What to do when you are sick and have diabetes

Why sick days matter

When you are sick:

• Your glucose levels may go higher than usual
• You may become dehydrated
• You may not feel like eating or drinking
• If you live with type 1 diabetes, your risk of diabetic ketoacidosis (DKA) can increase
• If you live with type 2 diabetes, your risk of hyperosmolar hyperglycaemic state (HHS) can increase

Even when you are not eating much, your body still needs insulin as the liver continues to release glucose to provide energy for your body.

Sick Day Rules

Follow these simple steps when you are unwell:

1. Be Prepared!

Create a sick day kit and keep it at home.

Include:

• Glucose monitoring supplies
• Diabetes medications and/or insulin
• Easy-to-digest foods
• Sugar-containing drinks for hypos
• Contact details for your healthcare team and/or a support person

You may also need ketone testing supplies. If you have type 1 diabetes or have been advised by your healthcare team to check your ketones when you are unwell, keep ketone strips or a blood ketone meter in your sick day kit. Some people with type 2 diabetes may also need to check ketones, including people taking SGLT2 inhibitor medicines. If you are unsure, check with your healthcare team.

2. Know which diabetes medications you should continue taking

• If you have nausea, vomiting or diarrhoea and are unable to eat - you may need to stop taking your diabetes medications. Ask your diabetes team for an individualised plan to follow when you are unwell.
• Know how to adjust your insulin. If you have type 1 diabetes you should always take your long-acting insulin, however you will need advice from your diabetes team on the dosage. You may need more insulin when you are sick.

If you are not sure which diabetes medications to take when you are feeling sick, contact your diabetes educator, GP or local pharmacy before taking your diabetes medications.

3. Check your glucose levels more often

• Check glucose levels every 2 to 4 hours
• If you use a continuous glucose monitor and your glucose levels are out of range, confirm readings using a finger-prick check
• Treat episodes of hypoglycaemia (glucose levels under 4 mmol/L) with 15 grams of quick acting carbohydrates
• Try to keep your glucose levels between 5-10 mmol/L

4. Stay hydrated

• Drink small amounts often. Aim for ½ cup of sugar free fluid every hour. Examples include water, sugar-free cordial or diet lemonade
• If you cannot eat, drinks containing carbohydrate may help maintain energy and prevent low glucose. Examples include fruit juice, regular soft drinks, Gatorade, regular jelly

5. Try to eat

• If you cannot manage regular meals, try foods that are easy to tolerate: soup, custard, plain crackers, plain pasta or rice, jelly, toast

When to get medical help

• You cannot keep fluids down
• You have ongoing vomiting or severe diarrhoea
• Your glucose stays above 15 mmol/L despite treatment
• You have moderate or high ketones (more than 1.5 mmol/L)
• You are feeling drowsy or confused
• You have difficulty breathing
• Your symptoms are getting worse instead of improving

Sick days need extra attention when you live with diabetes. Having a sick-day plan, acting early, monitoring your glucose levels and doing your best to stay hydrated can make all the difference in helping you stay well and avoid hospitalisation.

If you can’t contact your usual diabetes health professional, contact the Virtual Emergency Department (VED). This is a free service which is available 24/7

If you’d like to read more about sick day management, you can find information on this NDSS website