Managing your diabetes during sick days

By Delia Howling Wolf – Medical Support Assistant

What is sick day management? For people who have diabetes, sick day management refers to a plan to control your blood sugar levels while you are sick.  You should develop a plan with your health care providers. 

Why do I need a sick day plan?  Your blood sugar levels can increase because of stress from illness, surgery or injury.  Your plan will help prevent high blood sugar levels and other serious health conditions such as Diabetic Ketoacidosis (DKA) and Hyperosmolar hyperglycemic syndrome (HHS). 

With Diabetic ketoacidosis your body uses fat instead of sugar for fuel.  DKA happens when your body does not have enough insulin and your blood sugar levels get very high.  As fats are broken down, chemicals called ketones are produced and build up in your blood.  Ketones are dangerous at high levels.  DKA usually happens to people with type 1 diabetes and can lead to coma and be life-threatening if not treated. 

Hyperosmolar hyperglycemic syndrome (HHS) is another medical condition that occurs when your blood sugar gets too high.  Your body gets rid of the extra sugar through your urine.  This leads to severe dehydration.  HHS happens to people with type 2 diabetes, especially older people.  HHS can be life-threatening.

With plenty of foods, fluids, and rest, you can expect to feel better soon.  But every once in a while, people with diabetes need a little help getting through an illness.  

What you should do on days when you are sick?

Continue to take your medicines are directed. Your healthcare provider will tell you if you need to make any changes.  If you normally do not use insulin, you may need to use it while you are sick.  If you already use insulin, you may need to increase the amount you take.  Talk to your healthcare provider before you take any over-the-counter medicines 

Check your blood sugar level more often than usual.  If you have type 2 diabetes, check at least 4 times each day.  If you have type 1 diabetes, check every 4 hours.

Check your urine or blood for ketones if you use insulin, and as directed.  Ask your healthcare provider which type of ketone testing is best for you.  Ketone urine tests kits are sold in pharmacies and some stores.

Drink liquids as directed.  You may need to drink about 8 ounces (1 cup) of liquid each hour.  Drink liquids that do not contain sugar or caffeine. Ask your healthcare provider which liquids are best for you.  He or she may tell you water is the best liquid to drink.

Follow your usual meal plan as closely as possible.  If you cannot follow your meal plan, eat other foods that are easy for your body to digest.  If you are eating less food than normal or cannot eat any foods, drink liquids that contain calories.

Tell others who help you while you are sick about your sick day plan.  Put your plan in place that is easy to find.  Your sick day plan may change over tie based on your needs.

What can I drink and eat while I am sick?

Try to follow your usual meal plan as much as you are able. Prepare for sick days by having small amounts of non-diet drinks and foods at home.  Having some carbohydrates sources available for every 3-4 hours for upset stomach, vomiting or diarrhea.  Here is a list of foods that contain some carbohydrates that you can have on hand to help you during this time.


1/3 to ½ cup of fruit juice


½ cup of regular soda


1 cup of milk


1 double-stick popsicle


1 cup of a sports drink



½ cup of regular gelatin


½ cup of regular pudding


½ cup of mashed potatoes, macaroni or noodles


¼ cup or sherbet


1 slice of dry toast, 6 saltines crackers or 3 graham crackers


Call your healthcare provider if you have: 


Illness or fever lasts for a couple of days without getting better 


Vomiting or diarrhea that last longer than 6 hours


Blood sugar higher than 240 despite using extra insulin as directed by your healthcare provider


If you take diabetes medications and your blood sugar levels stay above 240 for 24 hours

Symptoms of dehydration or other serious conditions including fruity smell on your breath, chest pain, difficulty breathing, or dry and cracked lips or tongue.


Have someone call your local emergency number 911 if you have trouble breathing, you cannot be woken, you are drowsy or confused, or you are breathing faster than usual.


Please feel free to discuss your sick day plan with your provider.  Discuss treatment options with your providers to decide what care you want to receive and any questions or concerns about your condition or care.


If you would like help in making appointments please call the Fort Berthold Diabetes Program at 701-627-7931.