Diabetes doesn’t take a day off when you’re sick. Even though you may feel nauseous, tired, or congested, you still have to manage your diabetes. When you’re sick, you have to be even more careful and may even have to work harder to keep your blood sugar within its target range. Your body is stressed out when it’s sick, and in turn, can cause your blood sugar to rise above regular levels. Elevated blood sugars can put you at risk for serious complications including diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome.

Why Your Blood Sugar Spikes When You’re Sick

Whether you have the flu, a cold, or an infection, being sick can cause your blood sugar to rise. As part of the body’s defense mechanism for fighting an illness or infection, it releases more hormones into the bloodstream. The release of extra hormones causes an increase in blood glucose. This spike in blood sugar can be very dangerous for diabetics, specifically those with type 1 diabetes since they are unable to produce insulin. Those without diabetes counteract this spike in blood glucose by producing more insulin to maintain a normal blood sugar level. Unfortunately, diabetics continue to rely on medications such as insulin, even when they are sick, to maintain healthy blood sugar levels.

When the body doesn’t produce enough insulin it will break down fat as fuel, which produces ketones. When too many ketones are produced, they can cause the body to go into diabetic ketoacidosis, also known as DKA. DKA can be very serious and even life-threatening if left untreated. Ketones are expelled in the urine, which is why your doctor may encourage you to test your urine for ketones. If your urine tests positive for moderate to high levels of ketones, you should call your doctor immediately. You will most likely need to seek emergency medical attention at your nearest hospital.

Preparation Is Key

Having diabetes does not make you more likely to get sick, but it does increase your risk of suffering from complications when you do become ill. Having a plan for when you become sick will help manage your blood sugars and decrease your chances of suffering from any major complications. Work with your diabetes care team to prepare a sick day plan. According to the American Diabetes Association (ADA), your plan should be discussed with your doctor prior to becoming sick. It should include information for when you’re sick, such as:

  • How often to test your blood sugar
  • What to do if your blood sugar is higher than normal
  • When to test your ketones and how
  • Which medications to take
  • What to eat
  • When to call your doctor

The ADA suggests that you have this plan in writing, along with your doctor’s contact information. It can be helpful for a family member or friend who is taking care of you when you’re ill.

The last thing you want to do when you’re sick is to go shopping for over-the-counter medications, pick up prescriptions, or find diabetic supplies. With any chronic illness, it is suggested that you have at least two weeks worth of supplies in your home. This helps take any stress off of you if there’s an emergency, such as an earthquake, or if you get sick. Being a diabetic, this should include all your medications, syringes or an insulin pump, and blood glucose monitoring supplies. Depending on how you monitor your blood sugar, this can include test strips, lancets, and batteries for your glucometer, or an extra sensor and batteries for your continuous glucose monitor.

It can also be helpful to have simple over-the-counter medications and supplies at your home for when you become sick. Antacids, antidiarrheals, and cough medicine are a few items healthcare providers suggest having on hand. Your doctor may also encourage you to pick up an at-home ketone test kit, which can help test for ketones in your urine. Ketones in your urine can indicate diabetic ketoacidosis, or DKA, which is a serious yet treatable complication seen in diabetics.

Sick Day Rules

Always listen to your healthcare provider and diabetes care team, but there are some general guidelines that experts agree on when it comes to managing your blood sugars when you’re sick.

Take Your Medications

You should continue to take all diabetes medication as prescribed. It may be tempting to lower your insulin dose or stop your oral diabetic medications because you may be vomiting or not eating as much. It is important to continue to take your insulin and medications, as usual, to help manage your blood glucose. Since your blood sugars can spike when you’re ill, stopping or changing the dosages of your medications can cause serious complications.

If you feel uneasy about your medications, or your blood sugars have been outside of your target range, contact your healthcare provider to discuss adjusting your insulin dose and other medications based on blood sugar test results.

Person injecting insulin pen

Check Your Blood Sugar Levels Regularly

When you’re sick, blood sugars can become extremely difficult to manage. The stress of being ill can cause the body to expel more glucose into the bloodstream. This will cause blood sugar to spike in ways that you may not have experienced previously. As a result, you should test your blood sugar more often when you’re sick. Health professionals suggest checking your blood glucose every 4 hours, even when you’re sleeping, to ensure your blood sugars are maintained within your target range. If your blood glucose does spike over 300 mg/dL, the ADA recommends also checking for ketones in your urine, which can indicate whether or not you are in diabetic ketoacidosis.

Checking Blood Sugar Levels

What To Eat When You’re Sick

Eating may be the last thing you want to do when you’re sick, but it’s important to continue fueling your body. Appetite loss and nausea are common symptoms that can make eating difficult or nearly impossible. The ADA recommends taking in roughly 50 grams of carbohydrates every three to four hours, which may be quite tricky. Try eating foods that are easy on the stomach such as soups, crackers, applesauce, and Jell-O. Solid foods may be difficult to stomach, so liquids high in carbohydrates can be very beneficial, such as popsicles, pudding, and juice.

Stay Hydrated

As with anyone, it is important to stay hydrated while you’re sick as vomiting and diarrhea can quickly lead you to become dehydrated. Diabetics should be extra vigilant about staying hydrated when ill because the higher blood sugars can increase urination, increasing your risk of becoming dehydrated. Because your blood sugar tends to be higher when you’re sick, it is best to drink calorie-free liquids. To keep you from getting dehydrated, it is best to drink at least 8 ounces of caffeine-free liquid every hour while you’re awake. Good drink choices include:

  • Water
  • Club soda
  • Diet soda
  • Tomato juice
  • Chicken broth

Male Senior drinking water

It is possible to see your blood sugar drop, especially if you take insulin. In this case, you can raise your blood sugar by drinking fluids with some extra carbohydrates such as:

  • Apple juice
  • Orange juice
  • Sports drinks
  • Tea with honey
  • Ginger ale

Be Cautious About Over-The-Counter Medications

When choosing over-the-counter medications, be sure to follow your doctor’s recommendations. Cough syrup can be loaded with extra sugar, which can cause your blood glucose to spike even more. Other ingredients found in decongestants can also cause blood sugar and blood pressure to increase. It is important to work with your doctor or pharmacist to ensure you are taking safe medications for both your illness and diabetes.

Follow Your Healthcare Provider’s Advice

As everyone’s health is different, it is important to work closely with your diabetic care team in managing your chronic condition. Your doctor can help guide you to determine your blood sugar target range and how to maintain that level, especially when you’re sick. Whether it’s using insulin regularly, taking oral medications, or managing your diet, your health team knows you best and can help you make those decisions if the time comes. It is important to follow all instructions from your care team. If you don’t already have a sick plan in place, work with your provider at your next appointment to make sure you are prepared if you do fall ill, whether it be from the flu, a cold, or Covid-19.

Doctor writing prescription

Keep a Record

Brain fog from being sick and exhausted is common, which is why it is suggested to keep a record of a few important items. The most vital thing to track is your blood sugars along with what medications you took and when. Days and times may not be very clear when you’re sick in bed all day, so you should document when and how much insulin you give yourself. It is possible you can become confused and administer two doses of insulin because you forgot if or when you gave yourself the first dose. This mistake could drop your blood sugar to life-threatening levels. It can also be beneficial to record what and when you eat to help maintain your blood sugars within your target range.

Lastly, the ADA suggests tracking your weight when you’re sick. Your cells feed on glucose. But when sugar sits in your blood, known as high blood sugar, instead of your cells, your cells start to think they are starving. In turn, they eat fat and muscle for nutrients, causing you to lose weight quickly. A sudden, unintentional weight loss of more than five pounds can indicate a serious complication such as DKA.

When to See a Medical Provider

It is important to understand the signs associated with dangerous diabetes complications such as diabetic ketoacidosis. Don’t ignore the following symptoms and call your doctor or seek medical attention as soon as possible. If you are in DKA, you will most likely need to get treated at the nearest hospital.

  • Your blood sugar is consistently over 240 mg/dL
  • Your blood sugar is less than 60mg/dL
  • Your urine tests positive for moderate to a large amount of ketones
  • You are urinating excessively
  • You have a dry mouth
  • You are vomiting or have severe diarrhea for more than 6 hours
  • You have abdominal pain
  • You are confused or suffer any loss of consciousness
  • You have trouble breathing
  • You lose five pounds or more during your illness
  • You have a temperature over 101 degrees F for more than one day

Doctor measuring patients blood pressure

Your sick day plan should state when you or your caregiver should call your doctor. Even if you aren’t experiencing any of the above symptoms, call your doctor anytime you aren’t confident in how to care for yourself.

Diabetes doesn’t take a sick day. Unfortunately, even if you are sick, you still have to care for your chronic condition.Follow these key steps to ensure your sick day passes without trouble:

  • Take all diabetes medication as prescribed, including insulin
  • Test your blood sugar more often throughout the day, at least every 4 hours
  • Stay hydrated with calorie-free liquids
  • Try to eat as you normally would, or at least eat small, frequent meals throughout the day