How to Manage Sick Days With Type 1 Diabetes

It’s important to work with your healthcare team to prepare for days on which you are sick and to learn what to watch for when you are.

“Like so many issues of managing type 1 diabetes, handling illness works best when we’re prepared and plan ahead,” says Patti Urbanski, RD, CDCES, an American Diabetes Association board member and clinical dietitian in Duluth, Minnesota, who also has type 1 diabetes. “We always think that ‘this won’t happen to me,’ but sooner or later, it’s likely that everyone with type 1 diabetes is going to become ill and need a sick-day plan.”

“Typically, blood sugar rises with illness because of the added stress on the body, but it really depends on what kind of illness,” says Jennifer K. Frediani, PhD, RD, an assistant professor at the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta.

If you have gastroenteritis or a stomach bug, for example, your blood sugar may drop because you are not eating. If you are fatigued or if rest is part of your illness recovery, the change in your physical activity also can change your blood-glucose levels, Urbanski says.

Insulin treatment is required to manage type 1 diabetes. But the amount of insulin that you need may change when you are sick.

Your health and insulin needs can change quickly, so it’s best to prepare for these problems before they occur. You may need to adjust your doses.

“Talk to your diabetes healthcare team in advance of becoming ill to learn how to manage your insulin plan when you are sick,” Urbanski says.

“Whenever you’re dehydrated, all of the solutes or the compounds in your body, like sodium and glucose, can become concentrated,” Dr. Frediani says.

• Blurry vision
• Dry mouth
• Excessive urination
• Exhaustion
• Fruity breath

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• Unexplained weight loss

“Sip on fluids throughout the day,” Urbanski says. “If you are able to eat solid foods, sip on carbohydrate-free beverages.”

But if you don’t have enough insulin in your bloodstream, ketone production can quickly cascade into an emergency. A high level of ketones signals that your insulin is low, your blood is becoming acidic, and you may need treatment at a medical center.

• You are sick.
• Your blood-glucose level is more than 240 milligrams per deciliter (mg/dL).
• You have DKA symptoms.

Ask your healthcare team about ways to test for ketones and whether you should test more often or when you encounter different symptoms.

It is important to ensure that your body has enough nutrients and calories, even when you are sick. Plan now to keep your kitchen stocked with foods you can eat when you are sick, as you may be unable to go to the store when you’re feeling bad.

Foods that Urbanski recommends keeping on hand include:

• Gelatins and puddings (not sugar-free)
• Saltines or other similar crackers
• Animal crackers or vanilla wafer cookies
• Chicken noodle soup
• Fruit juices (go for small containers like small juice boxes if you don’t drink fruit juice often)
• Small bottles of sports drinks with carbohydrates
• Carbonated beverages that have carbohydrates

Frediani suggests that letting a carbonated beverage like regular ginger ale go flat and drinking it can be useful if you have a stomach bug, especially if you aren’t eating and need to keep your blood sugar up.

“If a person with type 1 diabetes is unable to tolerate solid foods, we suggest that they replace the carbohydrate they would normally eat with carbohydrates from liquids,” Urbanski says.

You may need to visit the emergency room when you get sick. Before that day comes, work with your healthcare team to determine when those visits are necessary and how to prepare for one.

“In general, if you’re sick and your blood glucoses are running higher than 300 mg/dL and not improving, you should be in touch with your healthcare team,” Urbanski says. “If you cannot reach them, or have any symptoms of DKA, it’s always best and safest to seek emergency medical treatment.”

DKA, in particular, requires emergency care, she says. Call 911 if you are experiencing DKA symptoms, especially fruity breath.

Be sure to carry your relevant medical information on you, in case you are unable to tell your medical team about your type 1 diabetes and treatment when you arrive at the emergency room.

• A glucose meter
• Enough insulin to last a week (make sure it is not stored unrefrigerated for more than 30 days)
• Batteries for your diabetes-related devices
• Supplies for your insulin pump or CGM
• Ketone test strips
• Flu or cold medications that won’t disrupt your diabetes management

• If you get sick when you have type 1 diabetes, keep a close eye on your blood sugar, and continue taking insulin as prescribed unless your doctor tells you otherwise.
• Dehydration from vomiting, diarrhea, or fever can increase your risk of diabetic ketoacidosis, a dangerous condition that requires immediate medical intervention.
• Regularly check for ketones when you are feeling ill, as high ketone levels in urine can signal DKA and a need for urgent medical attention.
• Work with your healthcare team now to determine the threshold for visiting the emergency room.