Guidelines for days when you are sick

When people with diabetes are sick with a cold or the flu, or are vomiting, or recovering from surgery, their blood glucose will often be higher than usual--even if they are eating less food. This is because insulin is often less effective during an illness or after an injury. Talk to your healthcare provider about how to manage your disease when you're not feeling well. In general, the following "sick day" steps should be taken to keep blood glucose under control:

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• Take your usual insulin even if you can't eat normally, unless your healthcare provider instructs you differently. In some cases, additional insulin is required.
• Check your blood glucose every three to four hours, including during the night. Have someone do it for you if you are too sick to do it yourself.
• Check for ketones if your plasma blood glucose is 250 mg/dl or higher, unless otherwise instructed by your healthcare team.
• Write the results of your blood glucose and ketone checks down and have them ready if you need to call your healthcare provider.
• Drink plenty of fluids--about 6 to 8 ounces every hour you are awake. If you are able to eat your meals, drink fluids that are sugar free and caffeine free. If you are unable to eat, alternate sugar-free fluids one hour with fluids containing sugar the next. Include liquids with salt, too, such as bouillon or clear soup.
• Rest. Stay warm.

Call your healthcare provider if:

• you are vomiting or have diarrhea for more than two hours,
• you have a fever,
• your blood glucose values remain above 250 mg/dl for at least two checks or do not decrease with extra insulin (whether or not you have ketones),
• you have stomach pains that won't go away.