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 increase. 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 2–4 hours. If you have type 1 diabetes, test your urine for ketones every 4 hours. If you have type 2 diabetes, test your urine for ketones as directed by your health care provider.

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

  • Replace fluids if you have a fever, vomit, or have diarrhea. Ask your health care provider for specific rehydration instructions.

  • Watch carefully for the signs of ketoacidosis if you have type 1 diabetes. Call your health care provider 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, or caffeine.

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

Food Choices for Illness

All of the food choices below contain about 15 g 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 regular gelatin.

  • ½ cup juice.

  • ½ cup ice cream or frozen yogurt.

  • ½ cup cooked cereal.

  • ¼ cup sherbet.

  • 1 cup clear broth or soup.

  • 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.

  • ½ cup sports drink.


  • You are unable to drink fluids, even small amounts.

  • You have nausea and vomiting for more than 6 hours.

  • You have diarrhea for more than 6 hours.

  • Your blood glucose level is more than 240 mg/dL, even with additional insulin.

  • There is a change in mental status.

  • You develop an additional serious sickness.

  • You have been sick for 2 days and are not getting better.

  • You have had a fever for 2 days.


  • You have difficulty breathing.

  • You have moderate to large ketone levels.


  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.