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Sick Day Management in Diabetes

Illness affects everyone, but in people with diabetes there are a few things to monitor for optimal healing and blood sugar control. When your body is fighting an infection or illness a person with diabetes can experience fluctuating blood sugars, change in appetite, and ketone formation.

Sick Day Guidelines

  • DO NOT stop taking insulin; you will likely need more
  • Check blood sugar every two to three hours (or use CGM)
  • Check urine ketones with each void
  • Drink plenty of fluids
  • Treat underlying illness of symptoms (infection/fever)
  • Continue to take in carbohydrates

During sick day the goal is to prevent ketones, since this can lead to diabetic ketoacidosis.

What Are Ketones?

Ketones are created when your body breaks down fat for energy. Three things are needed to keep ketones away:

  • Fluids
  • Insulin
  • Carbohydrates

This will make sure that cells have carbohydrates for energy, and the insulin helps that energy get into the cell.

When you are sick, your body may become insulin resistant from higher stress hormones. This means you may need more insulin during times of illness. Call your diabetes team for guidance. NEVER stop taking your insulin before speaking with your doctor.

Checking for Ketones

  • Dip strip in urine
  • Read result in 15 seconds (the strip will get falsely darker after 15 seconds).
  • MODERATE to LARGE ketones is considered an emergency. You should contact your doctor immediately.

How to Manage Sick Day


Carbohydrate intake is important in treating and preventing ketones. With illnesses that include nausea, vomiting or stomach pain, solid food may not be optimal. This is when you want to drink carbohydrates. Refer to the fluid section below.


You want to make sure you are taking in plenty of fluids. Fluids are also a form of carbohydrate intake during times of nausea and vomiting. You want to have sick day fluids available at all times that are carb-free and carbohydrate containing.

  • Carb-free fluids when blood sugar is > 150-200 mg/dL: broth, bouillon soup, Crystal Light, diet caffeine-free soda, Powerade Zero, sugar-free popsicles
  • Carb containing fluids when blood sugar is < 150-200 mg/dL: Gatorade, Powerade, regular soda (ginger ale), popsicles


Take your insulin as prescribed. You will want to check your blood sugar every two to three hours, and give a correction per your scale if needed. If you have moderate or large ketones, you will need to increase the amount of insulin given for high blood glucose correction.  Please call your diabetes team for a dose recommendation.

When to Call

Call your diabetes doctor or nurse if you experience:

  • Stomach ache, nausea, or vomiting
  • Diarrhea
  • Fever (with high glucose and/or positive ketones)
  • Infection
  • Consistent high or low blood sugars
  • Positive ketones
  • Prior to starting steroids

Call IMMEDIATELY for sick day emergencies:

  • Moderate or large ketones
  • Ketones not resolving after 12 hours
  • Throwing up for more than 2 hours
  • Heavy breathing (fruity breath)
  • Unable to drink anything
  • Blood sugar <70 after two treatments
  • Lethargy