How to Manage Diabetes When You’re Sick

This information has guidelines for managing diabetes when you are not feeling well. It also explains what to do ahead of time, so you have everything you need when you’re sick.

Follow these guidelines if you have:

• A cold.
• Influenza (the flu).
• An infection.
• Any illness, condition, or side effects that make it hard to eat or drink like usual.

What to do before you’re sick

It’s very important to plan ahead. Getting ready before you get sick will make it easier to care for yourself when you don’t feel well.

Make a sick day plan

Talk with your diabetes healthcare provider about what to do if you get sick. Your diabetes healthcare provider is the provider who manages your blood glucose (blood sugar) levels. They can give you a more detailed sick day plan.

• When you should contact them.
• How often to check your blood glucose levels.
• How to take your diabetes medicine.
• Which over-the-counter medicine you can use. Some can raise your blood glucose or affect your usual medicine. Over-the-counter medicine is medicine you buy without a prescription.
• If you should test your urine (pee) for ketones and when to test it.
• When to get emergency medical help.

Keep a list of all your healthcare providers and their phone numbers. Make sure to include how to contact them after business hours.

Stock up on medicine and other supplies

Your blood glucose levels may be higher than usual when your body is under stress. This includes being sick. You’ll need to be even more careful than usual to manage diabetes.

It’s important to keep your blood glucose in your target range, even if you can’t eat or drink. The target range is when your glucose is not too high or too low. You may need more medicine than usual to do this.

Make sure you always have enough medicine and supplies for several weeks or longer. Examples are listed below.

• Diabetes medicine and supplies, such as:
  • Oral diabetes medicine. This is diabetes medicine you swallow.
  • Injectable diabetes medicine. This is diabetes medicine you take as a shot.
  • Insulin pen needles.

• Other medicine and supplies, such as:
  • A thermometer.
  • Medicine for nausea (feeling like you’re going to throw up) that your care team prescribes.
  • Medicine for pain and fevers. Examples include acetaminophen (Tylenol®) or ibuprofen (Advil® and Motrin®).
  • Medicine for diarrhea (loose or watery poop). Examples include loperamide (Imodium®) or bismuth subsalicylate (Pepto-Bismol® and Kaopectate®).
  • Medicine for constipation (having fewer bowel movements than usual). Examples include milk of magnesia (Phillips’® Milk of Magnesia), polyethylene glycol (MiraLAX®), or bisacodyl (Dulcolax®).
  • Medicine for heartburn or upset stomach. Examples include antacids (Mylanta® or Maalox®).

Talk with your healthcare provider before taking any over-the-counter medicine. Some can affect the way your usual medicine works.

Stock up on foods and drinks

You should also have some quick and easy foods or meals. Examples are listed below.

• Saltine crackers or pretzels.
• Unsweetened applesauce.
• Instant cooked cereals, such as oatmeal or Cream of Wheat®.
• Canned soups.
• Regular or low-sodium broth from a box, can, or packet.
• Instant pudding or premade pudding cups.
• Regular gelatin (not sugar-free), such as Jell-O®.
• Regular soft drinks, such as ginger ale or Sprite®.
• Diet soft drinks (soft drinks without calories). Examples include diet ginger ale or Sprite Zero Sugar.
• Electrolyte drinks with calories. Examples include Gatorade® or vitaminwater®.
• Electrolyte drinks without calories. Examples include G-Zero or vitaminwater Zero.
• Juice boxes or small cans of fruit juice.
• Tea.
• Nutritional drinks for people with diabetes. Examples include Glucerna® or BOOST Glucose Control®.

• Follow your diabetes healthcare provider’s instructions for how often to test your blood glucose levels.
• Follow your diabetes healthcare provider’s instructions for taking your diabetes medicine.
• Get plenty of rest.
• Tell a family member or friend that you’re sick. They can check in with you to make sure you’re OK and help you if needed. Make sure they know where to find the list of your healthcare providers and their phone numbers.

Eating and drinking

Try to keep eating and drinking plenty of calorie-free liquids when you’re sick. If you can’t eat normal meals, take small bites of food and sips of liquids often.

Aim to eat or drink about 50 grams of carbohydrates every 3 to 4 hours when you’re awake. Check the nutrition facts label (see Figure 1) to see how many carbohydrates are in a serving. Nutrition facts labels can also help you compare the nutritional information for different products.

Preventing dehydration

Dehydration is when there aren’t enough fluids in your body. Being dehydrated can lead to kidney failure, even if it’s for less than 24 hours.

Drinking lots of liquids is one of the most important things to do when you’re sick. Aim to drink around 8 to 10 (8-ounce) glasses (about 2 liters) of liquids every day.

• Dizziness, especially when you stand.
• Urinating (peeing) less than usual.
• Dark, amber-colored urine.
• Feeling more thirsty than usual.
• Headache.
• Muscle cramps.
• Dry mouth or cracked lips.
• A fast, irregular heartbeat.
• Loss of appetite.

When to call your healthcare provider

Call your healthcare provider if:

• You have any signs of dehydration listed above.
• Your blood glucose is less than 70 milligrams per deciliter (mg/dL). Read About Hypoglycemia (Low Blood Sugar) to learn more about how to manage low blood glucose.
• Your blood glucose stays over 250 mg/dL, even after taking higher doses of medicine following your diabetes healthcare provider’s instructions.
• You have a fever of 100.4 °F (38 °C) or higher.
• You’ve vomited every time you drank something in the past 4 hours.
• You’ve had vomiting, diarrhea, or both for more than 6 hours.
• You’ve vomited every time you ate something in the past 24 hours.
• You don’t think you can take care of yourself and don’t have anyone to help you.

• Metformin (Glucophage®).
• An SGLT-2 inhibitor medicine. Examples include:
  • Invokana®
  • Jardiance®
  • Farxiga®
  • Steglatro®.
• A medicine that has metformin or an SGLT-2 inhibitor in it.

Call your healthcare provider if you take one of the medicines listed above and:

• You have vomiting, diarrhea, or both that won’t stop.
• You’re eating and drinking much less than usual.
• You’re scheduled for any type of surgery.
• You have an infection.
• You’re taking much less insulin than usual.

If you’re a patient at MSK and you need to reach a healthcare provider after 5 p.m., during the weekend, or a holiday, call 212-639-2000.

Call your healthcare provider and go to the emergency room if:

• You cannot stay awake or think clearly. If this happens, someone should take you to the emergency room and call your healthcare provider for you.
• Your blood glucose goes below 70 mg/dL and you cannot eat or drink to raise it to a normal level.
• You have any signs of DKA, such as:
  • Fruity-smelling breath
  • Fast breathing or trouble breathing.
  • Abdominal (belly) pain.
  • Feeling confused.
  • Moderate to high ketone levels in your urine.