Managing Illness and Diabetes

by diabetes care guide

Illness, infection and surgery can all have an impact on your diabetes management. As your body deals with the extra stress of illness, more glucose is released into your blood stream. Severe illness when you have type 1 can also result in the production of ketones in your blood. If ketone levels get too high it can be very serious.

Illness can mean many things, including nausea and vomiting, head or chest cold, flu, pain, diarrhea, fever, sore throat, toothache or surgery. When you are ill, you will probably not feel up to shopping for food, drinks and testing supplies. Plan ahead and keep a ‘Sick Kit’ filled with the supplies you would not normally keep in your house. Talk to your pharmacist about what over-the-counter medications for pain, fever, cold symptoms and nausea would be best for you and add them to your ‘Sick Kit’.

How to manage a sick day

When you are sick, your blood glucose levels may fluctuate and be unpredictable. During periods of illness, it is VERY IMPORTANT that you:

  • Test your blood glucose levels every two to four hours;
  • Continue to take your diabetes medication;
  • Drink plenty of extra sugarfree fluids or water;
  • Try to avoid coffee, tea and colas as they contain caffeine, which may cause you to lose more fluids;
  • Replace solid food with fluids that contain carbohydrate, if you can’t eat according to your usual meal plan;
  • Try to eat 15 grams of carbohydrate every hour;
  • Call your doctor or go to an emergency room if you vomit and/or have had diarrhea two times or more in four hours;
  • If you are on insulin, be sure to continue taking it while you are sick. Check with your healthcare team regarding guidelines for insulin adjustment during illness;
  • Rest.
  • Drink at least 8 oz of sugar-free fluid an hour (such as water, tea, broth, sugar-free pop, juice or flavoured water). If your stomach is upset, sip small amounts every 15 minutes. Watch for signs of dehydration such as thirst, dry skin or less frequent urination.
  • Discuss over-the-counter medications with your pharmacist. He or she can help you
    choose the best products for you.

If you have an upset stomach and are unable to eat regular meals, replace your carbohydrates with fluids at each meal.

What are fluid meals?

These meal examples (below) equal 50 grams of carbohydrate and can substitute a missed meal when you are feeling under the weather.

STARCH 6 soda crackers
1 cup soup (water)
1 slice toast
2 digestive cookies
FRUITS & VEGETABLES 1/3 cup apple juice
1/2 cup orange juice
1/2 cup applesauce
1/2 banana
SUGARS 1/2 cup regular pop
1/4 cup regular jello
1/4 cup sherbet
1/2 popsicle



EXAMPLES OF FLUID MEALS = 50g Carbohydrates
Example 1
orange juice
clear broth with 4 crackers
Example 2
chicken soup with 2 crackers
apple juice
half a popsicle
Example 3
Ginger ale
cup of clear tea


What about diabetes medication?

When you are ill, particularly if you become dehydrated (due to vomiting or diarrhea), some medicines could cause your kidney function to worsen or result in side effects. If you become sick and are unable to drink enough fluid to keep hydrated, STOP taking the following medications:

  • blood pressure pills
  • water pills
  • metformin
  • diabetes pills
  • pain medications
  • non-steroidal anti-inflammatory drugs, which are commonly found in pain medications (such as Advil) and cold remedies.

Check with your pharmacist before using over-the-counter medications and discuss all changes in medication with your healthcare professional. When you’re sick, you should also check your blood glucose levels more often. If they run too high or too low, contact your healthcare professional.

What are ketones?

Ketones are chemicals that the body produces when there is not enough insulin in the blood and instead must use fat for energy. They are a warning sign that your insulin is low and your cells are not getting enough glucose and the cells will start to burn fat for energy. When this happens, ketones build up in your blood and then spill over into your urine so your body can flush them out. Watch for:

  • nausea and vomiting which can lead to dehydration
  • stomach pains and rapid breathing
  • flushed face
  • dry skin
  • a sweet breath odour

If fluids and insulin are not given immediately there may be serious consequences. Do not ignore the warning signs.

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