Sick days with diabetes

When you are sick and you have diabetes your stress hormones increase and your blood sugars may rise even if you are not eating. During sick days most people (adults and children) with diabetes may require more insulin.

A sick day can be caused by a cold, flu, surgery, infection, injury, stress or dental work. It is important to be prepared for a sick day when living with diabetes. Below is guidance for sick days specific to adults and children, click on each link to learn more.

  • Check your blood sugar every 4-6 hours, at the first sign of illness. Keep a record of your blood sugar levels and insulin dose, if you take insulin.
  • Take your usual dose of insulin or diabetes pills. You may need more insulin, call your doctor for adjustments. *If you wear an insulin pump, do not take off your pump unless you will be taking insulin shots while you are off the pump.
  • Prevent dehydration, drink plenty of fluids. This includes water and caffeine free, sugar free beverages. The National Academies of Sciences, Engineering, and Medicine recommends that women drink 11.4 cups of water daily and men have 15.6 cups. (1) How much fluid you individually require depends on a number of factors. The important thing to do is consume at least 8 ounces of fluid per hour, stay hydrated and learn the signs of dehydration.
  • Carbohydrates are important. If you can't eat your usual meals, ensure that you eat or drink 15 carbs every hour, see our sick days carbohydrate guide link below.
  • People on insulin may need extra short-acting or rapid-acting insulin if blood sugar is 300 or higher. How much insulin should I take? Contact your doctor to tell you how much insulin to take based on your blood sugars.
  • If you have type 1 diabetes check your urine for ketones when your blood sugar is 300 or higher. Call you doctor, if you have moderate to high ketones in your urine or high blood sugars over 300 on two tests in a row that does not respond to insulin and fluids.
  • If you don't take insulin, continue to take your diabetes medications, even if you are sick and have been throwing up.

Let your doctor know as soon as possible, if:

  • Symptoms worsen
  • Illness lasts longer than 24 hours
  • Vomiting more than once within 4-6 hours
  • Diarrhea for five episodes of diarrhea or it lasts longer than six hours
  • Blood sugars over 300 mg/dL two times in a row that does not respond to insulin and fluids
  • Moderate to large ketones are present
  • Experience difficulty breathing
  • Have a high fever
  • If you can't think clearly or you feel more drowsy than usual
  • Have questions or are unsure what to do

Call our center, if you have any questions or concerns regarding being ill and your diabetes—it is better to contact us, than to wait until you become very ill.

  • Check your child’s blood sugar every 3 hours, at the first sign of illness. Keep a record of blood sugar levels and insulin dosing. Even if your child is not eating.
  • Always give basal/long acting insulin (Lantus, Basaglar, Levemir), regardless of whether your child is eating or drinking.
  • Check and record urine ketones every time your child urinates (or with a diaper change).
  • If ketones are moderate or large, contact the Harold Schnitzer Diabetes Health Center immediately for guidance on insulin dosing at 503-494-3273. If it is an evening or weekend, call 503-494-8311 and request the pediatric endocrinologist on call.

What about my child’s bolus/short-acting insulin (Humalog, Novolog)?

My child is eating:

  • If ketones are negative/trace/small, give rapid‐acting insulin (Humalog or Novolog) as you normally would at mealtimes, using insulin to carb ratio and high blood sugar correction as needed.
  • If ketones are moderate/large, call our center for guidance on giving insulin every 3 hours to correct for ketones.

My child is not eating:

  • Encourage fluids. The type of fluids will depend on the blood sugar:

If less than 200:

  • Consume carb-containing fluids (juice, Gatorade, regular soda, Pedialyte, popsicles, see sick days carbohydrate guide link below).
  • Do not dose insulin for the carbs in the fluids. 

If more than 200:

  • Carb-free fluids like water, diet soda, etc.
  • Give high blood sugar correction using Humalog/Novolog:
  • If ketones are neg/trace/small, give high sugar correction (if needed) at the times you normally would if your child were eating (example 8 a.m., noon and 5 p.m.).
  • If ketones are moderate/large, call our center for guidance on giving insulin every 3 hours to correct for ketones.

When to make an urgent call to our center:

  • Moderate or large ketones present
  • Difficulty breathing
  • Fruity-smelling breath
  • Significant drowsiness
  • Unable to keep down foods or fluids for 2-3 hours due to vomiting or diarrhea
  • Problems with low blood sugar
  • You have questions or are unsure what to do

Call our center, if you have any questions or concerns regarding your child's illness and their diabetes.

Food item Amount Grams of carbohydrate (15 grams)
Apple, orange or pineapple juice 1/2 cup 15
Gatorade 1 cup 15
Gelatin, regular 1/2 cup 15
Grape juice, prune juice 1/3 cup 15
Ice cream, vanilla 1/2 cup 15
Milk 1 cup 15
Popsicle 1 double-stick 15
Pudding, sugar free 1/2 cup 15
Regular soft drink 1/2 cup 15
Saltine crackers 6 crackers 15
Sherbet 1/4 cup 15
Soup 1 cup 15
Yogurt, plain or "lite" 6-8 oz. 15

Plan ahead by putting together a sick day kit when you are well. Talk to your doctor or diabetes educator, if you have questions regarding the following items.

General items:

  • List of important phone numbers, including health-care providers
  • List of all of the medications you (or your child) currently take and doses
  • Pain and fever relievers, such as acetaminophen and/or ibuprofen
  • 8-ounce measuring cup to help make sure you’re drinking enough liquids
  • Antidiarrheal and antivomiting medicines
  • Thermometer
  • Tissues

Diabetes specific items:

  • Alarm clock or timer to help you monitor blood glucose levels and ketones regularly
  • Sugar-free cough drops, syrups and throat lozenges
  • Blood glucose monitoring supplies
  • Ketone test strips
  • Glucose tablets/gel or quick carbs such as juice boxes
  • Insulin syringes
  • Small sharps container
  • Insulin pump supplies, if you use a pump
  • CGM supplies
  • Glucagon emergency kit
  • Fluids: six pack of regular and diet 7-Up, Sprite or ginger ale, three packets of regular and sugar-free Jell-O, Gatorade, broth, sparkling water or bottled water, see the sick day carbohydrate guide above for additional options.