Diabetes - when you are sick

What to Expect at Home:

Waiting too long to get medical care when you are sick can lead to getting much sicker. When you have diabetes, a delay in getting care can be life threatening. Even a minor cold can make your diabetes harder to control, and that can lead to more serious health problems.

When you are sick, keep a close watch on diabetes warning signs. These are high blood sugar that will not come down with treatment, nausea, vomiting, or low blood sugar that will not rise after you eat.

If you have any of these warning signs and cannot treat them yourself, call your doctor right away.

Drink Lots of Fluids:

Drink plenty of sugar-free fluids to keep your body from getting dried out (dehydration). Drink at least 12 8-ounce cups a day of water or other sugar-free drinks, such as diet soda, club soda, or seltzer.

If your blood sugar is low (100 mg/dl) or falling quickly, it is OK to drink fluids that have sugar (such as ginger ale, lemon-lime drinks, tea with honey, or a sports drink). Be sure to monitor their effect on your blood sugar, the same way you monitor how other foods affect your blood sugar.

Fluids you can drink if you are dehydrated are:

• Gatorade -- if your blood sugar is low
• Orange, apple, or grapefruit juice -- if your blood sugar is low
• Chicken broth
• Tomato juice
• Water, club soda or diet soda (caffeine-free)

If you throw up (vomit), do not drink or eat anything for 1 hour. Rest, but do not lie flat. After 1 hour, take sips of soda every 10 minutes.

Eating When You Are Sick:

When your stomach is upset, try to eat small meals. Try these carbohydrates: breads and starches, cooked cereal, bagels, bread, mashed potatoes, noodle or rice soup, saltines, gelatin, or graham crackers.

Many foods have the right amount of carbohydrates (15 grams) for your sick-day diet. Remember, on sick days it is okay to eat some foods you might not normally eat, if you cannot eat your regular foods. Some foods to try are:

• ½ cup apple juice
• ½ cup regular soft drink (non-diet, caffeine-free)
• 1 Popsicle (1 stick)
• 5 Lifesavers candies
• 1 slice of dry toast
• ½ cup cooked cereal
• 6 saltine crackers
• ½ cup frozen yogurt
• 1 cup Gatorade or sports drink
• ½ cup regular ice cream (if you are not throwing up)
• ¼ cup sherbet
• ¼ cup regular pudding (if you are not throwing up)
• ½ cup regular gelatin/Jell-O
• 1 cup yogurt (not frozen), sugar-free or plain
• Milkshake (½ cup low fat milk and ¼ cup ice cream mixed in the blender) if you are not throwing up

When you are sick, it is important to eat the same amount of carbohydrates that you normally do. If possible, follow your regular diet. If you are having a hard time swallowing, eat soft foods with the same amount of carbohydrates as your regular diet.

If you have already taken your insulin and are sick to your stomach, drink enough liquids with the same amount of carbohydrates that you would normally eat. If you cannot keep food or liquids down, go to the emergency room for treatment with fluids you will get through a tube in your blood vessel (intravenous).

If you have a cold, talk with your doctor, diabetes nurse, or pharmacist for help choosing over-the-counter cold treatments. Many of these products have sugar, alcohol, and other drugs in them. These can raise your blood sugar and your blood pressure.

Diabetes Drugs:

Take all of your medicines as you usually do. Do not skip or double up on any medicine unless your doctor tells you to.

Sick Day Plan:

Check your blood sugar more often than usual (every 2 to 4 hours). Try to keep your blood sugar at less than 200 mg/dl. There may be times when you need to check your blood sugar every hour. Write down all your blood sugar levels, the time of the test, and the medicines you have taken.

If you have type 1 diabetes, check your urine ketones (use Ketostix-foil wrapped strips) every time you urinate.

Eat small meals often. Even if you are not eating as much, your blood sugar can still get very high. If you use insulin, you may even need extra insulin injections.

Do NOT exercise when you are sick.

When to Call the Doctor:

Call your doctor if you have:

• Blood sugars higher than 240 mg/dl for more than 1 day
• Moderate-to-large ketones for 2 or more tests
• Vomiting or diarrhea for more than 4 hours
• Any severe pain
• A fever higher than 100 °F
• Trouble moving your arms or legs
• Vision, speech, or balance problems

If your doctor does not call back right away, you may need to go to the emergency room, especially if you are vomiting or have diarrhea for more than 4 hours.