Sick Day Guidelines for Type 2 Diabetes

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

• Some medicines

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.

Prevent Dehydration

• 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:

• Soda

• Jell-O

• Pudding

• Juices

• Popsicles

• Sports drinks

• Cooked cereals

• Soups

• 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 Medicines

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