Any type of illness can raise blood sugar. Even if you are not able to eat or drink, blood sugars tend to rise. This handout describes what to do.
Causes of High Blood Sugars
Any illness, infection, surgery
Missed or skipped insulin or diabetes oral medicine
Physical or emotional stress
Warning Signs of High Blood Sugar
Increased thirst: your body needs extra fluids
Increased urination: your body’s way of getting rid of extra sugar
Fatigue: your body’s cells are not getting enough sugar or energy because you lack insulin
Weight loss: your body is burning fat for energy
Dehydration: due to increased urination, vomiting, diarrhea, or fever
Checking Blood Sugars When Sick
If you get sick with a cold or flu or if you have an infection, you may need to check your blood glucose levels as often as every two hours. Stay in close contact with your health care team during these times.
Drink at least 4 ounces (1/2 cup) of fluids every 30 minutes.
With vomiting and diarrhea, your body loses electrolytes like potassium and sodium. Replace these losses with bouillon, soups, sports drinks, and juices.
If you cannot eat your normal meals, eat foods and/or drink fluids with sugar. These foods must have sugar to prevent the breakdown of fat into ketones. If you use insulin with meals, take insulin for the carbohydrates in the liquids or foods that you eat. Examples are:
Crackers or toast
Sherbet or ice cream
Remember, these choices should not be diet or sugar-free. Also, soda that is warm and flat are better tolerated than cold, carbonated sodas.
Adjust your medicines as follows or as your health care team has advised.
Oral medicines (pills):
If you are able to eat, you may keep taking your diabetes pills.
If you are not able to eat, stop taking your diabetes pills. If prescribed, you can keep taking Actos® (pioglitazone) or Avandia® (rosiglitazone).
Injectable medicine: Stop taking Victoza®, Byetta® and Bydureon® until you are able to eat.
Insulin: Your doses may change when you are sick. See next section to learn more.
Insulin Plan When Eating
Take your usual dose of basal (long-acting) insulin (NPH, Levemir®, Basaglar®, Lantus®, Toujeo®, or Tresiba®).
Keep taking your mealtime (short or rapid-acting) insulin.
Use correction insulin. Call your health care team to decide if your doses need to be changed while you are sick.
If you use an insulin pump, talk with your care team about what changes are needed. Take your usual correction per the pump bolus calculator.
Insulin Plan When Not Eating
It is always best to discuss insulin changes with your health care team. See below for common changes when not eating your usual meals.
NPH: Take ½ of usual dose.
Levemir, Basaglar, Lantus, Toujeo, or Tresiba: Take usual dose.
Regular Novolog, Apidra, Humalog, Admelog: Do not take meal insulin. Only use your correction scale.
Pre-mixed insulin (70/30, 75/25, 50/50): Take ½ of usual dose and call your health care team for direction.
Concentrated insulin (U-500, U-300, U-200): Call your health care team for direction.
When to Call
Blood sugar 300 mg/dL or higher for 6 hours or more
Vomiting or diarrhea for 6 hours
Unable to drink fluids
Not sure how to adjust your diabetes medicine your diabetes medicine