Have you noticed that your blood glucose levels get harder to manage when you are unwell? When we get sick, the body releases various stress hormones, some of which cause blood glucose levels to rise. You may easily find that you need more insulin to maintain your blood sugar in your usual range — and that your blood sugar generally acts in an unpredictable manner. The symptoms of illness may make it more difficult to eat or drink, frustrating your normal management habits.

Even common illnesses like stomach bugs, colds, and the flu can get dangerous for people with diabetes, especially those with type 1 diabetes and insulin-treated type 2 diabetes.

High blood glucose levels over a prolonged period can put people with diabetes at risk of severe dehydration, especially in the presence of vomiting or diarrhea. Eventually, this can lead to a potentially life-threatening case of diabetic ketoacidosis (DKA).

Your diabetes educator, endocrinologist, or primary care physician has likely stressed to you the importance of having a sick day plan in place. A sick day plan is simply your plan of action for managing diabetes on those occasions when you might feel unwell or have an infection.

What Should Be Included in a Sick Day Plan?

A sick day plan traditionally guides the management of your diabetes when you are unwell. Consider it an action plan that will make it easier to make decisions if things get bad. It can especially help you determine when to call a doctor, and when to visit a hospital.

It might be wise to keep your sick day plan in physical form — a folder or notebook. Having everything written down in one place can help others make decisions for you, should it be necessary. Some of the info you may wish to include in a sick day plan includes:

An emergency contact with whom you have discussed this plan, and who would like to be informed in the event of an emergency
Contact details of your healthcare team such as an endocrinologist, diabetes educator, primary care physician, or diabetes clinic
List of any allergies
List of any medications currently being taken, for diabetes and otherwise
Some basic instructions to manage your diabetes, both normally and when you are unwell, such as insulin or medication

When Should You Start Following Your Sick Day Plan?

You should follow a sick day plan when you feel unwell, or when you first begin to notice typical symptoms of an illness developing. Other indications to follow a sick day plan may include:

When your blood glucose levels have been greater than 270 mg/dL (15 mmol/L) for more than six hours
When ketones are present in people with insulin-dependent diabetes (“+” result on a urine ketone strip or >0.6 mmol/L on a blood ketone strip)

It may also be helpful to inform a loved one, who may be able to look out for you while you are unwell.

General Sick Day Guidelines for People with Type 1 Diabetes

Your sick day guidelines should always be determined with the help of your medical team. Consider the following to be merely general ideas; a medical professional can help you choose precise blood sugar targets and dosage adjustments.

Check your blood glucose levels much more frequently than usual, and correct hyperglycemia with insulin using normal correction ratios.
Check for ketones every 4-6 hours using urine ketone strips or a blood ketone meter.
If you are struggling with persistently high blood sugars, consider taking more basal insulin, either by taking a slightly increased dose of long-acting insulin or, for pump users, setting a temporary basal rate.
You may also need to take larger boluses of rapid-acting insulin for meals.
Drink fluids every hour (water is best) to keep your body hydrated, or consider a rehydration solution to help replace fluid and electrolytes (but be careful about sugar). Regular fluids can also help to flush out any ketones through the urine.
Treat hypoglycemia with sugary fluids if you are unable to keep solid food down.

It remains absolutely critical to continue using insulin. If your illness makes it difficult to use insulin normally — for example, if you want to use less insulin because you cannot eat and your blood sugar is getting too low — you should seek medical attention.

General Sick Day Guidelines for People with Type 2 Diabetes

People who use insulin to treat their type 2 diabetes are at an enhanced risk of complications from sickness and might consider using some of the more aggressive recommendations listed above for type 1 diabetes.

If you don’t use insulin, you are at a much lower risk of DKA.

Check your blood glucose levels more frequently than usual.
Continue taking your diabetes medications as usual.
Your doctor may ask you to stop taking metformin if you have a severe infection, or if there is a chance of dehydration.
Drink fluids frequently (water is best) to keep your body hydrated, or consider a rehydration solution to help replace fluid and electrolytes. Dehydration is a common cause of higher blood glucose levels.
Treat hypoglycemia with sugary fluids if you are unable to keep solid food down.

When Do You Need Medical Treatment?

An important part of a sick day plan is deciding, ahead of time, when to seek medical attention. If you have standards in place before your illness begins, it will be much easier to commit to calling your doctor.

It may be worth calling your doctor if any of the following occur:

Mild vomiting or diarrhea
Difficulty managing blood sugar
Low levels of ketones in the urine
Fever

The CDC provides a thorough list of situations that should prompt an immediate trip to the hospital:

You’re having trouble breathing.
You have moderate to high ketone levels in your urine.
You can’t keep any liquids down for more than 4 hours.
You lose 5 pounds or more during the illness.
Your blood sugar remains lower than 60 mg/dl.
You feel too sick to eat normally and are unable to keep down food for more than 24 hours.
You have vomiting and/or severe diarrhea for more than 6 hours.
Your temperature is over 101 degrees F for 24 hours.
You feel sleepy or can’t think clearly. Have someone else call your doctor or take you to the emergency room.

When Would a Sick Day Plan Come in Handy?

Given that many of us don’t have to deal with sick days too often, it can be easy to lose touch with these strategies. While most of us picture the self-management of a sick day from the comfort of our own lounge room, the reality may not be as cozy. Emergencies or unexpected situations could happen at any given time, increasing our chances of needing to put sick day knowledge into practice. Here are just a few examples:

Emergencies or natural disasters
Travel
Embarking on a new or unfamiliar activity
Situations where you are alone
Situations where you are away from familiar people or surroundings
Hospital admission or physical injury
Loss or damage to diabetes medication or insulin
Loss or failure of diabetes technology

It is well worth putting a plan in place to guide the management of your diabetes in an emergency, and having a conversation about it with your loved ones. You may find yourself in a situation where you need to be your own advocate, or where you may need to rely on a loved one to act as your advocate.

Takeaway

When you have diabetes, even common illnesses can get serious fast.

Putting a sick day plan in place will allow you to make good decisions in a stressful situation — including when to call a doctor, and when to seek immediate medical attention.

A good sick day plan leaves you far more prepared to manage your diabetes should the unexpected happen.