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.
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.
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.
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: