How to Manage Diabetes During Illness

Treating a cold, healing from injury, or having surgery is no fun for anyone. For people with diabetes, managing blood sugar (glucose) is an extra concern. The stress of illness or injury can cause blood sugar to rise. It can also make insulin work less well. This can lead to serious problems, including diabetic coma. That’s why it’s important to know what to do when illness strikes.

Manage medicine

When you’re sick, your blood sugar can be high even if you’re not eating much. So you need to take your diabetes medicine on time. You might need to stop taking certain medicines and start an extra medicine. If you take diabetes pills, you may also need to take insulin until you’ve recovered. And if you already take insulin, you may need more than normal. Talk with your healthcare provider.

Monitor glucose

When you’re ill, check your blood sugar often. Have someone help you if you can’t do it. You may need to check ketones, too. Record the results in case you need to report them to your healthcare provider.

Watch food and fluids

Try to follow your diabetes meal plan. Drink plenty of calorie-free fluids, especially water, at least every 15 minutes. These help rid your body of extra glucose. And they prevent dehydration. If you can’t eat solid food, you may need to have some soup or drinks that contain sugar, such as apple juice. You could also try licking a soothing ice pop. Or eat small bits of saltine crackers. Talk with your healthcare provider if you have questions about what you should eat or drink. 

Make a plan

The best way to cope with illness is to make a sick-day plan. Do this before you get sick. Work with your diabetes care team. Find out what type of diabetes medicine to take while sick and how much you will need. Ask how often you should check blood sugar and ketones. Check with your healthcare provider what sugar-free cold medicines are safe for you to take. Write down food and drink choices for when you can’t eat normally. Make sure to have some on hand in case you get sick. Write down the phone numbers of your diabetes care team so that you can reach them quickly if needed. When you're sick, some diabetes care teams want you to call every day for instructions.  

Some people with diabetes keep all of the above information in a special notebook, in a certain place. They let family members or close friends know where it is. This can be very helpful for caregivers (and yourself) to have during an illness. When you're sick, it can be hard to remember phone numbers, provider names, and what your provider has told you to do.

When to get help

According to the American Diabetes Association, you should call your healthcare provider right away if:

  • You feel sleepy and can't think clearly.

  • You can't eat for more than 6 hours and can't keep any food down.

  • You lose 5 or more pounds when you're not trying to lose weight.

  • You have other signs of dehydration, such as dry lips or tongue.

  • Your temperature increases to over 10°F (38°C), or as directed by your healthcare provider.

  • You feel sick or have fever for a few days and aren't getting better. 

  • Your blood sugar stays over 240 mg/dL even with extra insulin. 

  • You have trouble breathing.

  • You have diarrhea or vomiting for more than 6 hours.

  • You have ketones in your urine or your breath smells fruity. 

With a written plan in place, you’ll have peace of mind the next time illness or injury hits.

Online Medical Reviewer: Marianne Fraser MSN RN
Online Medical Reviewer: Raymond Kent Turley BSN MSN RN
Online Medical Reviewer: Robert Hurd MD
Date Last Reviewed: 1/1/2021