Navigating Glucose Monitoring During Illness or Stress

Managing diabetes during periods of illness or stress presents unique challenges that require careful attention and proactive planning. When you have diabetes, other illnesses can make your blood sugar go up, which can be dangerous. Understanding how these conditions affect glucose levels and knowing how to respond appropriately can make the difference between maintaining control and experiencing serious complications.

Understanding the Physiological Response to Illness and Stress

The Stress Hormone Connection

When you’re feeling stressed, your body releases stress hormones like cortisol and adrenaline. These hormones are part of the body’s natural defense mechanism, designed to prepare you for what’s commonly known as the “fight or flight” response. Stress stimulates the release of various hormones, which can result in elevated blood glucose levels.

Cortisol, often referred to as the stress hormone, has a profound effect on blood sugar levels and is released by the adrenal glands in response to stress. Cortisol stimulates the liver to release stored glucose into the bloodstream and promotes gluconeogenesis, the process by which the liver creates glucose from non-carbohydrate sources such as proteins. This mechanism ensures that your body has adequate energy available to deal with perceived threats or physical challenges.

Adrenaline works alongside cortisol in this process. The primary mechanism by which adrenaline raises blood sugar is by stimulating the liver to release more glucose, much like cortisol. Additionally, adrenaline inhibits the action of insulin, making it more difficult for cells to absorb glucose. This dual action can create particularly challenging situations for people with diabetes who are trying to maintain stable blood sugar levels.

How Illness Triggers Blood Sugar Changes

When you’re sick with the flu or another illness, your body releases hormones to fight infection, and these hormones raise blood sugar levels. They also make it hard for insulin or other medicines to lower your blood sugar. This means that even if you’re eating less than usual or not eating at all, your blood glucose levels may still rise significantly.

When you are sick, your body releases stress hormones that help you fight infection, but they also raise blood sugar by making your liver release more glucose and reducing the effect of insulin. This means your blood sugar may rise even if you are eating very little. This counterintuitive phenomenon often catches people with diabetes off guard, especially when they assume that reduced food intake would naturally lead to lower blood sugar levels.

The Impact of Chronic Stress

While acute stress and short-term illness present immediate challenges, chronic stress can have more profound and lasting effects on diabetes management. Sustained high cortisol levels can lead to consistently high blood glucose levels, complicating diabetes management. Persistent activation of the HPA axis leads to sustained high levels of cortisol and other stress hormones, which can cause prolonged periods of elevated blood glucose.

Chronic stress is often associated with unhealthy lifestyle behaviors such as poor diet, lack of physical activity, and inadequate sleep all of which can further exacerbate blood sugar instability. Moreover, chronic stress has been linked to increased inflammation, which plays a central role in insulin resistance and can worsen the underlying mechanisms of both type 1 and type 2 diabetes.

People with diabetes may be more sensitive to stress, as they worry about managing their condition and potential complications, creating a vicious cycle where stress leads to higher blood sugar, and high blood sugar increases stress and anxiety. Breaking this cycle requires both physiological management through monitoring and medication adjustments, as well as psychological support and stress-reduction techniques.

Essential Monitoring Strategies During Illness and Stress

Increased Testing Frequency

One of the most critical aspects of managing diabetes during illness or stress is increasing the frequency of blood glucose monitoring. During illness, check your blood sugar every two to four hours, and if levels are unstable, check more often. Test your blood sugar every 4 hours and keep track of the results. This frequent monitoring allows you to detect changes early and respond appropriately before blood sugar levels become dangerously high or low.

For individuals with type 1 diabetes, even more frequent monitoring may be necessary. Monitor blood glucose every 2-4 hours for Type 1 or 4 to 12 hours for Type 2, or as recommended by your provider. The specific frequency should be determined in consultation with your healthcare provider and may vary based on the severity of your illness, your typical blood sugar patterns, and your treatment regimen.

Nighttime checks may also be necessary. Blood sugar levels can change significantly during sleep, especially when you’re ill, and waking up to check your levels can help prevent dangerous overnight highs or lows. Setting an alarm for middle-of-the-night testing may be inconvenient, but it’s an important safety measure during periods of illness.

Utilizing Continuous Glucose Monitors

If you use a continuous glucose monitor (CGM), illness and stress periods are times when this technology becomes particularly valuable. While using a continuous glucose monitor, pay close attention to trends. CGMs can alert you to rising or falling blood sugar levels before they reach dangerous thresholds, allowing for earlier intervention.

However, it’s important to remember that CGM readings may not always be perfectly accurate, especially during illness when factors like dehydration or medication changes can affect sensor performance. Confirm unexpected readings with a finger test, especially if symptoms do not match the numbers. This dual approach ensures you’re making treatment decisions based on accurate information.

Comprehensive Record Keeping

Maintaining detailed records during illness or stress is essential for effective diabetes management. Keep a record of your blood sugar levels and insulin dose, if you take insulin. Your records should include not just blood glucose readings, but also information about symptoms you’re experiencing, medications you’re taking, food and fluid intake, and any changes to your treatment regimen.

These records serve multiple purposes. They help you identify patterns in how your body responds to illness or stress, they provide valuable information for your healthcare team when you need to consult them, and they can help you remember what interventions were effective if you face similar situations in the future. Consider using a dedicated notebook, smartphone app, or diabetes management software to keep all this information organized and easily accessible.

Ketone Testing: A Critical Safety Measure

Understanding Ketones and Diabetic Ketoacidosis

If your body does not have the proper amount of insulin, you run the risk of your body producing too many ketones, which puts you at risk of developing a serious condition called diabetic ketoacidosis (DKA). Ketones are produced when your body breaks down fat for energy instead of using glucose. While this is a normal metabolic process in certain situations, excessive ketone production in people with diabetes can be life-threatening.

People with type 1 diabetes have a higher risk of diabetic ketoacidosis, and ketone testing is essential if blood sugar rises above 250 milligrams per deciliter. However, people with type 2 diabetes can also develop ketones during severe illness, though the risk is generally lower.

When and How to Test for Ketones

Testing for ketones every four to six hours when you’re feeling sick is recommended. If you take insulin, do a test for ketones, especially when you have high blood sugar. Ketone testing is particularly important when blood glucose levels are persistently elevated despite taking your usual medications.

Check ketones if blood sugar stays above 250 milligrams per deciliter, if you feel nauseated, or if you are vomiting. Nausea and vomiting are warning signs that ketones may be building up in your system, even if your blood sugar readings aren’t extremely high. Other symptoms that warrant ketone testing include unusual fatigue, abdominal pain, and fruity-smelling breath.

Ketone testing can be done using urine test strips or blood ketone meters. Some home blood sugar meters can also measure blood ketones. Blood ketone testing is generally more accurate and provides real-time information, while urine testing shows ketone levels from several hours earlier. Discuss with your healthcare provider which method is most appropriate for your situation and ensure you have the necessary supplies on hand before you get sick.

Recognizing Warning Signs and When to Seek Help

Warning signs include fruity smelling breath, fast breathing, severe tiredness, stomach pain, and confusion. Persistent vomiting with high blood sugar is also concerning. If you experience any of these symptoms, it’s crucial to seek medical attention immediately, as diabetic ketoacidosis can progress rapidly and become life-threatening.

Seek urgent care if moderate or high ketones continue, if blood sugar remains above 300 milligrams per deciliter despite extra insulin, or if you cannot keep fluids down. Don’t wait to see if symptoms improve on their own. When in doubt, it’s always better to err on the side of caution and contact your healthcare provider or go to the emergency room.

Medication Management During Sick Days

Continuing Your Regular Medications

Take your diabetes medicines as usual, and keep taking your diabetes medicine, even if you vomit and have trouble eating or drinking. This is one of the most important rules for sick day management. Many people mistakenly believe that if they’re not eating, they shouldn’t take their diabetes medications, but this can be dangerous.

Insulin must never be stopped. For people with type 1 diabetes especially, stopping insulin can quickly lead to diabetic ketoacidosis. Even if you’re not eating normally, your body still needs insulin to process the glucose that’s being released by your liver in response to the stress of illness.

If you are vomiting and can’t take your medicine, call your doctor, as you may need to adjust your medicines. Your healthcare provider can guide you on alternative ways to take your medications or may prescribe anti-nausea medication to help you keep your diabetes medications down.

Adjusting Insulin Doses

During sick days most people with diabetes may require more insulin. People on insulin may need extra short-acting or rapid-acting insulin if blood sugar is 300 or higher. The amount of additional insulin needed varies from person to person and depends on factors like your current blood sugar level, the presence of ketones, and your usual insulin sensitivity.

Work with your doctor to write a sick-day plan for how to help prevent high blood sugar when you’re sick, and keep your plan in a handy place. This plan should include specific instructions about when and how much to increase your insulin doses, when to check for ketones, and when to contact your healthcare provider. Having this plan prepared in advance means you won’t have to make complex decisions when you’re feeling unwell.

Special Considerations for Certain Medications

Some diabetes medications may need to be temporarily adjusted or stopped during illness, particularly if you’re experiencing dehydration or reduced kidney function. Some medications may need temporary adjustments, especially if dehydration occurs. Medications like metformin, SGLT2 inhibitors, and certain blood pressure medications may need to be held during severe illness.

Don’t take any nonprescription medicines unless you talk to your doctor first, as many nonprescription medicines can affect your blood sugar level. Over-the-counter cold and flu medications, pain relievers, and even cough syrups can contain ingredients that raise blood sugar levels or interact with your diabetes medications. Always check with your pharmacist or healthcare provider before taking any new medication, even if it seems harmless.

Nutrition and Hydration Strategies

The Critical Importance of Hydration

Drink plenty of water to prevent dehydration. Hydration is absolutely essential during illness for several reasons. High blood sugar levels cause increased urination, which can lead to dehydration. Dehydration, in turn, can cause blood sugar levels to rise even further, creating a dangerous cycle.

Your body needs water to move sugar into cells and flush out excess glucose, and even mild dehydration can make blood sugar levels harder to control. Aim to drink fluids regularly throughout the day, even if you don’t feel thirsty. Be sure you’re getting enough water, and if you’re having trouble keeping water down, have small sips every 15 minutes or so throughout the day.

The type of fluids you choose matters. Water, sugar-free beverages, and broth are good choices when blood sugar levels are high. However, if your blood sugar is low or you’re having trouble eating solid foods, you may need fluids that contain carbohydrates to prevent hypoglycemia and provide energy.

Managing Carbohydrate Intake When You Can’t Eat Normally

Try to eat as you normally would. However, this isn’t always possible when you’re sick. If you can’t eat meals, you’ll need to eat or drink about 50 grams of carbohydrates every 4 hours, such as 1½ cup of unsweetened applesauce or 1½ cup of fruit juice.

Being sick can make it hard to eat, and having simple carbs handy like regular soda, Jell-O, or popsicles will help keep your blood glucose up if you are at risk for lows. Other easy-to-tolerate options include crackers, toast, applesauce, soup, and sports drinks. The goal is to maintain a steady intake of carbohydrates to prevent hypoglycemia while avoiding foods that might upset your stomach further.

Keep a variety of these foods and beverages on hand as part of your sick day kit. When you’re feeling unwell, the last thing you want to do is go shopping or prepare complicated meals. Having appropriate foods readily available makes it much easier to maintain adequate nutrition during illness.

Balancing Nutrition with Blood Sugar Control

The challenge during illness is balancing the need for nutrition and hydration with blood sugar control. If your blood sugar is high, you’ll want to avoid sugary drinks and foods. If it’s low or normal, you may need carbohydrate-containing fluids to maintain energy and prevent hypoglycemia. This is where frequent monitoring becomes essential—it guides your food and beverage choices throughout the day.

Consider keeping both sugar-free and regular versions of beverages in your sick day kit. This allows you to choose the appropriate option based on your current blood sugar level. Sports drinks can be particularly useful because they provide both hydration and electrolytes, which can be depleted during illness, especially if you’re experiencing vomiting or diarrhea.

Creating a Comprehensive Sick Day Plan

Essential Components of Your Sick Day Plan

It is a good idea to make a sick-day plan before you get sick. Your sick day plan should be developed in consultation with your healthcare provider and tailored to your specific needs, type of diabetes, medications, and typical blood sugar patterns. This plan serves as your roadmap for managing diabetes when you’re not feeling well.

Your sick day plan should include specific instructions for monitoring frequency, target blood glucose ranges, when to test for ketones, how to adjust medications, what to eat and drink, and when to contact your healthcare provider. Write down the diabetes medicines you’ve been taking and note if you have changed the dose based on your sick-day plan. This documentation helps you track what you’ve done and provides important information if you need to contact your healthcare team.

Assembling Your Sick Day Kit

If you do get sick, it’ll make things easier if you already have a sick-day kit ready to go with the things you’ll need. Your sick day kit should be assembled when you’re healthy and stored in an easily accessible location. Make sure family members know where the kit is kept and what it contains.

Essential items for your sick day kit include extra blood glucose testing supplies, ketone testing strips or a blood ketone meter, a thermometer, your written sick day plan, contact information for your healthcare team, extra diabetes medications, sugar-free beverages, carbohydrate-containing foods and drinks, and over-the-counter medications approved by your doctor. Make sure you have insulin, other diabetes medicines, and easy-to-make foods, enough for several weeks or longer.

Review your sick day kit periodically to ensure medications haven’t expired, testing supplies are adequate, and contact information is current. Replace any items you use and update your plan as your diabetes management evolves or your medications change.

Communication with Your Healthcare Team

Ask your provider for sick day guidelines specific for you. Every person with diabetes is different, and what works for one person may not be appropriate for another. Your healthcare provider can give you personalized guidance based on your medical history, current medications, and typical blood sugar patterns.

Know when to contact your healthcare provider. Minor illnesses in people with diabetes can lead to very high blood sugar levels and possible emergencies, so when children are sick, watch them closely for signs that they need medical attention right away, and your doctor will tell you what signs to watch for and what blood sugar level they recommend. This guidance applies to adults as well—don’t hesitate to reach out if you’re unsure about how to manage your diabetes during illness.

Recognizing Stress-Induced Changes

When people with diabetes experience mental stress, they generally experience an increase in their blood glucose levels. However, people with T1D may have a more varied response, meaning they can experience either an increase or a decrease in their blood glucose levels. Understanding your personal response to stress requires careful monitoring and record-keeping over time.

Stress can be emotional, physical, or situational. Stress can be physical, nutritional, and chemical, and can be experienced as physical pain or illness, or triggered by situations such as an accident, the death of a friend or relative or confrontations with other people. All types of stress can affect blood sugar levels, though the magnitude and direction of the effect may vary.

The Psychological Burden of Diabetes Management

A global survey by the International Diabetes Federation found that 77% of people with diabetes experienced anxiety, depression, or another mental health issue related to their condition. This highlights that diabetes management isn’t just a physical challenge—it’s an emotional and psychological one as well.

Having diabetes to manage on top of life’s normal ups and downs can itself be a cause of stress. Some people may start to feel overwhelmed by their diabetes, feeling frustrated and distressed about having it, worrying about getting complications or feeling guilty if the way they manage their diabetes goes off track, and this feeling of being overwhelmed can get worse when you’re feeling a lot of stress.

Notably, 75% of people pointed out that diabetes burnout led them to stop or interrupt their management and treatment, because of stress or feeling overwhelmed. This creates a dangerous cycle where stress affects blood sugar control, which creates more stress, which further compromises diabetes management. Breaking this cycle requires both practical strategies and emotional support.

Stress Reduction Techniques

Knowing stress triggers and practicing stress-reduction techniques may help people manage these occurrences. While you can’t always eliminate stress from your life, you can develop healthier ways of responding to it. Effective stress management techniques include regular physical activity, mindfulness meditation, deep breathing exercises, adequate sleep, and maintaining social connections.

Consider working with a mental health professional who has experience with diabetes-related issues. There’s nothing to be ashamed of in seeking support from a qualified medical professional, as diabetes burnout and stress can take a toll on mental health and diabetes management overall. Therapy can help you develop coping strategies, address diabetes-related anxiety or depression, and improve your overall quality of life.

Regular exercise deserves special mention as a stress-reduction tool. Physical activity not only helps reduce stress hormones and improve mood, but it also improves insulin sensitivity and helps with blood sugar control. Even moderate activities like walking, swimming, or yoga can provide significant benefits. However, be mindful that intense exercise can sometimes temporarily raise blood sugar levels, so monitor your response and adjust accordingly.

Special Considerations for Different Types of Diabetes

Type 1 Diabetes Sick Day Management

People with type 1 diabetes face unique challenges during illness because they have no endogenous insulin production. People with type 1 diabetes have a higher risk of diabetic ketoacidosis. This means that vigilant monitoring and proactive management are absolutely critical.

Insulin must never be stopped, and monitoring should happen every two to three hours. Even if you’re not eating, your body needs basal insulin to prevent ketone production. In fact, you may need more insulin than usual during illness, not less. The stress hormones released during illness increase insulin resistance, meaning your usual doses may not be as effective.

For people with type 1 diabetes, having rapid-acting insulin readily available is essential. This allows for quick corrections when blood sugar levels rise. Your sick day plan should include specific guidelines for supplemental insulin doses based on your blood sugar levels and the presence of ketones.

Type 2 Diabetes Sick Day Management

In sick day rules type 2 diabetes, the risk of diabetic ketoacidosis is lower, but very high blood sugar can still be dangerous. People with type 2 diabetes often have some remaining insulin production, which provides a degree of protection against ketoacidosis. However, severe illness can still lead to dangerously high blood sugar levels and serious complications.

Medication management for type 2 diabetes during illness can be more complex because people with type 2 diabetes often take multiple medications, some of which may need to be adjusted or temporarily stopped during illness. For example, metformin may need to be held if you’re severely dehydrated or have reduced kidney function. SGLT2 inhibitors may also need to be stopped during illness due to the risk of ketoacidosis.

Some people with type 2 diabetes who don’t usually take insulin may need temporary insulin therapy during severe illness. This is because oral medications may not be sufficient to control blood sugar when stress hormones are elevated. Don’t be alarmed if your healthcare provider recommends insulin during illness—this doesn’t necessarily mean your diabetes has worsened or that you’ll need insulin permanently.

When to Seek Medical Attention

Warning Signs That Require Immediate Care

Knowing when to seek medical attention can be lifesaving. Keep a close watch on diabetes warning signs when you’re sick, and if necessary, get medical attention immediately, as some illnesses require immediate care at the Emergency Department while others can be managed by consulting your doctor, and when in doubt or if you can’t reach your provider, go to an urgent care clinic or Emergency Department.

Specific situations that warrant immediate medical attention include persistent vomiting that prevents you from keeping down food, fluids, or medications; blood sugar levels that remain above 300 mg/dL despite taking extra insulin; moderate to large ketones that don’t improve with treatment; signs of dehydration such as extreme thirst, dry mouth, decreased urination, or dizziness; difficulty breathing or rapid breathing; chest pain; severe abdominal pain; confusion or altered mental status; and loss of consciousness.

Being sick and/or having a low blood sugar level can cause fatigue or difficulty thinking clearly, so if needed, have someone else call your doctor or take you to the emergency room to avoid unsafe driving. Don’t try to drive yourself to the hospital if you’re experiencing severe symptoms or impaired judgment.

Communicating with Healthcare Providers

When you contact your healthcare provider about illness-related diabetes management issues, be prepared to provide specific information. This includes your recent blood glucose readings, ketone test results if applicable, symptoms you’re experiencing, medications you’ve taken and any dose adjustments you’ve made, how much you’ve been able to eat and drink, and how long you’ve been sick.

Having this information readily available helps your healthcare team make informed decisions about your care. This is another reason why keeping detailed records during illness is so important. If you’re too sick to communicate this information yourself, make sure a family member or caregiver knows where to find your records and can speak with your healthcare team on your behalf.

Don’t hesitate to call your healthcare provider if you’re unsure about how to manage your diabetes during illness. It’s always better to ask for guidance than to wait and hope things improve on their own. Many diabetes-related emergencies are preventable with early intervention, and your healthcare team would rather hear from you early in an illness than deal with a crisis later.

Prevention and Preparedness Strategies

Reducing Your Risk of Illness

While you can’t prevent all illnesses, there are steps you can take to reduce your risk. You’ll also want to be sure to get your annual flu shot to make getting the flu less likely. Vaccinations are particularly important for people with diabetes, who are at higher risk for complications from infectious diseases.

In addition to the annual flu vaccine, discuss with your healthcare provider whether you should receive other vaccinations such as pneumonia vaccines, COVID-19 vaccines and boosters, shingles vaccine, and hepatitis B vaccine. Staying current with recommended vaccinations is one of the most effective ways to prevent serious illness.

Other illness prevention strategies include practicing good hand hygiene, avoiding close contact with people who are sick, maintaining a healthy diet and regular exercise routine to support your immune system, getting adequate sleep, managing stress effectively, and keeping your diabetes well-controlled. Good blood sugar control supports immune function and helps your body fight off infections more effectively.

Regular Review and Updates

Your sick day plan shouldn’t be a static document. Review it regularly with your healthcare provider, especially if your medications change, your diabetes management evolves, or you experience an illness that reveals gaps in your plan. Each illness can be a learning experience that helps you refine your approach for the future.

After recovering from an illness, take time to review what worked well and what could be improved. Did you have all the supplies you needed? Were your medication adjustment guidelines appropriate? Did you know when to contact your healthcare provider? Use these insights to update your sick day plan and kit so you’re even better prepared next time.

Consider scheduling an annual “sick day plan review” with your healthcare provider, similar to how you might review your overall diabetes management plan. This ensures that your plan stays current and appropriate for your needs.

The Role of Support Systems

Educating Family and Caregivers

Your family members and close friends should understand your sick day plan and know how to help you implement it. Make sure they know where you keep your sick day kit, how to recognize warning signs of serious problems, when to contact your healthcare provider, and when to call emergency services.

Consider having a family meeting to review your sick day plan when you’re healthy. Walk them through the steps you need to take during illness, show them where supplies are kept, and explain what kind of help you might need. This preparation can be invaluable if you become too sick to manage your diabetes independently.

For children with diabetes, parents and other caregivers need detailed education about sick day management. Schools, daycare providers, and other adults who spend time with your child should also have basic information about diabetes management during illness and know how to contact you or your healthcare provider if concerns arise.

Building a Healthcare Team

Effective diabetes management during illness often requires coordination among multiple healthcare providers. Your team might include your primary care physician, endocrinologist, diabetes educator, pharmacist, and mental health professional. Make sure all members of your team have current contact information for each other and understand their roles in your care.

Establish clear communication channels with your healthcare team before you get sick. Know who to contact for different types of issues, what the best method of contact is (phone, patient portal, etc.), and what the expected response time is. Some healthcare systems offer nurse advice lines or after-hours services that can provide guidance when your regular providers aren’t available.

Consider joining a diabetes support group, either in person or online. Connecting with others who have diabetes can provide emotional support, practical tips, and a sense of community. Other people with diabetes can share their experiences with managing illness and stress, which can help you feel less alone and provide new ideas for your own management.

Long-Term Implications and Recovery

Returning to Normal Management

As you recover from illness, you’ll need to gradually transition back to your usual diabetes management routine. Blood sugar levels may remain somewhat elevated for a few days after you start feeling better, as your body continues to recover and stress hormone levels normalize. Continue monitoring more frequently than usual until your blood sugar patterns stabilize.

If you made medication adjustments during your illness, work with your healthcare provider to determine when and how to return to your usual doses. Don’t make abrupt changes—gradual adjustments are usually safer and more effective. Keep monitoring your blood sugar closely during this transition period to ensure your usual medication regimen is still appropriate.

Weigh yourself every day, as losing weight without trying is a sign of high blood sugar. After recovering from illness, you may need to regain weight you lost. Focus on nutritious foods and adequate hydration to support your recovery while maintaining good blood sugar control.

Learning from Each Experience

Each illness provides an opportunity to learn more about how your body responds to stress and how to manage your diabetes more effectively in challenging situations. Keep notes about what worked well and what didn’t, and use this information to refine your sick day plan for the future.

If you experienced complications or had difficulty managing your diabetes during illness, schedule a follow-up appointment with your healthcare provider to discuss what happened and how to prevent similar problems in the future. This might involve adjusting your sick day plan, changing your usual medications, or addressing other aspects of your diabetes management.

Remember that managing diabetes during illness and stress is challenging for everyone. Don’t be too hard on yourself if things don’t go perfectly. The goal is to stay safe, prevent serious complications, and learn from each experience so you’re better prepared next time.

Essential Action Steps for Illness and Stress Management

Successfully navigating glucose monitoring during illness or stress requires preparation, vigilance, and a willingness to seek help when needed. By understanding how illness and stress affect blood sugar levels, maintaining frequent monitoring, following your sick day plan, and knowing when to contact your healthcare provider, you can minimize complications and maintain better control even during challenging times.

Develop a comprehensive sick day plan with your healthcare provider before you get sick
Assemble a sick day kit with all necessary supplies and keep it easily accessible
Increase blood glucose monitoring frequency to every 2-4 hours during illness or significant stress
Test for ketones when blood sugar is above 250 mg/dL or when experiencing nausea and vomiting
Continue taking your diabetes medications even if you’re not eating normally
Stay well-hydrated by drinking fluids regularly throughout the day
Maintain carbohydrate intake of approximately 50 grams every 4 hours if unable to eat regular meals
Keep detailed records of blood sugar readings, symptoms, medications, and food intake
Know the warning signs that require immediate medical attention
Contact your healthcare provider early if you’re unsure how to manage your diabetes during illness
Practice stress-reduction techniques regularly to minimize the impact of emotional stress on blood sugar
Educate family members and caregivers about your sick day plan and how they can help
Stay current with recommended vaccinations to reduce your risk of serious illness
Review and update your sick day plan regularly, especially after experiencing an illness

Managing diabetes is always a balancing act, but illness and stress add extra complexity to this challenge. With proper preparation, frequent monitoring, appropriate medication adjustments, and timely communication with your healthcare team, you can successfully navigate these difficult periods while minimizing the risk of serious complications. Remember that you don’t have to manage diabetes alone—your healthcare team, family, and diabetes community are all valuable resources to support you through both routine days and challenging times.

For additional information and resources on diabetes management, visit the American Diabetes Association, the Centers for Disease Control and Prevention Diabetes Resources, or the National Institute of Diabetes and Digestive and Kidney Diseases. These organizations provide evidence-based information, support resources, and tools to help you manage diabetes effectively in all situations.

Table of Contents