Diabetes and Sick Day Management

Blood sugar (glucose) can be more difficult to control when you are sick. Colds, fever, flu, nausea, vomiting, and diarrhea are all examples of common illnesses that can cause problems for people with diabetes. Loss of body fluids (dehydration) from fever, vomiting, diarrhea, infection, and the stress of a sickness can all cause blood glucose levels to rise. Because of this, it is very important to take your diabetes medicines and to eat some form of carbohydrate food when you are sick. Liquid or soft foods are often tolerated, and they help to replace fluids.


These main guidelines are intended for managing a short-term (24 hours or less) sickness:

  • Take your usual dose of insulin or oral diabetes medicine. An exception would be if you take any form of metformin. If you cannot eat or drink, you can become dehydrated and should not take this medicine.

  • Continue to take your insulin even if you are unable to eat solid foods or are vomiting. Your insulin dose may stay the same, or it may need to be increased when you are sick.

  • You will need to test your blood glucose more often, generally every 2 to 4 hours. If you have type 1 diabetes, test your urine for ketones every 4 hours. If you have type 2 diabetes, test your ketones as directed by your caregiver.

  • Eat some form of food that contains carbohydrates. The carbohydrates can be in solid or liquid form. You should eat 45 to 50 grams of carbohydrates every 3 to 4 hours.

  • Replace fluids if fever, vomiting, or diarrhea is present. Ask your caregiver for specific rehydration instructions.

  • Watch carefully for the signs of ketoacidosis if you have type 1 diabetes. Call your caregiver if any of the following symptoms are present, especially in children:

  • Moderate to large ketones in the urine along with a high blood glucose level.

  • Severe nausea.

  • Vomiting.

  • Diarrhea.

  • Abdominal pain.

  • Rapid breathing.

  • Drink extra liquids that do not contain sugar, such as water or sugar-free liquids, if your blood glucose is higher than 240 mg/dl.

  • Be careful with over-the-counter medicines. Read the labels. They may contain sugar or types of sugars that can raise your blood glucose.

Food Choices for Illness

All of the food choices below contain around 15 grams of carbohydrates. Plan ahead and keep some of these foods around.

  • ½ to ¾ cup carbonated beverage containing sugar. Carbonated beverages will usually be better tolerated if they are opened and left at room temperature for a few minutes.

  • ½ of a twin frozen ice pop.

  • ½ cup sweetened gelatin dessert.

  • ½ cup juice.

  • ½ cup ice cream or frozen yogurt.

  • ½ cup cooked cereal.

  • ¼ cup sherbet.

  • 1 cup broth-based soup with noodles or rice, reconstituted with water.

  • 1 cup cream soup.

  • ½ cup regular custard.

  • ½ cup regular pudding.

  • 1 cup sports drink.

  • 1 cup plain yogurt.

  • 1 slice toast.

  • 6 squares saltine crackers.

  • 5 vanilla wafers.


  • You are sick and see no improvement in 6 to 8 hours.

  • You are unable to eat regular foods for more than 24 hours.

  • You have blood glucose readings over 240 mg/dl, 2 times in a row.

  • Your blood glucose is less than 70 mg/dl, 2 times in a row.

  • You are not sure what to do to take care of yourself.

  • You vomit more than once in 4 to 6 hours.

  • You have moderate or large ketones in your urine.

  • You have a fever.

  • Your symptoms are getting worse even though you are following your caregiver's instructions.