Why is it important to plan for sick days?

If you have diabetes, getting sick can affect your blood sugar. This can happen in different ways:

• As your body fights the illness, it makes hormones that can raise your blood sugar levels. Then, your body needs more insulin to work properly.

• If you are not eating or drinking normally, or if you have vomiting or diarrhea, this can lower your blood sugar levels.

If your blood sugar gets too high, and your body does not have enough insulin, it can lead to a serious condition called "diabetic ketoacidosis." This is an emergency and needs treatment right away. If your blood sugar gets too low, it can cause problems like passing out or seizures.

It is important to be prepared and know what to do if you get sick, even with a minor illness. This includes getting a cold, the flu, COVID-19, or another illness like a stomach bug.

Sick day planning is especially important for people who take insulin or other medicines that need to be adjusted when you are not eating regularly. Some medicines, like sulfonylureas or SGLT2 inhibitors, should be stopped if you are sick and cannot eat or drink enough. If you take medicines for diabetes, make sure you know what they are and how to adjust them if you get sick.

What should I do differently when I am sick?

Your doctor or nurse will give you specific instructions. Your plan will depend on your symptoms, your blood sugar levels, and your diabetes medicines.

Tell your doctor or nurse right away if your blood sugar is higher or lower than usual. They will ask about your symptoms and tell you if you need any treatment besides following your sick day plan.

In general, when you are sick, you should:

• Check your blood sugar more often than usual – For example, you might need to check your blood sugar at least every 2 to 3 hours, even during the night. If you use a continuous glucose monitoring ("CGM") device, this can make it easier to check more often. Keep track of your sugar level each time you check.

• Check your ketones, if your doctor tells you to – Ketones are chemicals that can build up in the blood if the sugar level gets too high. They are a sign of diabetic ketoacidosis, which is a dangerous condition that requires treatment right away.

  You might need to check your ketones if your blood sugar gets above a certain level or if you have symptoms like nausea or vomiting. Most adults use special test strips to check their urine for ketones. In some cases, you can test your blood instead.

• Drink plenty of fluids – It is important to drink plenty of water to stay hydrated. If you cannot eat normally, try to drink some fluids that contain sugar, like juice. These can keep your blood sugar from getting too low. Keep checking your blood sugar often to make sure it does not get too high either.

• Adjust your insulin dose, if needed – If you use insulin shots, keep taking the long-acting insulin on your normal schedule. You might need to decrease your dose if you cannot keep food or drinks down. Keep taking the short-acting insulin only if you can eat and keep food down. You might need to use extra insulin if your blood sugar gets above a certain level. Make sure you know when to do this, which kind of insulin to use, and how much to take.

  If you use an insulin pump, it is important to know what kind you have. For some, you might need to change the amount of insulin the pump delivers every hour or tell it to give you extra doses. Other kinds of pumps can automatically change the insulin amount based on your sugar level.

• Adjust or pause other diabetes medicines, if needed – If you are not eating because you are sick, it is important to temporarily stop certain medicines. These include sulfonylureas, meglitinides, or SGLT2 inhibitors. Metformin and GLP-1 medicines can usually be taken during mild illness, but your doctor or nurse might recommend pausing these if you have nausea, vomiting, or diarrhea. If you are not sure which category your medicine is in, ask your doctor or nurse.

You should also:

• Ask your doctor before taking any over-the-counter medicines. Things like cold and flu medicines can sometimes affect blood sugar levels.

• Avoid exercise if your blood sugar is very high (above 250 mg/dL, or about 14 mmol/L) or if you have ketones in your urine.

How do I plan ahead for a sick day?

You cannot predict when you will get sick. But there are things you can do to be prepared. Knowing your sick day plan will make it easier to do these things when the time comes.

You can also make sure you have certain supplies, including:

• Your blood sugar monitor and extra batteries

• Enough insulin, if you use insulin

• Extra supplies for your insulin pump, if you use one – These include batteries and insulin syringes or pens (in case the pump is not working).

• Ketone test strips, if you use these

• Foods and drinks that are quick sources of sugar

• Glucagon that has not expired – If you keep glucagon at home, make sure it is not expired. Glucagon is used to treat low blood sugar.

• Your doctor's or nurse's contact information

Ask your doctor or nurse about which medicines you should adjust or temporarily stop when you are sick. It is important to plan ahead.

How can I prevent getting sick again?

It is not always possible to prevent illness. But there are some things you can do to lower your risk:

• Wash your hands often, especially if you need to be around people who are sick.

• Get all the vaccines your doctor recommends. These include the COVID-19 vaccine, pneumonia vaccine, and flu vaccine.

When should I call the doctor?

You will get specific instructions about when to call. In general, get help if you cannot get your blood sugar under control or if you continue to have ketones in your urine.

Someone should take you to a hospital or call for an ambulance (in the US and Canada, call 9-1-1) if you have:

• Problems related to high blood sugar or ketones, such as:

  • Feeling very thirsty

  • Urinating a lot

  • Belly pain

  • Feeling very tired or confused

  • Fruity-smelling breath

  • Weight loss

• Problems related to low blood sugar, such as:

  • Still being confused 15 minutes after being treated with a dose of glucagon

  • Passing out with no glucagon nearby

  • Low blood sugar levels even after treatment

Call your doctor or nurse for advice if you have:

• Vomiting or diarrhea that is not getting better

• Any other symptoms that concern you