Complete Guide to Managing Diabetes During Illness: Sick Day Rules

When you're living with Type 1 diabetes, illness can make blood sugar management particularly challenging. Understanding how to handle these situations effectively can help prevent complications and support faster recovery. This comprehensive guide will walk you through everything you need to know about managing diabetes during sick days.

Understanding Why Illness Affects Blood Sugar

During illness, your body undergoes several changes that can significantly impact blood glucose levels. When you're sick, your body responds by releasing stress hormones like cortisol and adrenaline as part of its natural defense mechanism. These hormones serve an important purpose in fighting illness, but they also make your body more resistant to insulin.

The combination of stress hormones and insulin resistance means your blood sugar may rise higher than usual, even if you're eating less than normal. Additionally, some illnesses can cause dehydration, which concentrates glucose in your blood and may lead to even higher readings.

Essential Monitoring During Illness

Blood Sugar Monitoring

When you're sick, your usual testing schedule likely won't be sufficient. Increased monitoring becomes crucial because your blood sugar can change rapidly and unpredictably. Check your blood glucose every 2-4 hours, even during the night. This frequent monitoring helps you catch and respond to problems early, preventing more serious complications.

Keep detailed records of your readings during illness. These records can help you identify patterns and may be valuable if you need to consult your healthcare team. Many diabetes management apps make it easy to track and share this information.

Understanding Ketone Testing

Ketone testing becomes particularly important during illness, especially when blood glucose levels remain above 250 mg/dL. Ketones are acids that build up in your blood when your body starts breaking down fat for energy instead of using glucose. This can happen during illness even if you're eating, because insulin resistance may prevent your cells from accessing the glucose in your bloodstream.

Test for ketones every 4-6 hours when you're sick, and more frequently if your blood sugar stays high or if you're experiencing nausea or vomiting. The presence of ketones during illness can indicate a need to adjust your insulin doses or seek medical attention.

Medication Management During Illness

The Critical Role of Basal Insulin

One of the most important rules during sick days is to never skip your basal (background) insulin. Even if you're not eating much, your body still needs basal insulin to prevent ketone formation and maintain basic metabolic functions. In fact, you might need more basal insulin than usual during illness due to increased insulin resistance.

Your healthcare team might have provided guidelines for temporary basal rate increases during illness. If you use an insulin pump, you might need to increase your basal rate by 10-20%. For those on multiple daily injections, you might need to increase your long-acting insulin dose.

Adjusting Bolus Insulin

Meal-time insulin requirements can be tricky during illness because nausea might affect your food intake. However, you might still need correction doses to address high blood sugars caused by illness-related insulin resistance. Work with your healthcare team to develop guidelines for insulin adjustments during illness, including:

• How to calculate correction doses when sick
• When to give additional corrections
• How to handle reduced food intake
• Guidelines for insulin adjustments based on ketone levels

Hydration: A Critical Component

Maintaining proper hydration during illness plays a crucial role in blood sugar management and overall recovery. Dehydration can concentrate glucose in your blood, making it harder to bring high blood sugars down. Aim to drink at least 8 ounces of fluid every hour while awake.

Choose a mix of sugar-free and regular fluids based on your blood sugar levels. If your blood sugar is high, focus on sugar-free options like water, sugar-free sports drinks, or clear broths. If your blood sugar starts trending low, incorporate regular sodas, juice, or sports drinks containing carbohydrates.

When to Seek Medical Help

Understanding when to contact your healthcare team or seek emergency care can prevent serious complications. Contact your healthcare provider if you experience:

• Persistent vomiting or diarrhea lasting more than 6 hours
• Blood sugar remaining above 300 mg/dL for more than 6 hours despite corrections
• Moderate or large ketones that don't improve with additional insulin
• Inability to keep fluids down
• Fever above 101.5°F (38.6°C)

Seek immediate emergency care if you develop:

• Severe abdominal pain
• Difficulty breathing
• Extreme lethargy or confusion
• Signs of severe dehydration
• Persistent high ketone levels with vomiting

Building Your Sick Day Kit

Being prepared for illness can make managing sick days much easier. Create a dedicated sick day kit that includes:

Testing Supplies

Keep extra supplies of all testing materials, including:

• Blood glucose test strips
• Ketone testing supplies
• Backup CGM sensors if you use them
• Fresh batteries for all devices
• Alcohol swabs for clean testing

Treatment Supplies

Stock your kit with items that can help manage both high and low blood sugars:

• Sugar-free fluids for hydration
• Regular soda or juice for treating lows
• Easy-to-digest foods like crackers or toast
• Glucose tablets for quick sugar if needed
• Anti-nausea medication (check with your healthcare team first)

Recovery and Return to Normal Routine

As you start feeling better, take a gradual approach to returning to your normal diabetes management routine. Continue frequent monitoring as you recover, as insulin needs might still be elevated even after other symptoms improve. Document what worked well during your illness to help prepare for future sick days.

Remember to replenish your sick day supplies after you've recovered, ensuring you're prepared for the next time you might need them.

Key Takeaways for Successful Sick Day Management

Managing diabetes during illness requires extra attention and care, but having a clear plan makes it more manageable. Focus on frequent monitoring, maintaining hydration, never skipping basal insulin, and knowing when to seek help. Keep detailed records of your experience to help refine your sick day management strategy over time.

Learn more about how stress affects blood sugar

References

1. Think Like a Pancreas by Gary Scheiner
2. Type 1 Diabetes Self-Care Manual by American Diabetes Association