Diabetes and Illness


Illness can lead to an increase in blood sugar levels. The most important step to take during illness is to make sure that blood sugar levels are stable to prevent a small problem like a cold or the flu from causing greater problems. When ill, a person with diabetes is advised to:

  • Take insulin or diabetes pills at the correct time, even if unable to eat, unless otherwise instructed by the healthcare team.
  • Test blood sugar not less than every four hours, before each meal, and at bedtime.
  • Test for ketones. Since blood sugar is generally higher during sick days, there is a fair chance that the sugar in the blood is not being utilized for energy and that fat is being broken down instead. This will lead to an accumulation of ketones, which may start to appear in the urine. It is vital to check urine for ketones when checking blood sugar levels by using the easy to use “dip and read” ketone strips. The color of the test pad will change, indicating the presence of ketones. The color on the test pad compares to those given on the strip bottle that indicate the amount of ketones in the urine. Tests should be conducted more often if blood sugar is greater than 240 mg/dl, or if vomiting or symptoms of ketoacidosis occur.
  • Rest as much as possible.
  • Drink plenty of fluids. The body loses fluids during illness if there is a fever or vomiting. Therefore, it would be advisable to drink at least 1/2 cup of water or any other calorie free, caffeine-free liquid every half hour. It may be easier to take in liquids in small sips.
  • Continue with the usual meal plan if the stomach is not affected by the illness.
  • However, if there is a loss of appetite, soft foods and liquids can be eaten in exchange for usual food.
  • It is important that the carbohydrate balance is not upset by a change in food intake. Liquids or soft foods should be taken to provide 60g of carbohydrate if replacing a meal and 15g of carbohydrate if replacing a snack. This is a time when regular sodas and ice cream can be consumed. A few examples of foods that would give 15g of carbohydrates are as follows:
    • Fruit juice                 1/3 to 1/2 cup
    • Soda (with sugar)      1/2 cup
    • Ice cream (vanilla)     1/2 cup
    • Broth based soup       1 cup
  • Keep in touch with the healthcare team and inform them if the illness lasts more than a day, includes running a high fever, a ketone test is moderate to high, or if one is unable to retain food, pills or liquids.
  • Keep a record of blood sugar levels and ketone test results, a record of the amount of food and liquid consumed, and a record of body temperature for the health care team to have the best understanding of the illness.