Managing diabetes when you are sick

While you are unwell, you should:

• drink plenty of fluids to avoid getting dehydrated
• continue to eat normally if you can
• try liquid food if you are unable to eat normally
• check your blood glucose more often (if you have testing strips).

Your tablet dose may need to be changed while you are unwell, especially if you are:

• throwing up (vomiting)
• have runny poos (diarrhoea)
• are unable to eat.

It is important to talk to your healthcare provider before making any changes.

It is safe to take paracetamol if you have a fever, headache or other pain.

If you take insulin when you are unwell or going through a period of severe emotional stress, you will need to check your blood sugar more often and adjust your dose as needed.

When you are unwell, your body releases hormones that increase your blood glucose levels. The way you manage your diabetes to avoid developing high blood glucose levels is different when you are sick. You may need more insulin, even though you may not be eating as much as usual or even throwing up.

If you are unwell, you need to take steps to:

• avoid hypoglycaemia (low blood glucose)
• avoid becoming dehydrated
• make sure you still eat well
• prevent diabetic ketoacidosis (DKA) if you have type 1 diabetes.

Take action

There are several things you should do to manage your diabetes when you are unwell.

• Keep using insulin. You may need to adjust the dose, but do not stop your usual injections.
• Test your blood glucose every 2 hours. If your blood glucose levels are less than 4 mmol/l, test them every hour.
• Keep good records — write down the results when you test your blood glucose.
• Measure your ketones if your blood glucose is persistently above 15 mmol/l and you have type 1 diabetes and use a ketone meter.
• Avoid strenuous physical activity, especially if testing shows ketones are present.

You can take paracetamol if you have a fever, headache or other pain.

Drink plenty of fluids

Make sure you drink enough fluid — about a glass every hour.

For type 1 diabetes:

• if your blood glucose levels are below 15 mmol/l and you are not eating, drink sweetened fluids such as soft drink, lemonade ice blocks, ordinary jelly or fruit juice
• if your blood glucose levels are above 15 mmol/l, drink unsweetened fluids.

For type 2 diabetes:

• if your blood glucose levels are below 8 mmol/l and you are not eating, drink sweetened fluids such as soft drink, lemonade ice blocks, ordinary jelly or fruit juice
• if your blood glucose levels are above 8 mmol/l, drink unsweetened fluids.

If you have to fast before having surgery or a medical procedure, make sure you have guidelines for adjusting your insulin beforehand. Speak to your healthcare provider about this.

If you have lost fluids and electrolytes through diarrhoea or vomiting, you can take rehydration solutions such as Gastrolyte. But rehydration solutions have relatively low concentrations of carbohydrates so you may need extra carbohydrates.

Take care with sweetened fluids if you get runny poos. You may have to dilute them up to 5 times so you can absorb them well.