Sick Days

Understanding What Happens

Minor illnesses, such as the flu and upset stomach, often change the body’s need for insulin.  As a result, the blood glucose may rise much higher than usual, or it may be lower than target. 

High blood sugars during illness can lead to dehydration because they cause frequent urination at a time when you are least inclined to drink large amounts of fluid.  Illness can also lead to diabetic ketoacidosis through a build up of ketones (acetone) in the blood and urine.

What To Do

  1. Insulin must be taken every day, even when you are sick.  Your insulin requirements may change on sick days.  Infections such as strep throat may require higher insulin doses, whereas illnesses that cause vomiting and diarrhea may require less insulin than usual.  You should call your doctor to help determine the appropriate insulin dose.
  2. Carbohydrates must be taken every day, even when you are sick.  Try to eat as much of your usual diet as possible.  If you cannot, you may drink small sips of fluid containing sugar (juice/regular soda) if your blood sugar is less than 180 mg/dL.
  3. Check your blood sugar frequently, at least prior to meals, snacks and bedtime.
    1. If your blood sugars are elevated (more than 250 mg/dL) and you have ketones in your urine, you need more rapid acting insulin.  Call for recommendations.
    2. If your blood sugars are low (less than 70-80 mg/dL) you need regular juice or soda to help keep your blood sugars in target.
  4. Check your urine for KETONES if your blood glucose is over 250 mg/dL.  Moderate or large ketones decrease the effectiveness of insulin and you will require higher doses of insulin.  Ketones can be a sign of insufficient carbohydrate intake as well as insufficient insulin dosing.  CALL YOUR DOCTOR’S OFFICE IF YOU HAVE MODERATE OR LARGE KETONES IN YOUR URINE.


  • Vomiting
  • Moderate or Large Ketones
  • Confused thinking/feeling very sleepy
  • Shortness of breath
  • Other serious/alarming medical problems


If you are unable to eat your usual meals, it is very important for you to eat some type of food with calories that your body can easily digest and keep down.  It is especially important to drink enough fluids such as tea, broth, water, or even ice pops.  Sip fluids slowly throughout the day.

The following foods are easily tolerated and absorbed forms of carbohydrate.  Each provides 15-20 grams of carbohydrates:

  • ½ cup jello
  • ¼ cup sherbet
  • 1 popsicle
  • 5 saltines
  • 1 slice bread
  • 6 pretzel rings
  • ½ cup cooked cereal
  • ½ cup cooked rice
  • ½ cup regular soda or gingerale

Make sure you have plenty of supplies, as you will be checking blood sugars more frequently than usual.

  • Blood glucose strips
  • Blood glucose meter
  • Record book
  • Ketone strips (check expiration date)
  • Insulin (regular and long acting)
  • Glucagon (check expiration date)
  • Fluids – both sugared and non-sugared (or ice pops—both sugar-free AND with sugar)

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