Sick days with diabetes

Being sick can affect your glucose levels

Getting sick from time to time is part of life for everyone. But when you live with diabetes, being sick can make it harder to keep your glucose levels in your target range.

Have a sick day action plan

A sick day action plan has step-by-step instructions on how to look after your diabetes when you are unwell. If you do not have one, ask your doctor, diabetes nurse practitioner or diabetes educator to make one for you.

You can find examples on our sick day action plan page. Your diabetes health professional will need to tailor one of these plans for you.

Start your sick day action plan as soon as you feel unwell

Start following your sick day action plan immediately if you feel unwell OR if any of the below apply.

Type 1 diabetes

• Your blood ketones are higher than 0.6 mmol/L (small [+] or above on a urine ketone strip).

or

• Your blood glucose level is higher than 13 mmol/L (even if you feel ok) for more than:
  • 6 hours if you are using multiple daily injections (MDI)
  • 2 to 3 hours if you are using an insulin pump
  • 1 to 2 hours if you are pregnant.

Type 2 diabetes

• Your blood glucose levels are higher than 15 mmol/L for 8 to 12 hours.

Other things to do when you are sick

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. If possible, have someone stay with you or check in on you often.

Check your glucose levels more often

If you already check your glucose levels

Check your glucose levels every 2 hours or more according to your sick day action plan. You can go back to your usual routine when your glucose levels are back in your target range.

If you do not usually check your glucose levels

Ask your health professional if you should check them when you are sick. They may advise you to keep a blood glucose meter at home to use when you are unwell. They can also show you how to use the meter and access supplies through the NDSS.

Check if your diabetes medicines need to change

You might need to stop or reduce your diabetes medicines if you cannot eat, or if you have vomiting and/or diarrhoea lasting more than a few hours. This is to reduce your risk of low blood glucose levels (hypoglycaemia).

Your sick day action plan will tell you if you need to stop or adjust the medicines you are taking.

Check if your insulin needs changing

If you use insulin, you may need to increase your rapid-acting insulin doses to keep your glucose levels in range. Sometimes you may need to reduce your dose.

Check your glucose levels often and follow the instructions on your sick day action plan. It will tell you how to adjust your insulin according to your glucose levels.

If you are unsure about how to adjust your insulin doses when you are sick or have questions about your sick day action plan, please talk to your doctor or diabetes educator.

Keep drinking and (if possible) eating

It is very important to keep drinking to prevent dehydration. Try also to keep eating if you can, to keep your energy up and prevent low blood glucose levels.

If you cannot eat normally:

• have snacks or small meals of plain, bland food
• try dry toast, plain rice, dry biscuits, crackers, mashed potato, plain ice cream or custard.

If you have vomiting or have diarrhoea:

• avoid dairy food
• sip slowly on half to 1 cup of fluid (125–250 mL) every hour.

Your sick day action plan will tell you if your drinks should contain carbs or not, depending on your glucose levels. You can also replace fluid and electrolytes with drinks such as Hydralyte®.

Ask for help

If you do not feel well enough to look after your diabetes, or if you are not sure what to do, contact your doctor, diabetes nurse practitioner, or diabetes educator.

Ask for help early so you do not become even more unwell and need emergency care.

When to seek medical attention 

Diabetic ketoacidosis (DKA)

People with diabetes who use insulin or medicines called SGLT2 inhibitors are at risk of DKA when they are sick. DKA is a serious condition that needs urgent medical attention.

DKA can happen when the body is unable to use glucose for energy, such as when you are sick and your body is not getting the extra insulin it needs. Instead, it may start to use fat for energy. This causes ketones to be produced, which are toxic in large amounts and can lead to DKA.

Symptoms of DKA include:

• nausea, vomiting and/or tummy pain
• feeling very thirsty, having a dry mouth or not passing urine
• breathing fast or feeling short of breath
• fruity-smelling breath
• feeling drowsy, weak, or confused

If you experience these symptoms, seek urgent medical help.

Hyperglycaemic hyperosmolar syndrome (HHS)

When you have high blood glucose levels, your body tries to get rid of the extra glucose through your urine. This can make you dehydrated.

If you are not drinking enough because you are sick, the dehydration can become severe and lead to HHS, which can be life-threatening. 

HHS is more common in older people with type 2 diabetes but can happen at any age.  It is rare in people with type 1 diabetes.

Symptoms of HHS can develop over several days and include: 

• very high blood glucose levels (often over 30 mmol/L)  
• extreme thirst and/or a dry mouth  
• passing urine more often 
• feeling drowsy, weak, or confused  
• dry skin  
• fever.

If you experience these symptoms, seek urgent medical help.