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Managing Sick Days

Feeling fine? It's the perfect day to create a sick day plan.

When you're feeling ill, you'd like nothing more than to lie in bed with a good book or movie. Yet that's when you need to focus even more on diabetes self-care.

The key to sick days with diabetes is doing all of the thinking ahead of time. That way, when you don't feel like concentrating, you can simply follow the plan.

What to include in your plan

Involve your diabetes care team in developing your sick day plan1—ask them when you should call for help, how often you should check your blood glucose and ketones, what medicines to take and what to eat.

Gather a sick day kit so the additional items you might need will be ready.

Sick day kit checklist

  • Thermometer
  • Pain reliever
  • Sugar-free throat lozenges
  • Cough medicines, expectorants and acetaminophen have no effect on blood glucose1
  • Urine ketone strips
  • Extra blood glucose test strips and lancets
  • Extra insulin and supplies
  • Glucagon emergency kit
  • Easy-to-eat foods that contain carbs

At the first sign of illness

Understanding how illness might affect your blood glucose can help you take the right steps to care for yourself. For example:2

  • If you use insulin, don't stop taking it. Even if you are having trouble eating, you will likely need extra insulin to combat the hormones that often cause high blood glucose during illness. You might do this by raising meal or correction boluses, or using a temporary basal rate on an insulin pump. Follow your healthcare provider's recommendations.
  • Monitor blood glucose levels more frequently, at least every 1 to 2 hours.
  • Check your urine for ketones if blood sugar is high.
  • Stay hydrated. Drink lots of unsweetened liquids (sparkling water, diet soft drinks, bouillon, etc.) to avoid becoming dehydrated, at the rate of 250 ml every hour.1
  • Make sure you eat according to your regular meal plan. Keep easy-to-eat, fast-acting carbohydrates available. They can be useful in treating a low, as well as substituting for a meal. If you feel nauseated or are vomiting, try a sports drink, juice, regular soda or even frozen fruit bars to get the carbs you need. If you lose your appetite, drink liquid or semi-liquid sources of carbohydrates (fruit sauces, yogurt, etc.) at the rate of 15 g of carbohydrates per hour if you have taken the proper insulin doses.1
  • Talk to your diabetes care provider about any medications you take, or any unexpected blood glucose results you experience while taking them. Some cold medicines, antibiotics and other prescription and over-the-counter drugs are known to affect blood glucose levels.3

When to contact your healthcare team

Get in touch with your doctor any time they recommend, as well as when you:1

  • Have been sick or had a fever for more than 48 hours without improvement.
  • Have had 2 or more vomiting or diarrhea episodes within 4 hours.4
  • Detect moderate to large ketones in your urine.
  • Your blood sugar is higher than 20 mmol/L with the presence of ketones (moderate to high) — type 1 diabetes
  • Your blood sugar is higher than 25 mmol/L and you feel excessively drowsy — type 2 diabetes
  • Experience symptoms that might signal ketoacidosis or dehydration, such as worsening abdominal pain, trouble breathing or breath that smells fruity or like acetone.

The key to successfully navigating an illness is preparation. By creating your sick day plan and kit before you experience the first signs of illness, you'll be ready to attack a virus head-on.


Sick day snacks4
These foods contain 10 to 15 grams of carbohydrate, and may be easier to eat when you don't feel well.
6 soda crackers 1 cup soup (water)
1 slice toast 2 digestive cookies
1/3 cup apple juice 1/2 cup orange juice
1/2 cup applesauce 1/2 banana
1/2 cup regular pop 1/4 cup regular Jello
1/4 cup sherbet 1/2 popsicle



1Diabetes Quebec. Understanding diabetes: Specific situations. Available at: Accessed June 30, 2015.
2International Diabetes Federation. Diabetes education modules 2011: hyperglycemia. Available at: Accessed June 30, 2015.
3Vue MH, Setter SM. Drug-induced glucose alterations part 1: drug-induced hypoglycemia. Diabetes Spectrum. 2011;24(3):172-177. Available at: Accessed August 21, 2015.

4Canadian Diabetes Care Guide: Managing Illness and Diabetes. Available at: Accessed August 21, 2015.

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