Why You Need a Diabetes Sick Day Plan, and the 7 Things to Make Sure It Covers

Being under the weather can throw your diabetes management out of whack. A sick day plan can help you avoid serious complications.

When you get sick from a bad cold or other illness, your body reacts to this stress by raising levels of hormones to fight it off. Unfortunately, your body’s response to fighting off germs can also raise your blood sugar and potentially lead to diabetes complications. You can’t predict when an illness is going strike, but you can be prepared with a diabetes sick day plan.

Why Do You Need a Sick Day Plan?

People with diabetes are not only more likely to get infectious diseases than people without diabetes, but they’re also more likely to have more serious complications from those illnesses. People with diabetes are at a greater risk of pneumonia or bronchitis after developing the flu, for example.

Usually being sick means spending a few days snuggled on the sofa with a box of tissues, taking some pain relievers, and slurping bowls of chicken noodle soup, but the stakes are higher when you have diabetes. Blood sugar spikes related to fighting off an infection can make it harder to keep your blood sugar in the target range. Being sick also increases your risk of developing a life-threatening complication called diabetic ketoacidosis, according to the American Diabetes Association. (Learn more about diabetic ketoacidosis symptoms here.)

Having a sick day plan will help you manage your blood sugar, adjust your medications if necessary, and ensure you know when to seek medical attention. A diabetes sick day plan can also provide a sense of security for you and your family members.

How Do You Create a Sick Day Plan?

When an illness hits, you feel tired and uncomfortable. You want to hibernate until it passes—the last thing you want to worry about is your diabetes management. Having a sick day plan in place *before* you get sick is a proactive approach that pays off. Of course, you’ll want to talk to your doctor about a specific sick day plan for your needs, formulating a sick day plan should generally include the following information, accordinh to Akankasha Goyal, MD, an endocrinologist at NYU Langone Medical Center. Ask your doctor to answer these questions to determine your diabetes sick day plan:

  1. How often should I check my blood sugar?
  2. What is an acceptable blood sugar reading when I'm sick?
  3. How should I manage high blood sugar levels?
  4. How should I adjust my medication if I'm vomiting or skipping meals?
  5. When should I check my urine for ketones (a sign of ketoacidosis)?
  6. When should I call the doctor?
  7. Are there any other sick day rules I should follow?

Managing Your Blood Sugar When You're Sick

To keep track of fluctuating blood sugar levels when you’re sick, be prepared to test your blood sugar more often than you usually do. “Individuals with diabetes should check their blood glucose more frequently when glucose is elevated; every two to four hours,” say diabetes educators Lisa Muras, RD, and Nadine Jakim Young, RD, who run clinics to help people lower their A1C levels at the Virginia Hospital Center, in Arlington, Virginia.

In addition, Dr. Goyal advises people on insulin therapy to check their blood glucose in the morning after fasting, before each meal, and if they have any possible symptoms of hypoglycemia, such as feeling lightheadedness, shakiness, nausea, sweating, vomiting, or mental confusion.

Keep an Eye on Ketones

When you burn fat for energy, the fat breaks down into components called ketones, which are acids. When you’re ill, an increase in stress hormones such as cortisol and adrenaline counter the effect of insulin, which makes your body more likely to burn fat for energy and thus create more ketones. The ketones pour into the blood and sometimes urine.

High levels of ketones cause the blood to become acidic and can lead to diabetic ketoacidosis, a serious and sometimes life-threatening condition. Ketoacidosis is more common in type 1 diabetes, as the body already produces little or no insulin. Symptoms of diabetic ketoacidosis include nausea, fruity breath, vomiting, excessive thirst, loss of appetite, and fatigue.

Keep a supply of ketone test strips on hand. If your blood glucose ever measures above 250 mg/dL, check your ketones. After testing, compare the color on the stick with the color chart included with the test. If testing indicates your ketone levels are high, call your doctor. They may want to see you in the office; if they’re very high, you may need treatment in the hospital to deliver fluid, insulin, and electrolytes to bring your levels down.

What to Eat When You're Sick with Diabetes

Sometimes when you’re sick you just don’t have much of an appetite, but it’s important to avoid skipping meals when you have diabetes, especially if you’re taking medication to manage your diabetes. (Here are other healthy eating rules for diabetes.)

“Try to stick to your meal plan and consume a similar amount of carbohydrates across meals and snacks,” say Muras and Young. “If your appetite is poor, try soups, broth, toast, crackers, and soft foods such as applesauce, pudding, or Jello-O.”

On the other hand, if you’re nauseous and unable to keep any solid food down, drink fluids that contain sugar such as juice or sports drinks, or suck on ice pops. “Try to take in 15 grams of carbohydrates every hour. A half cup of fruit juice such as apple or orange juice equals 15 grams of carbohydrates,” say Muras and Young.

Keep Drinking Fluids

It’s no secret how important it is to drink fluids when you’re sick (just ask any mom or grandma!), but when nothing seems to taste good, it’s hard advice to, um, swallow. But adequate fluid intake is essential to prevent dehydration (which can contribute to high blood sugar), especially if you’re experiencing vomiting or diarrhea.

Plain ole water just doesn’t have that comfort feel you crave when you’re sick but it’s important to drink to keep blood sugar levels from rising even further. “Alternate between a sugar-free beverage and sugar-sweetened beverage, such as juice or a sports drink. Sugar-free ice pops are also an option if water is not appealing,” say Muras and Young.

Managing Your Diabetes Medications When You're Sick

While your doctor will provide specific guidance and adjustments, for the most part you’ll stick to your usual medication regimen when you’re sick, says Dr. Goyal. “You need them because your body makes extra glucose when you are sick. Some medications such as SGLT-2 inhibitors may be held in cases of nausea or vomiting,” he notes. If you have type 1 diabetes, you may have to take extra insulin to bring down high blood glucose levels. If you have type 2 diabetes and take diabetes meds, you can usually still take those, but you may need to use insulin for a short time to manage elevated blood sugar, if your doctor advises.

Taking OTC Medications with Diabetes

Talk to your doctor before you take any OTC meds, because they could have side effects you’re not aware of. “Several over-the-counter medicines such as decongestants and cough medications contain sugar,” says Dr. Goyal. “Small doses of medicines with sugar are usually OK but always ask the pharmacist about sugar-free options.”

One way to avoid some sugar is to take pills instead liquids or syrups that can contain sugar, says Papatya Tankut, registered pharmacist, and vice president of Pharmacy Affairs for CVS Health. If you have difficulty taking pills, ask your pharmacist to help you identify a liquid medication that is sugar-free.

Luckily, more products are clearly labeled “sugar-free” or “diabetic care” to make the search less confusing. In addition, avoid medicines with high alcohol content, as that isn’t safe when your blood glucose levels aren’t stable.

Taking Antibiotics with Diabetes

Some antibiotics can impact blood glucose levels in people with diabetes, though the risk is relatively low. One example is fluoroquinolones, a category of antibiotics that are commonly used to treat urinary tract infections and certain cases of pneumonia. Prescriptions including Cipro, Levaquin, and Avelox all fall under this family of antibiotics. “People with diabetes should consult their doctor to determine whether it is safe for them to take these drugs,” says Tankut.

When to Call Your Doctor When You're Sick

Waiting out a fever or hanging tough may not be the safest course when you’re sick and have diabetes. If you’re ever unsure of how to manage your diabetes when you’re sick, call your doctor. These are some clear signs that it’s time you call the doctor right away:

  • Vomiting or diarrhea that lasts longer than six hours
  • Blood glucose levels greater than 250 mg/dL before meals and remain high for 24 hours
  • Blood glucose levels greater than 400 mg/dL or less than 70 mg/dL
  • Symptoms of ketoacidosis and/or moderate or large levels of ketones in your urine
  • You don't have a sick day plan and are unsure of how to take care of yourself