Sick day guidelines for type 1 diabetes

Before getting sick

The American Diabetes Association (ADA) recommends people with type 1 diabetes make certain preparations in case they get sick, such as the following:

Prepare a plan

It is best for people with diabetes to speak with a doctor about steps they need to take if they get sick, such as:

• when to call a doctor, which is usually in the following situations:
  • if a person experiences vomiting or diarrhea more than three times over 24 hours
  • if a person has a fever of more than 101°F (38°C) for 24 hours
• how often to check their blood glucose levels
• what fluids and foods to consume while they are sick
• how to adjust insulin or oral medications, if required
• if and when to check for ketones, a type of chemical the liver produces when it breaks down fats
• what over-the-counter (OTC) drugs to take, as some may raise blood glucose or affect other medications

Once they have spoken with a doctor, a person can write down their plan and their doctor’s contact information, any medications they take, and their insurance information for emergencies.

It is best to keep this information somewhere easy to access.

The ADA also recommends that people with diabetes get an annual flu shot.

Make a sick day kit

A person with diabetes may benefit from making a sick day kit. The ADA suggests including the following:

• a glucose meter
• supplies for a glucose pump or continuous glucose monitor
• extra batteries
• ketone test strips
• a 1-week supply of glucose-lowering medication, which people should not store for more than 30 days before use
• glucose tablets or gels
• flu or cold medications that will not interfere with diabetes management
• a list of family and friends who can check up on them

The Centers for Disease Control and Prevention (CDC) recommends that people with diabetes also keep the following supplies in their home:

• canned soup
• sports drinks
• fruit juice
• regular soda
• instant cooked cereals
• crackers
• instant pudding
• unsweetened applesauce
• milk of magnesia
• diarrhea medication
• antacids
• pain medication
• a thermometer
• suppositories to treat vomiting

What to do while sick

A person who has diabetes needs to be aware of possible risks involved with being sick. The ADA notes that having diabetes increases a person’s chances of becoming seriously ill.

Certain preventive measures can help reduce the risk of serious illness:

Drinking more water

It is important for people with diabetes to drink plenty of water when they are unwell. If a person is having trouble keeping liquids down, they can try having small sips around every 15 minutes.

Managing blood glucose levels

A doctor may ask a person to check their blood glucose levels more often when they are unwell. This is because the person may have difficulty eating or drinking while they are sick, which may affect their blood sugar levels.

The CDC recommends that a person tests their blood glucose every 4 hours while they are unwell.

If a person is unable to eat meals, they need to ingest 50 grams (g) of carbohydrates every 4 hours. For example, a person may eat 1.5 cups of applesauce or drink 1.5 cups of fruit juice.

People who are having trouble eating can try having simple carbohydrates, such as regular soda, Jell-O, or popsicles. Consuming these foods and drinks may help increase blood glucose levels that are low.

The person can also follow the 15-15 rule, which involves eating 15 g of carbohydrates and then checking blood glucose after 15 minutes. If their levels are still low, they can eat another 15 g and repeat the 15-15 rule until their blood glucose is at least 70 milligrams per deciliter (mg/dL).

Additional tips

People with diabetes can follow these steps when they are unwell:

• try to eat meals as usual
• continue taking insulin and diabetes medications as normal
• weigh themselves daily, as losing weight without trying may be a sign of high blood sugar
• check their temperature every morning and evening for signs of a fever

When to seek emergency care

When a person does not have enough insulin, their body begins to break down fat to use as energy. This process produces ketones. Producing too many ketones too quickly can put a person at risk of developing diabetic ketoacidosis (DKA), which can be life threatening.

The American Diabetes Association recommends that a person tests their ketone level every 4 to 6 hours when they are sick.

The CDC notes that a person should check their ketone level if their blood glucose is 240 mg/dL or more.

A person should speak with their doctor immediately if they develop:

• high blood glucose levels
• high ketones levels
• drowsiness
• thirst or dry mouth
• frequent urination
• abdominal pain
• nausea
• dry or flushed skin
• a fruity odor on the breath
• vomiting
• confusion

People with diabetes should seek immediate medical attention if they:

• have difficulty breathing
• have ketones in their urine
• cannot keep liquids down for more than 4 hours or keep food down for more than 24 hours
• lose 5 pounds or more while they are sick
• have a blood glucose level under 60 mg/dL
• experience vomiting and/or severe diarrhea for more than 6 hours
• have a temperature of 101°F (38°C) for 24 hours

Summary

A person with type 1 diabetes may find that their blood glucose levels become hard to manage when they are sick. Being unwell can also put a person with type 1 diabetes at risk of diabetic ketoacidosis (DKA).

It is best for people who have diabetes to speak with their doctor about what to do it they get sick. They can also put together a sick day kit, which may include a glucose meter, extra batteries, and ketone test strips.

A person with diabetes who becomes sick will need to take certain precautions, such as drinking plenty of water and checking their blood glucose levels frequently.

People should seek immediate medical attention if they develop any signs of DKA.