You Need a Sick-Day Plan If You Have Diabetes

Getting sick with a cold, flu, or stomach bug can make managing blood sugar (glucose) more difficult for people with type 1 or type 2 diabetes.

When you’re sick, your immune system works harder, and hormones like cortisol and adrenaline can raise blood sugar levels. Symptoms you experience, like a fever, congestion, vomiting, or diarrhea, may reduce your appetite and increase the risk of dehydration, too.

For people with diabetes, illness can also raise the risk of diabetic ketoacidosis (DKA). DKA is a medical emergency that requires hospitalization.

The good news: with preparation and the right steps, you can keep your blood glucose in range and recover from being sick safely.

1. Monitor Your Blood Glucose Closely

While you’re sick, check your blood sugar every 2–4 hours, or as directed as your care provider, including at night. This will help you stay on top of highs or lows.

Test your urine or blood for ketones:

• If you have type 1 diabetes, and your blood sugar is higher than mg/dL or if you feel nauseated or unwell
• If you have type 2 diabetes, and your blood sugar stays high or if you have any symptoms of DKA. These include nausea, vomiting, stomach pain, fruity-smelling breath, rapid breathing, and confusion.

2. Know When to Call Your Care Team

Contact your healthcare provider if you have:

• Blood glucose higher than 200 mg/dL that doesn’t come down
• Moderate to large amount of ketones
• Vomiting or diarrhea for more than 2 hours
• Fever over 101 degrees Fahrenheit that doesn’t improve
• Trouble breathing or confusion
• Symptoms of DKA as noted above. DKA requires immediate medical care.

3. Continue Taking Your Diabetes Medications

Don’t stop taking insulin unless your healthcare provider advises it. Even if you’re eating less, your body still produces glucose during illness. Work with your care team to adjust doses if needed.

4. Stay Hydrated

Aim to drink 8 ounces of fluid every hour while you’re awake. Choose water, clear broth, or herbal tea for hydration without raising your blood sugar.

If you can’t eat, sip carbohydrate-containing fluids (diluted juice, sports drinks, or regular soda) to prevent low blood sugar.

If you’re able to eat, try foods that are gentle on the stomach, like applesauce, oatmeal, scrambled eggs, or toast.

5. Set Sick-Day Rules in Advance

Work with your provider to outline the guidelines you’ll follow when you’re sick. This includes:

• How often to check blood glucose and ketones
• Any medication/insulin adjustments you should make
• Which over-the-counter medicines are safe to take when you’re sick
• Foods and fluids you should keep on hand
• When to seek urgent care

Keep your plan somewhere easy to find, and share it with your family, roommate, or caregivers.

6. Have the Right Tools Ready

Keep diabetes and sick-day care supplies in your home, so you’re ready in case of illness. This may include:

• Glucose meter and/or continuous glucose monitor (CGM), plus extra supplies and batteries
• Ketone test strips
• Glucose tablets or gels, and a glucagon kit (teach your family members how to use it)
• Cold/flu medications your doctor has deemed safe for diabetes

Being sick when you have diabetes takes extra attention. Monitor often, stay hydrated, follow your care plan, and know when to call for help. Think of your sick-day plan as your safety net — when illness strikes, you’ll be ready to focus on getting well, not crisis management.