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Diabetes Sick Day GuidelinesMinor illness can alter your blood sugar and require some changes in your daily diabetes routine. Your diabetes can become uncontrolled quickly when you are ill. By following a few simple guidelines, you can minimize the effects of an illness on your diabetes.Diabetes Web Resources
Need for InsulinDuring an illness, blood sugar levels tend to rise. As a result of this increase, your body may require more insulin. Illness causes a greater than normal demand for insulin due to the release of stress hormones. These hormones are triggered by such things as fever, loss of body fluid (dehydration), and infection.
Monitoring Your Blood Glucose During IllnessFrequent blood glucose monitoring is especially important during an illness. Blood glucose should be monitored (preferably with a meter) every four hours. If your blood sugar level exceeds 240mg/ml, it is important to test the urine for ketones. Testing for ketones should also be done every twelve hours.
Eating MealsLoss of appetite is common during illness. Nausea and vomiting may prevent you from eating your usual meals. However, you need food and fluids to help you get better. Sip or eat slowly, especially if you feel nauseous and if you are vomiting, do not eat for two hours.
FluidsFluids are also important during an illness, especially if you are experiencing nausea and vomiting. Repeated vomited can lead to dehydration (loss of body fluid) and loss of important electrolytes such as sodium and potassium. Try to consume four to eight ounces of fluid every one to two hours. Fluids such as broth, teas, Gatorade, water, cola or soda, orange juice, and soup will not only help with fluid replacement, but also with sodium and potassium losses. You should not eat for two hours after vomiting. If you take your routine dose of insulin and you are not eating or taking fluids, there is a danger of hypoglycemia (low blood sugar).Sick Day Rules:1. Always take your usual daily dose of insulin or diabetes medication. Never omit your medicines, even if you are unable to eat. Illness may even be a time when you need additional insulin or to change to a different schedule. 2. Test your blood sugar every four hours or as directed by your physician. If your blood sugar is 240mg/ml or greater, you should also check your urine for ketones and notify your physician if ketones are present in your urine. Keep a record of your results to report to your physician. 3. Weigh yourself frequently during an illness. This can help your physician estimate any fluid loss you may be experiencing. 4. Drink four to eight ounces of fluid (e.g., beverages containing sugar, water, broth, teas) every two hours. Keep a record of total fluid intake that you can report to your physician. 5. If you are unable to eat regular meals, try to consume liquid or soft foods that equal 15 grams of carbohydrate every hour or 50 grams every three to four hours. See sample diet at bottom of page. 6. Rest and stay warm. Do not exercise. Have someone available to help you take care of yourself. 7. If you should be alone during an illness, contact a neighbor, friend, or relative who will check on you several times a day. 8. Check with your doctor to determine at what blood sugar level he/she wants to be notified. Usually a blood sugar greater than 320 or 2+ ketones. KEEP NAME AND TELEPHONE NUMBER OF PHYSICIAN HANDY. 9. In any illness preventing you from eating anything at all (Nausea/Vomiting) for more than six hours, you should check your blood sugar every four to six hours and adjust with sliding scale of regular insulin and cut down long-acting insulin to half the daily insulin dose, per physician recommendation. 10. Call your doctor if: a) Fever persists b) Vomiting and/or diarrhea is severe c) Illness persists beyond one to two days 11. Once the illness has passed, gradually return to your regular diabetic meal plan. Sick Day Foods and DrinksIf you are unable to eat regular meals, try to consume liquid or soft foods that equal 15 grams of carbohydrate every hour or 50 grams every three to four hours. The following is a list of sample foods suitable for a sick day. Fluids containing 10-27 grams of carbohydrate: 1 cup soup (1 cup Chunky Chicken Noodle ready-to-serve has 27 grams CHO OR 1 cup Tomato with milk=22 grams CHO OR 1 cup Tomato with water=17 grams CHO OR 1 cup Potato with water=17 grams CHO OR 1 cup Chicken Rice with water=7 grams CHO 1 cup Gatorade 1 cup Milk half cup Fruit Juice half cup Soft Drink (not sugar free) Foods containing 10-15 grams of carbohydrate: half cup Gelatin (not sugar free 5 to 7 Saltine Crackers 10 to 11 Wheat Thins or 5 Ritz Crackers half cup Cooked Cereal (Oatmeal) or half Single-Serve Packet of Instant Oatmeal 3 Graham Crackers 6 Vanilla Wafers half cup Custard 1 Popsicle quarter cup Sherbet half cup Applesauce half cup Ice Cream half cup Sugar-Free Pudding half cup Mashed Potatoes
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