Sick Day Management for Diabetes

Written By Orlando Li

Being sick with a cold, flu, or infection can affect your blood glucose.
Before you get sick, create a written sick-day plan with your diabetes healthcare team so you can refer to it during illness.

Why do blood glucose values go up when I am sick?

Your body is under stress when you are sick. Stress hormones raise glucose levels. Your body may also become less sensitive to insulin, so you may need more support than usual to manage blood sugar.

What should I always keep on hand for a sick day?

  • Glucose testing kit and strips or CGM sensors

  • Ketone testing supplies (if recommended by your care team)

  • Plenty of water or sugar-free beverages

  • Any diabetes medications and/or insulin you currently use

What should I do when I am sick?

  • Continue taking your diabetes medications.
    If you use insulin, continue your long-acting/basal insulin even if not eating much.

  • Check blood glucose every 3–4 hours.
    If using a CGM, watch trends and ensure correction doses are working.

  • Check ketones if recommended or if blood glucose is consistently high.

  • Stay hydrated: drink fluids every hour (tea, water, broth, diet soda).

  • Try to eat some carbohydrates, even with a reduced appetite.

When should I call for medical help?

Call your doctor or diabetes team if:

  • You’ve been sick or have a fever for a few days and aren’t improving

  • Vomiting or diarrhea lasts more than 6 hours

  • You have moderate or high ketones

  • Blood glucose stays above 240 mg/dL despite taking medication/insulin

  • You aren’t sure what to do next

When should I get emergency help (911 or ER)?

Seek emergency care if you have vomiting or diarrhea AND any of the following:

Possible signs of diabetic ketoacidosis (DKA):

  • Very thirsty / dry mouth

  • Frequent urination

  • Nausea or vomiting

  • Drowsiness or confusion

  • Deep breathing

  • Fruity smell on the breath

  • Stomach pain

  • Coma if untreated

Reminder

Sick-days make diabetes harder to manage.
Contact your healthcare team if you have questions about blood glucose, ketones, or medication adjustments.

Source: ADCES – Association of Diabetes Care & Education Specialists
https://www.adces.org/docs/default-source/handouts/lifestyle/handout_pwd_lifestyle_sickday_adult.pdf

Orlando Li
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