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Living with type 2 diabetes – what to do when you are sick fact sheet

PDF coverThis fact sheet is available in two formats.

You can download and print out the PDF version.

Or you can read it as a website page below.

Note: This fact sheet was previously known as Managing sick days for type 2 diabetes.

Like everyone, people with diabetes can get sick with the flu, a cold or other common infections or illnesses.

When you have type 2 diabetes, everyday illnesses or infection can affect your blood glucose levels. It’s important to be prepared and to know what to do if you get sick. This includes having a personalised sick day action plan and sick day management kit ready to use at the earliest sign of illness. You should discuss your sick day action plan and kit with your General Practitioner (GP), Credentialled Diabetes Educator (CDE) and diabetes team.

What is a “sick day”?

A sick day is when you have an illness or infection to manage as well as your diabetes—such as a common cold, influenza, gastro or a respiratory infection. You may need to make changes to your usual diabetes management plan to help prevent your blood glucose levels from going too high or too low. These changes are usually only needed until you are well again.

Why it’s important to manage sick days

Being unwell (e.g. with an infection) can make it more difficult to manage your diabetes. This is because your body releases stress hormones when you are sick. These hormones make your liver increase the amount of glucose in your bloodstream, and they can also make it difficult for insulin to do its job. This can cause your blood glucose levels to rise.

If you are sick and have high blood glucose levels, you may be at risk of severe dehydration. This can result in you feeling drowsy and confused, and needing urgent medical attention.

What to do when you are sick

Follow your sick day action plan

Start following your plan if you feel unwell or have any signs of sickness or an infection. If your blood glucose levels are higher than 15mmol/L for 8-12 hours or more, start following your sick-day action plan even if you feel ok.

Let a friend or family member know that you are unwell. Tell them about your sick day action plan in case you need any help.

Check your blood glucose levels more often

When you are sick, check your blood glucose levels every two to four hours until levels are back in the target range recommended by your GP or CDE or other health professionals.

Keep taking your diabetes medications or insulin dose(s)

If you have vomiting or diarrhoea, most diabetes medications can continue, with some exceptions. If vomiting and diarrhoea is significant (multiple episodes, or lasting more than a few hours), consult your GP or other health care professional.

There are two types of oral medicine that you may need to stop taking—these are Metformin and SGLT-2 inhibitors. So ask your doctor or pharmacist about these if you have significant vomiting or diarrhoea.

If you are taking insulin, expect to increase your dose(s)

If you are taking insulin, you may need extra insulin when you are unwell, even when you are not eating much, and even with vomiting or diarrhoea. You should monitor your blood glucose levels regularly and this will help indicate if you need extra insulin. If you do, it will be an additional dose of short-acting insulin*.

Refer to your sick-day action plan or talk to your GP or diabetes health professional for advice on making changes to your insulin dose or type of insulin when you are sick.

*Occasionally blood glucose levels may be low during illness. In this case, a reduction in insulin doses may be needed.

If your blood glucose levels are above 15mmol/L for 8 – 12 hours or more, check your blood glucose levels every two hours.

Ask for help

Seek medical help to treat the illness or infection. Contact your doctor early to avoid becoming more unwell and needing emergency care. You may need to contact your CDE or other diabetes health professional for advice about adjusting your insulin dose or medications during periods of illness, especially if your glucose levels stay above 15mmol/L or below 4mmol/L.

If possible, have a friend or relative either stay with you or check on you frequently. Seek urgent medical attention if you have symptoms such as shortness of breath, chest pain or a foot infection.

Keep drinking and (if possible) eating

It’s very important to keep up your fluid and carbohydrate intake when you are feeling unwell, to avoid dehydration and low blood glucose levels (hypoglycaemia, or hypo).

  • Try to eat normally. If you can’t, have some easy-to-manage carbohydrate drinks, snacks or small meals, such as dry toast, plain rice, dry biscuits or crackers, mashed potato, plain ice cream or custard.
  • Try to have a cup of fluid (250 mL) every hour.
  • If your blood glucose levels are 15mmol/L or lower and you can’t eat, drink one cup of fluids containing carbohydrate every hour. These include regular cordial or soft drink, juice, sports drinks, weak tea with sugar/honey, jelly or sweet ice blocks.
  • If your blood glucose levels are higher than 15mmol/L, drink one cup of fluids that does not contain carbohydrate every hour, such as water, diet cordial or diet soft drink, weak tea with no sugar/ honey, diet jelly or broth.
  • If you are vomiting or have diarrhoea, oral rehydration fluids such as Gastrolyte® or Hydralyte® can help replace fluid and electrolytes.

Your diabetes health professionals can help you manage your illness until you are well again.

Seek medical attention IMMEDIATELY if you:

  • are drowsy or confused
  • have deep rapid breathing or shortness of breath
  • chest pain
  • foot infection
  • can’t keep food or fluids down and are experiencing persistent vomiting, diarrhoea and/or stomach pain
  • are showing signs of dehydration (such as extreme thirst, weakness, confusion, lack of urination)
  • have blood glucose levels that continue to rise even though you have been following your sick day management plan
  • have difficulty keeping your blood glucose levels above 4mmol/L
  • are not well enough to follow your sick-day action plan or you don’t have anyone to help you.

Sick day checklist

  • Follow your sick day action plan and use your sick day kit.
  • Let someone know you are unwell.
  • If you use insulin, check your blood glucose levels more often.
  • Keep taking your diabetes medications or insulin dose(s).
  • If you are taking insulin, expect to increase your dose(s).
  • Ask for help—see your doctor or contact your CDE/diabetes educator.
  • Drink plenty of fluids and keep eating (if possible).
  • Seek urgent medical care if needed.

Tips to stay healthy

  • Get immunised for flu and pneumonia.
  • Take care with personal hygiene to avoid the spread of germs.
  • Keep your blood glucose levels within your target range to help reduce the risk of illness and infections.

Sick day kit

The following items should be included in your kit:

  • a copy of your sick day action plan
  • a blood glucose meter
  • in-date blood glucose testing strips
  • your blood glucose diary
  • a thermometer
  • pain relief medication
  • food and drinks for sick days
  • hypo treatment
  • if you use insulin—in-date rapid-acting or short-acting insulin
  • insulin syringes or insulin pen (if you use insulin)
  • telephone numbers for medical and support people
  • A list of relevant medical information, for example Medicare number, NDSS number, medical insurance information.

Check your kit every six months to make sure it is still date and restock your kit if you have used it.

Well managed blood glucose levels can help reduce the risk of illness and infection.

More information

For a sample sick day action plan and management kit, refer to the Australian Diabetes Education Association’s Sick day management of adults with type 2 diabetes consumer resource.

These guidelines are available online at adea.com.au.

The NDSS and you

A wide range of services and support is available through the NDSS to help you manage your diabetes. This includes information on diabetes management through the NDSS Helpline and website. The products, services and education programs available can help you stay on top of your diabetes.

This fact sheet is intended as a guide only. It should not replace individual medical advice. If you have any concerns about your health, or further questions, you should contact your health professional.

Version 4 June 2020. First published June 2016.