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Managing diabetes during cold and flu seasons requires heightened vigilance and strategic planning. People with diabetes, even when well-managed, are at higher risk of developing serious flu complications that can result in hospitalization and sometimes even death. Understanding how illness affects blood sugar levels and implementing comprehensive management strategies can help prevent complications and maintain optimal health throughout the challenging winter months.
Understanding How Illness Affects Blood Sugar Levels
When a person with diabetes gets sick, the stress causes their body to release hormones that upset blood sugar levels. This physiological response occurs as your body attempts to fight infection, but these stress hormones have significant effects on glucose metabolism. Your body releases hormones to help fight the disease, and in addition to fighting the disease, the hormones also make your blood sugar higher and keep the insulin from working.
Acute illnesses like the flu can make controlling blood sugar levels harder, and the flu may raise blood sugar levels. This creates a challenging situation where even if you’re eating less than usual due to illness, your blood glucose can still rise significantly. People with diabetes may experience unpredictable blood sugar levels during illness, which can lead to hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar).
The complexity increases because a reduced appetite when sick can cause blood sugar levels to fall. This means you must carefully balance medication, food intake, and hydration while managing illness symptoms—a task that requires preparation and knowledge.
Serious Complications to Watch For
Diabetic Ketoacidosis (DKA)
Diabetic ketoacidosis (DKA) is a life-threatening medical emergency that most commonly affects people with type 1 diabetes, but the condition can occur in people with type 2 diabetes who have a severe illness or infection. Understanding this condition is crucial for anyone managing diabetes during illness.
When your body doesn’t make enough insulin, cells can’t turn glucose into energy, so your body will start to break down fat as fuel, which can cause a harmful buildup of acids (ketones) in the blood, and dangerous levels of ketones can cause the blood to become acidic.
High blood sugar can cause ketoacidosis in people with Type 1 diabetes and hyperosmolar hyperglycemic non-ketotic coma in people with Type 2 diabetes, and both of these conditions are very serious and can be life-threatening.
Additional Complications
Flu-related complications include pneumonia, bronchitis, sinus infections, and ear infections, and about 30% of adults hospitalized with flu reported to the CDC had diabetes in recent seasons. These statistics underscore the importance of preventive measures and careful illness management for people with diabetes.
Comprehensive Blood Sugar Monitoring During Illness
Frequency of Testing
During illness, standard blood sugar monitoring schedules must be intensified. Patients with diabetes should check their blood glucose levels every two to four hours while they’re under the weather. This frequent monitoring allows you to detect fluctuations quickly and respond appropriately.
Check your blood sugar levels every 4 hours, or as often as recommended by your doctor. Some healthcare providers may recommend even more frequent testing depending on your individual situation and the severity of your illness. Check your blood glucose every 3 to 4 hours and write down your numbers.
Keeping detailed records during sick days is essential. Document your blood sugar readings, medication doses, food and fluid intake, symptoms, and temperature. This information helps you and your healthcare provider make informed decisions about adjusting your treatment plan.
Ketone Testing
The CDC recommends testing for ketones anytime you’re sick, especially if your blood sugar is 240 mg/dL or above, and if your blood sugar remains elevated above 240 mg/dL, monitor your ketones every 4-6 hours. Ketone testing is a critical component of sick day management that should not be overlooked.
People with Type 1 diabetes should monitor their blood sugar and ketones every four hours, while people with Type 2 diabetes should check their blood sugar every two to four hours and check for ketones if the blood sugar is over 240mg/dl.
If you detect ketones in your urine, get in touch with your healthcare provider right away for guidance, stay well-hydrated as drinking fluids helps flush ketones from your system, and if you can’t get in touch with your provider promptly, can’t keep fluids down or your ketone levels stay high, call 911 or go to the nearest emergency room.
Medication Management During Illness
Continue Taking Diabetes Medications
One of the most important sick day rules is continuing your diabetes medications. Most of the time, you should take all of your medicines as you usually do, and do not skip or double up on any medicine unless your provider tells you to. This applies even when you’re feeling too ill to eat normally.
Do not skip your diabetes medications or insulin even if you feel too sick to eat. Your body may actually require more insulin during illness due to the stress hormones that raise blood sugar levels, even if you’re consuming fewer calories than usual.
Medication Adjustments and Precautions
Clinicians should consider holding metformin and SGLT2 inhibitors when oral intake cannot be maintained or if there is concern for acute kidney injury, GLP-1 RAs may need to be held for illnesses with significant gastrointestinal symptoms, and thiazolidinediones should be held in the setting of heart failure exacerbation or other conditions with hypervolemia.
If you cannot eat your normal amount of carbohydrates, use your sick day plan or contact your provider, as you may need to make a change in your insulin dose or in the dose of your diabetes pills or other injections, especially if your illness is making your blood sugar higher than normal.
Over-the-Counter Medications
Some cold and flu drugs, such as cough syrups or liquid medicines, have sugar in them, so read the ingredients label carefully and ask your doctor or pharmacist to recommend over-the-counter drugs that are safe for you. Many people with diabetes are unaware that common cold remedies can significantly impact blood sugar levels.
Many medicines can affect your blood sugar level—some antibiotics can lower blood sugar levels in people with Type 2 diabetes, while decongestants and products to treat colds can increase your blood sugar level and blood pressure. Always consult with a pharmacist or healthcare provider before taking any over-the-counter medication.
One of the common side effects for someone who closely monitors their blood sugars and takes steroids for flu or cold symptoms is having elevated blood sugars from the steroids. This is particularly important to communicate to any healthcare provider you see during illness.
Nutrition and Hydration Strategies
Maintaining Adequate Hydration
Proper hydration is absolutely critical during illness. Drink plenty of sugar-free fluids to keep your body from getting dehydrated, drinking at least twelve 8-ounce cups (3 liters) of fluid a day. Dehydration can worsen blood sugar control and increase the risk of serious complications.
If you have a fever, vomiting, or diarrhea, drink 1 cup of liquid every hour you’re awake, with water and broth being good choices, and you can sip the liquid if you want—no need to gulp it down all at once. The key is consistent fluid intake throughout the day.
If your blood sugar is less than 100 mg/dL (5.5 mmol/L) or falling quickly, it is OK to drink fluids that have sugar in them. This helps prevent dangerous drops in blood sugar when you’re unable to eat solid foods.
Eating During Illness
You may not feel hungry when you first get sick, but it’s important to try to eat something anyway, because if you don’t eat, your blood sugar might fall too low. This is especially important for people taking insulin or medications that can cause hypoglycemia.
If you can’t eat meals, you’ll need to eat or drink about 50 grams of carbohydrates every 4 hours, with examples including 1½ cup of unsweetened applesauce or 1½ cup of fruit juice. These easily digestible carbohydrate sources help maintain blood sugar levels when you can’t tolerate regular meals.
If you cannot eat and drink your regular food then eat or sip about 15 grams of carbohydrates every hour. Having a variety of easy-to-digest options available before you get sick makes this much easier to manage.
Sick Day Food Options
When you’re too ill for regular meals, certain foods and beverages can help maintain blood sugar levels while being gentle on your stomach. Sugar-free options include water, tea without sugar, instant broth, diet sodas, sugar-free popsicles, and sugar-free gelatin.
When blood sugar is low or falling, appropriate carbohydrate-containing options include regular soda, fruit juices, sports drinks like Gatorade, regular gelatin, popsicles, and crackers. Having these items stocked in your home before illness strikes ensures you’re prepared.
Preventive Measures and Vaccinations
Importance of Flu Vaccination
It is important for people with diabetes to get annual flu vaccinations to prevent flu and serious flu complications, and flu vaccination has been associated with reduced hospitalizations among people with diabetes (79%). This dramatic reduction in hospitalization risk makes vaccination one of the most important preventive measures.
People with diabetes should avoid the nasal spray flu vaccine, opting for injectable vaccines. This is an important distinction that many people may not be aware of when scheduling their flu shot.
Additional Recommended Vaccines
Tips for cold, flu and allergy seasons for people with diabetes include getting the recommended vaccines for the flu, pneumonia and respiratory syncytial virus (RSV). These vaccines provide comprehensive protection against the most common and dangerous respiratory infections.
Vaccines improve your immune response to infections and help reduce the severity and length of symptoms, which can keep you out of the hospital. For people with diabetes, avoiding hospitalization is particularly important given the increased risk of complications.
Daily Prevention Strategies
Beyond vaccinations, daily preventive measures significantly reduce infection risk. Practice thorough hand hygiene by washing hands with soap and water for at least 20 seconds, especially before eating, after using the bathroom, and after being in public spaces.
Wear a mask when around large groups of people and/or those who have cold or flu symptoms, and wash hands thoroughly several times a day. These simple measures create barriers against infection transmission.
Avoid close contact with people who are sick whenever possible. If you must be around someone who is ill, maintain distance, wear a mask, and increase hand hygiene frequency. Keep frequently touched surfaces in your home clean, including doorknobs, light switches, phones, and keyboards.
Developing a Comprehensive Sick Day Plan
Creating Your Plan Before Illness Strikes
If you have diabetes, it is very important to plan ahead, and having a plan before you are sick will help you prevent more serious problems. Don’t wait until you’re feeling ill to figure out what to do—preparation is key to successful illness management.
Patients are encouraged to discuss how to manage illnesses with their providers before flu season arrives, so they are better prepared if they get sick. Schedule a visit with your healthcare team to develop a personalized sick day plan that addresses your specific medications, target blood sugar ranges, and individual health considerations.
Components of an Effective Sick Day Plan
Your sick day plan should include specific instructions for medication adjustments based on blood sugar readings, guidelines for when to test for ketones, target ranges for blood sugar during illness, and clear criteria for when to contact your healthcare provider or seek emergency care.
People with diabetes need to follow the sick day guidelines if they become ill. Your plan should be written down and easily accessible, with copies kept in multiple locations and shared with family members or caregivers who might need to help you during illness.
Assembling a Sick Day Kit
Having supplies ready before you get sick makes management much easier when you’re not feeling well. Your sick day kit should include a thermometer for monitoring fever, ketone test strips with current expiration dates, extra blood glucose testing supplies, and a backup supply of all diabetes medications.
Include easy-to-digest foods and beverages such as regular and diet clear sodas, sugar-free and regular gelatin, sports drinks, broth, crackers, and applesauce. Add over-the-counter medications approved by your healthcare provider for treating cold and flu symptoms, along with contact information for your healthcare team including after-hours and emergency numbers.
When to Contact Your Healthcare Provider
Warning Signs Requiring Medical Attention
Contact your healthcare provider if your blood sugar level remains higher than 180 mg/dL, your blood sugar level remains lower than 70 mg/dL, you cannot keep down solids or liquids, or your temperature is over 101 F. These are clear indicators that your illness requires professional medical guidance.
If you have blood sugar levels of 200 to 400 mg/dl and have symptoms call the clinic or your provider, if you have blood sugar levels above 400 always call your provider, and if you have blood sugar levels under 70 mg/dl for two readings in a row and you have symptoms.
Patients with diabetes should contact their medical provider if they become significantly ill, fatigued or have difficulty controlling blood sugar levels. Early intervention prevents minor illnesses from becoming serious complications.
Emergency Situations
Go to the emergency room right away if you’re having trouble breathing, you have ketones in your urine, you can’t keep any liquids down for more than 4 hours or can’t keep food down more than 24 hours, you lose 5 pounds or more during the illness, your blood sugar is lower than 60 mg/dl, or you have vomiting and/or severe diarrhea for more than 6 hours.
Don’t hesitate to seek emergency care if you experience symptoms of DKA, including excessive thirst, frequent urination, nausea and vomiting, abdominal pain, shortness of breath, fruity-scented breath, or confusion. These symptoms indicate a medical emergency requiring immediate treatment.
Special Considerations for Antiviral Treatment
CDC recommends prompt flu antiviral treatment for people with diabetes who have flu infection or suspected flu infection, and if you have diabetes and experience flu symptoms, call your health care provider right away. Antiviral medications are most effective when started within the first 48 hours of symptom onset.
Antiviral medications may reduce the severity of an infection, if appropriate. These medications can shorten the duration of illness and reduce the risk of complications, making early contact with your healthcare provider crucial when flu symptoms appear.
Managing Stress and Emotional Well-being
Managing diabetes requires the person living with it to make lots of decisions on a daily basis; illness can create even more complexity when the person is already not feeling well. The emotional burden of managing diabetes during illness should not be underestimated.
Stress makes it difficult to pay attention to responsibilities, especially diabetes management, and sickness requires even more careful monitoring. Recognizing this challenge and planning for support is an important part of illness management.
Family and friends can help by reminding the person to check blood glucose levels more frequently (every 2-4 hours), preparing snacks or medications that will help address blood glucose levels, and providing emotional support during a stressful time. Don’t hesitate to ask for help when you need it.
Temperature Monitoring and Fever Management
Check your temperature every morning and evening, as a fever may be a sign of infection. Regular temperature monitoring helps you track the progression of illness and provides important information for your healthcare provider.
Check your temperature every four hours and continue to monitor until you feel better. Keep a record of your temperature readings along with your blood sugar levels, as fever often correlates with increased blood sugar levels and may indicate the need for medication adjustments.
Understanding Immune Function in Diabetes
People with diabetes may have altered immune function, particularly when blood sugar levels are not well controlled. High blood sugar can impair the function of white blood cells, reducing the body’s ability to fight infections effectively. This makes prevention even more critical and explains why infections can be more severe in people with diabetes.
Maintaining good blood sugar control year-round supports optimal immune function. Keeping your blood glucose on target is one of the best ways to help your body deal with sickness. This underscores the importance of consistent diabetes management, not just during illness but as a foundation for overall health.
Recovery and Returning to Normal Routines
As you recover from illness, continue monitoring blood sugar levels more frequently than usual until they stabilize within your target range. Gradually return to your normal eating pattern as your appetite improves, but continue to monitor how different foods affect your blood sugar as your body recovers.
Review your sick day experience with your healthcare provider at your next appointment. Discuss what worked well, what was challenging, and whether any adjustments to your sick day plan are needed. This reflection helps you prepare even better for future illnesses.
Replenish your sick day kit after recovering, replacing any supplies you used and checking expiration dates on medications and test strips. Update your emergency contact information if needed and ensure family members know where to find your sick day plan and supplies.
Long-term Health Optimization
Beyond managing individual episodes of illness, focus on long-term strategies that support immune health and reduce infection risk. Maintain consistent blood sugar control through regular monitoring, appropriate medication use, balanced nutrition, and regular physical activity.
Get adequate sleep, as sleep deprivation impairs immune function and makes blood sugar control more difficult. Aim for 7-9 hours of quality sleep per night. Manage stress through relaxation techniques, regular exercise, social connections, and professional support when needed.
Attend all scheduled appointments with your healthcare team, including annual comprehensive diabetes evaluations. These visits allow for early detection and management of complications, medication adjustments, and updates to your diabetes management plan based on the latest evidence and your changing needs.
Resources and Support
Numerous resources are available to help you manage diabetes during cold and flu seasons. The Centers for Disease Control and Prevention provides comprehensive information about flu prevention and management for people with diabetes. The American Diabetes Association offers educational materials, support groups, and the latest research on diabetes management.
Consider working with a certified diabetes care and education specialist (CDCES) who can provide personalized guidance on sick day management, medication adjustments, and lifestyle strategies. These specialists have advanced training in helping people with diabetes navigate complex situations like illness management.
Join diabetes support groups, either in person or online, where you can share experiences and learn from others managing similar challenges. Many people find that connecting with others who understand the daily realities of diabetes management provides valuable emotional support and practical tips.
Stay informed about the latest developments in diabetes care by following reputable sources such as the American Diabetes Association, the CDC’s diabetes resources, and your healthcare provider’s recommendations. Diabetes management strategies continue to evolve with new research and technologies.
Conclusion
Managing diabetes during cold and flu seasons requires preparation, vigilance, and a comprehensive understanding of how illness affects blood sugar levels. By developing a detailed sick day plan before illness strikes, assembling necessary supplies, staying current with vaccinations, and knowing when to seek medical help, you can navigate illness safely and minimize the risk of serious complications.
Remember that prevention is always preferable to treatment. Prioritize annual flu vaccinations, practice excellent hand hygiene, avoid contact with sick individuals when possible, and maintain optimal blood sugar control year-round to support immune function. When illness does occur, frequent blood sugar monitoring, continued medication use, adequate hydration, and early communication with your healthcare provider are essential for successful management.
The challenges of managing diabetes during illness are real, but with proper preparation and knowledge, you can maintain your health and avoid serious complications. Work closely with your healthcare team to develop a personalized approach that addresses your specific needs, and don’t hesitate to reach out for support when you need it. Your proactive approach to illness management is an investment in your long-term health and well-being.