DAM: Diabetes and Sick Day Rules

1209598_63761593I thought this might be a good post for today, seeing as our entire house is under a red level threat: snot alert. The Kid developed a runny, then stuffy nose and John and I knew we were next. We were not disappointed.

I have a tough time being sick. As a person with diabetes, I’ve been labeled “sick” while feeling perfectly healthy. When I begin to feel under the weather, I always have to ask myself: “Is this diabetes or is it something else?” If I am actually just sick, my diabetes takes an extra beating, so I have to be extra careful and follow the rules.

I’m talking Sick Day Rules. This is the plan that you use, developed by your medical team, to deal with your diabetes while you are dealing with illness.

A cold is not just a cold. A fever is not just a fever. A bout with a gastrointestinal bug is not… well, you get the gist. People with diabetes and their family members go into high gear, even when we feel like we can’t get out of bed, because diabetes doesn’t stop and rest.

What’s the big deal about being sick with diabetes?

As I’ve said before, our bodies are amazing machines, doing lots of things behind the scenes that we don’t consciously control. When we get sick, the fighting commences against whatever ails us, which often involves an increase of hormones making our blood sugars harder to control and rise with normal insulin doses.

If you don’t follow the sick day rules (and sometimes it should be called sick week rules), you can end up in the emergency room, dehydrated with high ketones and blood sugars. If you don’t have a sick day rules sheet, you should talk with your medical team about it and plan ahead. You can look at some great samples here:

U Mass Memorial’s Sick Day Rules for Type 1 Diabetes

Clinical Diabetes’ Sick Day Guidelines

University of Wisconsin-Madison Sick Day Guidelines for Patients with Type 1 Diabetes

I’m not eating. Why do I have to take insulin?

Your body is fighting, remember? The hormones are waging war against the invaders and your blood sugars rise with the hormones. Even if you are puking your guts up, you still need insulin. I know, it sounds crazy, but insulin must be taken, and sometimes, in larger quantities than when you feel fine and dandy.

(You didn’t think that your body would miraculously start making insulin because you’re sick? Nah. Didn’t think so.)


As if being sick didn’t suck enough, people with diabetes have to be super-vigilant about ketones. Your body, while amazing, also fails miserably when separating being sick from being “ketone sick” – it feels the same. Nausea? Shortness of breath? Vomiting? You can be sick – or have ketones – or both. So, the only way to know for sure is… check ketones by peeing on a stick (one that measures ketones, not one you found in your backyard) or by using a blood monitor that measures ketones and glucose levels.

If you’ve got ketones, follow your medical team’s guidelines. For me, depending on my ketone level, it’s more insulin and more liquids and more frequent testing. If it’s not coming down, I’m required to call for further instructions. I’m not failing if I have to call; I’m sick and I need help.

Help When You’re Sick With Diabetes

Some people have an emergency preparedness kit with water and matches and extra batteries. Do you have a sick day preparedness kit? If nothing else, have a list to give someone to pick up items at a pharmacy or grocery store if you don’t keep this stuff handy (but you should!). My list includes:

  • Sugar-free cough drops/throat soothers (I love Ricola.)
  • Sugar-free cough/cold medicine (ask for recommendations from your medical team)
  • Pedialyte – I know. Why Pedialyte? It’s got sugar in it. Yep. And electrolytes. If I’m puking, I’ll need both to absorb quickly. You can also get Pedialyte pops. If you have ketones, your body still needs carbs ingested to help clear out the ketones. I’ll talk ketones later this month. It’s fascinating.
  • Fever medication/Pain reliever
  • Tissues for your tender nose! (You can never have enough and when you run out? Ow!)
  • Prescription anti-emetics (If you can hold it down long enough to absorb it, you’ll thank yourself later. There are dissolving tablets of Zofran available. I adore these.)
  • Popsicles (sugar-free and regular)
  • Broth/clear soup/tea/soda
  • Bananas, toast, crackers and pudding
  • Glucagon, in case things go south fast (And while it may not happen, the whole point is to be prepared.)

You must check glucose levels and ketone levels more frequently. You must stay hydrated. You must keep carbohydrates in your system. And if you don’t normally write all the tests and dosages down (::raising my hand::), then start in case you need to call your medical team.

Calling Your Medical Team When You’re Sick with Diabetes

There are times when you must call your medical team. Fever doesn’t go down? Food doesn’t stay down? Blood sugars won’t stay down? Ketones refuse to come down? It’s a downer, but making a call can save your life. The medical team may give you extra advice or advise you to go to the ER. You may need reassurance and it’s perfectly OK to ask for that help.

The best thing that you can do for yourself is to have your sick day rules ready before you need to use them. At your next appointment with your medical team, get it in writing. Then share it with a friend or family member in case you’re too sick to get out of bed. 

You’ll save yourself a lot of hassle. It may not do anything to shorten the duration of the cold or fever or puke-a-palooza, but at least you’ll have your diabetes covered.

Fortunately, this cold is mild. I’ve raised my basal a little bit and no ketones, so I’m holding steady. I know that this won’t be the last time I fall prey to whatever bug is out there, but I’m going to play by the rules, even when my body doesn’t.

Remember: I am not a medical professional. Do not think that what I’m giving you is medical advice for even a second. I do not play a doctor on TV or on the Internet. 

  1. Thanks for sharing! My 10 y/o T1 is in the process of getting over a cold now (and I am just starting it – yay for teaching our kids to share, right?) and this was her first illness since diagnosis. Thankfully it wasn’t too bad but we definitely saw insulin needs increase. I’m just so glad that she is on a pump so that I can adjust that extra need a little at a time and cut it back closer to her normal level if necessary. I can’t wait until she gets her first post-dx stomach bug. (please note the sarcasm in that last sentence)

    1. My first pukefest post diagnosis was not pretty. I remember pleading with my parents between throwing up to not take me to the ER. Fortunately, my doc at Joslin gave them detailed assistance and I narrowly escaped. That was back in 1983… Having a pump now is amazing.
      Make sure your doc gets your daughter an anti-emetic script!

      1. Oh absolutely! I just kind of winged it this time as we’ve never been given detailed sick day protocols. Lots of BG checks and checking for ketones a couple times a day (thankfully all were negative, despite a few BGs in the 400’s!) and I seriously bought like $50 worth of gatorade, juice, popsicles, broth etc. Thankfully most of that stuff has a decent shelf life. She sees the endo in 2 weeks so will be asking about an rx for some zofran. She had stomach bug 3 times last winter in addition to a bunch of other stuff and ended the season with pneumonia which brought out her t1 symptoms and diagnosis in March.

  2. This was great. Thanks so much for sharing this. I know that when I get “sick” it’s probably the worst thing that can happen. I am down for the count, but like you said, diabetes doesn’t just suddenly give you the day off. Great points. And I really should have a sick day kit. 🙂

  3. […] a topic that you struggle with in your daily diabetes management: treating hypoglycemia, ketones and sick day management, glycemic index, healthy choices for eating, ways to start an exercise program when you can’t […]

Leave a Reply