Sick Day Rules for Diabetes (2024)

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Managing diabetes on sick days requires special attention, as illness can significantly impact blood glucose levels and overall health.

Any illness can cause glucose levels to rise, including:

• Cold
• Influenza
• Diarrhoea
• Urinary tract infection
• Pneumonia
• Injury

It’s crucial for people with diabetes to understand how to adjust their management strategies during these times to maintain stability and prevent complications.

The essential mantra for diabetes management during these times revolves around the “SICK” day rules:

• S: Sugar
• I: Insulin
• C: Carbohydrates
• K: Ketones

Sugar (glucose) monitoring

During sick days, blood glucose levels can be unpredictable. It’s crucial for individuals with diabetes to monitor these levels more frequently to adapt their management plan accordingly.

Testing should be done every 4 hours to ensure that any significant changes are promptly addressed.

Keeping a detailed log of these readings, along with symptoms and any adjustments made to medication or dietary intake, can provide valuable insights for both the individual and their healthcare provider.

Diligent monitoring is the cornerstone of effective diabetes management during illness, ensuring that decisions are data-driven and responsive to the body’s needs.

Insulin and medication

Continuing insulin and diabetes medications during illness is critical as your body’s need for insulin might actually increase, despite eating less.

There are some medication classes that may need to be temporarily stopped if at risk of dehydration (SADMAN rules).

These are:

• S SGLT2 inhibitors: If taken during an acute illness that can lead to dehydration, there is an increased risk of developing euglycaemic DKA.
• A ACE inhibitors: If taken during an acute illness that can lead to dehydration, there is an increased risk of developing AKI due to reduced renal efferent vasoconstriction.
• D Diuretics: If taken during an acute illness that can lead to dehydration, there is an increased risk of developing AKI.
• M Metformin: If taken during an acute illness that can lead to dehydration, there is an increased risk of developing lactic acidosis.
• A ARBs: If taken during an acute illness that can lead to dehydration, there is an increased risk of developing AKI.
• N NSAIDs: If taken during an acute illness that can lead to dehydration, there is an increased risk of developing AKI due to reduced renal afferent vasodilation.

Once the unwell person is feeling better and able to eat and drink for 24–48 hours, these medications can be restarted.

Never skip your doses without consulting a healthcare professional.

• Missing insulin injections

If you’re experiencing higher than usual blood glucose levels, you might need to adjust your medication dosage.

Adjustment should be based on a plan previously discussed with your healthcare provider, tailored to your specific needs during illness.

Carbohydrates

Maintaining stable blood glucose levels can be challenging when you’re sick.

However, nutrition and hydration is paramount during sick days.

If you find it hard to eat your regular meals, focus on consuming small amounts of carbohydrates regularly to keep blood sugar levels stable.

Hydration is equally important, especially to help lower high blood sugar levels and prevent dehydration.

Consider easy-to-eat options like broth or low-sugar fruits such as blueberries or strawberries.

The goal is to manage glucose levels and stay hydrated, even when your usual diet is disrupted by illness.

Ketones

Monitoring for ketones is essential during sickness, especially for people with type 1 diabetes, as the risk of ketoacidosis increases.

Use a ketone test strip to check your urine for ketones if your blood glucose is consistently high or if you feel sicker than expected.

A positive ketone test indicates that your body is using fat for energy due to insufficient insulin which requires immediate action.

This may include adjusting your insulin dosage and consuming more fluids.

Consult with your healthcare provider promptly if ketones are present.

When to get medical assistance

It’s vital to know when an illness with diabetes necessitates medical intervention.

Immediate healthcare attention is required if you experience:

• Severe dehydration
• Persistent high blood sugar levels
• Significant ketones in urine
• Symptoms of ketoacidosis, like nausea, vomiting, and abdominal pain
• Difficulty breathing, chest pain, or altered consciousness

Preparing a sick day plan in consultation with your healthcare team, including when to seek help, can make managing these situations more straightforward and less stressful.