When you are sick, it may be challenging to keep your blood glucose under control, as vomiting, nausea, stress hormones, and changes in eating may affect your blood sugar level. The best way to manage your diabetes when you are sick is to have a sick day plan created ahead of time. It is important to discuss a sick day plan with your doctor or health care team so you can be prepared and know what to do when you are sick.
When you are sick, make sure you check your blood sugar regularly, every 2 to 4 hours, even overnight, until levels are back in the target range. In the meantime, drink plenty of sugar-free fluids (250 mL or 1 cup every hour) to prevent dehydration. Eat well-tolerated foods, like crackers, soups, and applesauce, to prevent low blood sugar (hypoglycemia). If you can't tolerate these foods, you need to drink fluids that contain glucose and electrolytes (fruit juice, sports drinks, etc.). You should try to consume 15 grams of carbohydrates every hour. Examples of well-tolerated food that contain about 15 g of carbohydrates include 1 slice of dry toast, 6 to 7 soda crackers, 1 popsicle, or ½ cup of fruit juice.
If you are using insulin, use it as prescribed, but you may need to increase your dose as discussed with your health care team in advance. If you have high blood sugar, test for ketones, a chemical your body produces when there is too much sugar in your blood. Most diabetes medication should be taken as prescribed as your blood sugar rises when you are sick, but some oral medications may need to be stopped if you are unable to drink enough fluid to stay hydrated. Ask your doctor or health care team if any of your medications need to be stopped when you are sick. Do not start on over-the-counter medications on your own, as many medications may affect your blood sugar level. Talk to your pharmacist to see what over-the-counter medications are safe for you.
You should call your physician or primary health care provider if you have:
- blood sugar levels that stay higher than the sick day level your doctor has set for you
- a blood sugar level that remains low (less than 4 mmol/L)
- trouble keeping liquids or solids down
- a fever above 38.3°C (101°F)
- diarrhea or vomiting for more than 6 hours
- symptoms such as confusion, drowsiness, shortness of breath, or sweet-smelling breath
- signs of dehydration
- moderate to large amounts of ketones in the urine
Get plenty of rest. If you need to use a cough or cold medication, be sure to ask your pharmacist to help you make the best choice. Always let your family or friends know you are sick, and ask them to stay with you or check on you while you are managing your sick day.
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