When you are sick, your body reacts by releasing
hormones to fight infection. But these hormones raise
blood sugar levels and at the same time make it more difficult for
insulin to lower blood sugar. When you have
diabetes, even a minor illness can lead to dangerously
high blood sugar. This may cause life-threatening complications, such as
diabetic ketoacidosis or a
Work with your doctor to make a sick-day plan for you
or your child with diabetes. Discuss your target blood sugar goal during an
illness, how you should adjust your insulin dose and timing (if you take
insulin), and when you need to contact your doctor for help. Also, make sure
you know how often to check blood sugar and urine ketone levels. Keep your plan
in a convenient place, and include contact information in case you need to
reach your doctor at night or on the weekends.
Steps to take during an illness
Here are some
general sick-day guidelines:
Continue taking your diabetes medicine even if you are vomiting
and having trouble eating or drinking. Your blood sugar may continue to rise
because of your illness. If you cannot take your medicines, call your doctor
and discuss whether you need to adjust your insulin dose or other medicine.
Try to eat your normal types and amounts of food and to drink
extra fluids, such as water, broth, carbonated drinks, and fruit juice.
Encourage your child to drink extra liquids to prevent
If your blood sugar level is higher than 240
milligrams per deciliter (mg/dL), or the blood sugar level your doctor recommends, drink extra liquids that do not contain
sugar, such as water or sugar-free cola.
If you cannot eat the
foods in your regular diet, drink extra liquids that contain sugar and salt,
such as soup, sports drinks, or milk. You may also try eating foods that are
gentle on the stomach, such as crackers, gelatin, or applesauce. Try to eat or
drink 50 grams (g) of carbohydrate every 3 to 4 hours. For example, 6 saltine
crackers, 1 cup (8 fl oz) of
milk, and ½ cup (4 fl oz) of orange juice each contain approximately 15 g of
Check your blood sugar at least every 3 to 4
hours, or more often if it is rising quickly, even through the night. If your
blood sugar level rises above 240 mg/dL and your doctor has told you to take an
extra insulin dose for high blood sugar levels, take the appropriate amount. If
you take insulin and your doctor has not told you to take a specific amount of
additional insulin, call him or her for advice.
If you take
insulin, do a
urine test for ketones every 4 to 6 hours, especially
if your blood sugar is higher than 300 mg/dL. Call your doctor if you have more
than 2+ or moderate ketones in your urine. Check your child's urine for ketones
at least every 6 hours, even through the night.
Weigh yourself and
check your temperature, breathing rate, and pulse frequently if your blood
sugar is higher than 300 mg/dL. If you are losing weight and your temperature,
breathing rate, and pulse are increasing, contact a doctor. You may be getting
Don't take any
nonprescription medicines without talking with your
doctor. Many nonprescription medicines affect your blood sugar level.
When to call your doctor
Minor illnesses in people with diabetes—especially children with
type 1 diabetes—can lead to very high blood sugar
levels and possible emergencies. When children are sick, watch them closely for
signs that they need immediate medical attention. Call 911 or other emergency services if you or your child has:
Symptoms of diabetic ketoacidosis (DKA), such
as abdominal (belly) pain, vomiting, rapid breathing, fruity-smelling breath, or severe
Symptoms of dehydration, such as a dry mouth and very
yellow or dark urine. Dehydration is particularly dangerous in
children and may be caused by vomiting and
A low blood sugar level that continues.
It may not be necessary to call your doctor every time you
or your child with diabetes has a mild illness, such as a cold. But it is a
good idea to call for advice when you are sick and:
You have a blood sugar level that stays higher than the level the doctor has set for you, for example, 240 mg/dL for two or more readings.
You have more than 2+ or moderate ketones in your
You still have a fever and are not feeling better after a
You are vomiting or having diarrhea for more than 6
When you are sick, write down the medicine(s) you have been
taking and whether you have changed the dosage of your diabetes medicines based
on your sick-day plan. Also note changes in your body temperature, weight,
blood sugar, and urine ketone levels. Have this information with you when you talk
to your doctor.
Primary Medical Reviewer
John Pope, MD - Pediatrics
Specialist Medical Reviewer
Stephen LaFranchi, MD - Pediatrics, Pediatric Endocrinology
How this information was developed to help you make better health decisions.