Ask your doctor which ones are safe options for you.
      
2. Know when and where to get help
   Call your doctor right away* if you:
   • Can't take your oral medications or have diarrhea for more than 6 hours
   • Test positive for a moderate to high level of ketones
   • Have a blood sugar reading above 240 mg/dL
   • Have a fever higher than 101 degrees for 24 hours
   • Have very low blood sugar levels
   • Can't or don't know how to take care of yourself
   • Do not feel better after a few days of being sick
   • Extreme thirst or dry mouth
   • Frequent urination
   • Lack of appetite
   • Nausea, vomiting or stomach pain
   • Dry or flushed skin
   • Fruity smelling breath

   Ask your doctor when you should call if you are pregnant and have diabetes, as he or she may want you to call sooner.

   Go to the emergency room or seek emergency care if you are sick and have any of the following symptoms of ketoacidosis or HHS:

   Call 9-1-1 if you:

   • Are having any trouble breathing or visual problems
   • Are confused, dizzy or lightheaded
   • Have passed out or had a seizure
      
3. A word on prevention
   Of course, the best plan is to not get sick in the first place. To help you stay well, make sure to get your flu shot every year and ask your doctor if you need the pneumonia vaccine. Ask your doctor as well about other vaccines, such as one against hepatitis B. Wash your hands regularly and avoid other people who are sick. Managing your diabetes well and keeping blood sugar levels in check are also essential for good health.

Even if you take these precautions, you may still get sick every now and then. So, it's best to have your diabetes sick day plan ready.

By Jenilee Matz, MPH, Contributing Writer

Sources
American Diabetes Association. When you're sick. Accessed: October 13, 2015.
Centers for Disease Control and Prevention. Sick days. Accessed: October 13, 2015.
Centers for Disease Control and Prevention. Stay well in flu season. Accessed: October 13, 2015.

Last Updated: October 19, 2015