Chapter 12: Sick Days

Sick Days

Blood glucose levels are often harder to control when a person with diabetes is sick. Illness makes the body release stress hormones. This causes high blood glucose numbers. Illness is a common reason people with diabetes get ketones in their blood and urine. Decreased appetite or throwing up (vomiting) can lead to low blood glucose. Ketones can form even when blood glucose numbers are in target or low. Good control of blood glucose is not usually possible during illness. The goal is to keep from having very high or very low blood glucose and to prevent or treat ketones.

General Rules

  • If you do not feel like eating much, carbohydrates may be given in the form of liquids instead of solid food.
  • Keep taking your usual dose of long-acting insulin (Lantus® or Levemir®). Do this even when you are vomiting or do not want to eat.
  • Check blood glucose every 3 hours during the day and night.
  • Check ketones every 3 hours. Keep checking until you have no ketones and the result on your ketone strip stays negative.
  • Give insulin for ketones every 3 hours.
  • Drink a lot of fluids. Try to drink 8 ounces (1 full glass) every 30 to 60 minutes.
  • Follow your Diabetes SOS: Sick Day Self-Management guidelines for help managing your diabetes.

Image Credit: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Carbohydrates for Sick Days
Foods Liquids
  • Bread or Toast
  • Crackers
  • Applesauce
  • Regular Jello
  • Pedialyte
  • Gatorade
  • Regular Popsicles
  • Soup broth


Many prescription and over-the-counter medicines have sugar and carbohydrates in them. Ask your pharmacist if you can get the medicine in a sugar-free form. If your child is taking a medicine that might raise his or her blood glucose, make a note of it in the logbook. Keep giving the medicine your child’s regular doctor tells you to give to treat the illness or fever.

Surgery & Diabetes

Your child’s insulin dose may need to be changed if your child has surgery or a procedure that needs anesthesia. The dose will depend on how long the surgery is and how long he or she is without food and drink before the surgery. This includes dental procedures. If possible, your child’s surgery should be done first thing in the morning.
Call the Diabetes Center office as soon as you know that a surgery has been scheduled. The diabetes doctor and surgeon will need to make a plan for your child’s diabetes before, during, and after the procedure.

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