The first time I caught the flu after my diabetes diagnosis, I was completely unprepared for how it would affect my blood sugar. I remember lying in bed, feeling absolutely miserable, when my glucose meter beeped with a reading that made my heart race despite my weakness. 287 mg/dL – and I hadn’t eaten a thing all day! That was my introduction to the complicated world of managing diabetes during illness, and boy, do I wish someone had warned me what to expect.
Over the years, I’ve learned that being sick with diabetes requires its own playbook. Those “sick day rules” my doctor briefly mentioned? They’re actually really important, not just optional suggestions. Through fevers, stomach bugs, and one particularly memorable case of bronchitis, I’ve gathered some hard-earned wisdom about keeping diabetes under control when your body is fighting other battles.
Why Illness Sends Blood Sugar Haywire
No one warned me that getting sick would mess with my glucose levels so dramatically. The first time it happened, I was convinced my meter was broken!
When your body is fighting an infection or illness, it releases stress hormones like cortisol and adrenaline. For people without diabetes, the pancreas just pumps out more insulin to handle the resulting glucose surge. But for us diabetics? Those stress hormones can send blood sugar levels through the roof, even if you’re not eating much.
During my last bout with a nasty cold, my fasting numbers were 40-60 points higher than normal – despite having zero appetite. It felt completely unfair! I was already feeling terrible, and now I had to worry about high blood sugar too?
The opposite can happen too, especially with stomach bugs that cause vomiting or diarrhea. If you’re taking medication but not getting enough carbs to balance it, you can drop dangerously low. I learned this lesson during a stomach virus when I kept taking my full medication dose but couldn’t keep food down. Not a mistake I’ll repeat!
Creating Your Sick Day Plan Before You Need It
One of my biggest regrets is not having a sick day plan in place before that first illness hit. I was scrambling to figure things out while feeling absolutely awful, which is definitely not the best time for decision-making.
These days, I have a typed-up sick day plan on my refrigerator and saved in my phone. It includes:
- Contact information for my healthcare team
- When to call the doctor (specific blood sugar thresholds, ketone levels, and symptoms)
- How to adjust my medications (as previously discussed with my doctor)
- A list of diabetes-friendly sick day foods and fluids to keep on hand
- Testing schedule for blood sugar and ketones
- Location of all my supplies
I worked out this plan with my doctor during a regular appointment – not while I was already sick. Trust me, this approach works so much better! During my last cold, I just followed my pre-made plan instead of panicking about what to do.
Blood Sugar Monitoring During Illness
When I’m healthy, I typically check my blood sugar about 3-4 times a day. But when illness strikes? That number goes way up.
During my most recent bout with the flu, I was checking every 2-3 hours. Excessive? Maybe to some, but after seeing how quickly things can change during illness, I’d rather be safe than sorry. Those frequent checks helped me catch a dangerous rise before it got out of hand.
I’ve learned that testing for ketones is just as important as checking glucose when I’m sick. My first endocrinologist didn’t emphasize this enough, and I went years without owning ketone strips. Now I keep them on hand at all times and check for ketones whenever my blood sugar stays above 250 mg/dL or when I’m feeling particularly unwell.
During one memorable illness, my blood sugar was only moderately elevated (around 200), but I felt much worse than that number would suggest. A ketone check showed moderate ketones, which explained my symptoms and prompted me to call my doctor right away. That decision might have kept me out of the hospital.
Medication Adjustments During Illness
“Never stop taking your diabetes medication when sick” – that was drilled into my head, and it’s generally good advice. But the reality is more nuanced, and I wish I’d understood that sooner.
For those on insulin, you might actually need MORE insulin when you’re sick, even if you’re eating less. This completely confused me the first time my doctor suggested it. More insulin when I’m barely eating? But those stress hormones I mentioned earlier can create significant insulin resistance during illness.
During my last respiratory infection, I needed to increase my basal insulin by about 20% to keep things under control. My doctor and I had discussed this possibility in advance, which made adjusting much less stressful.
If you’re taking oral medications, the adjustments might be different. With some stomach bugs, you might need to temporarily reduce certain medications that could make nausea worse or affect hydration. This is definitely something to discuss with your healthcare provider before you need the information.
What I’ve learned is that there’s no one-size-fits-all approach to managing diabetes during illness. Your adjustment plan should be personalized based on your specific medications, type of diabetes, and the nature of your illness.
Keeping Hydrated: Harder Than It Sounds
Staying hydrated when sick is important for everyone, but for diabetics, it’s absolutely crucial. High blood sugar leads to increased urination, which can quickly lead to dehydration – especially if you’ve already got other fluid losses from fever, vomiting, or diarrhea.
During one particularly nasty stomach bug, I became severely dehydrated because I wasn’t tracking my fluid intake. I thought I was drinking “enough,” but in reality, I was nowhere close to replacing what I was losing. That mistake landed me in the ER for IV fluids – not an experience I care to repeat!
Now I keep a large water bottle with measurement markings by my bed when I’m sick. My goal is to drink at least 8 ounces every hour while awake, more if I have a fever or stomach issues. If plain water becomes unpalatable (which often happens when I’m sick), I switch to sugar-free electrolyte drinks or broth.
One trick I’ve learned: freezing sugar-free electrolyte drinks into ice cubes or popsicles. These are easier to consume when nausea strikes and help both with hydration and soothing a sore throat.
What to Eat When You’re Sick with Diabetes
Food becomes complicated when you’re sick with diabetes. When my non-diabetic husband gets sick, he can just eat whatever sounds good (or nothing at all). I don’t have that luxury.
Even when food is the last thing on my mind, I’ve learned that I need to consume some carbs to prevent lows and provide energy for recovery. But finding the right balance is tricky – too many carbs can send high blood sugar even higher, while too few can drop me dangerously low if I’m still taking my usual medications.
My go-to sick day foods include:
- Chicken broth with a small amount of rice or noodles
- Toast with a thin layer of peanut butter
- Applesauce (unsweetened)
- Yogurt (plain or with minimal added sugar)
- Crackers with cheese
- Diluted fruit juice (half juice, half water)
I aim for about 15 grams of carbs every couple of hours when I can’t eat normal meals. This approach has worked well for keeping my blood sugar in a reasonable range while giving my body some fuel to fight the illness.
The hardest part? Fighting the childhood association of ginger ale and saltines for upset stomachs. Regular ginger ale is basically sugar water – exactly what a diabetic doesn’t need when sick! I’ve switched to diet ginger ale or ginger tea with a few saltines instead.
When to Call the Doctor: Better Safe Than Sorry
I used to pride myself on rarely needing to see a doctor. That stubborn self-reliance? It’s dangerous with diabetes, especially during illness. I’ve since developed a much healthier respect for when to seek help.
My sick day plan includes specific thresholds for when to call my healthcare provider:
- Blood sugar above 300 mg/dL that doesn’t come down after two correction doses
- Moderate to large ketones
- Inability to keep down fluids for more than 4 hours
- Fever above 101.5°F that persists despite fever reducers
- Vomiting or diarrhea that lasts more than 6 hours
- Symptoms that worsen despite home care
During one particularly bad cold, my blood sugar stayed stubbornly high despite increased insulin. I was tempted to just keep increasing my dose, but that inner voice (and my sick day plan) told me to call my doctor first. Good thing I did – the approach she suggested was much more measured and safer than what I was considering.
I’ve found that many doctor’s offices have specific protocols for diabetic patients calling about illness. Mentioning “I’m diabetic and sick” often gets you faster attention – use this to your advantage!
Building a Sick Day Supply Kit
After fumbling through a couple of illnesses, I put together a dedicated “diabetes sick day kit” that I keep ready at all times. This has been a game-changer for managing diabetes during illness.
My kit includes:
- Extra glucose testing supplies (more than you think you’ll need)
- Ketone testing strips (check expiration dates regularly!)
- Easy-to-read thermometer
- Sugar-free electrolyte drinks
- Easily digestible carb sources (crackers, applesauce cups)
- Glucose tablets or gel (in case of lows)
- Anti-nausea medication (doctor-approved)
- Copy of my sick day plan
- List of current medications and doses
- Relevant contact numbers
I keep this separate from my regular diabetes supplies, specifically for sick days. This way, I’m not hunting around for what I need while feeling terrible. During my last bout with a respiratory infection, having everything in one place made managing so much easier.
The Emotional Side of Being Sick with Diabetes
Let’s talk about something that doesn’t get mentioned enough – being sick when you have diabetes is emotionally draining in a way that others might not understand.
There’s a special kind of frustration that comes from doing everything “right” with your diabetes management, only to watch your numbers go haywire because of a simple cold. During my last illness, I found myself irrationally angry at the unfairness of it all. On top of feeling physically awful, I was dealing with the mental load of constant monitoring and decision-making about my diabetes care.
I’ve learned to give myself grace during these times. Perfect blood sugar control during illness isn’t always possible, and that’s okay. My goal has shifted from “perfect numbers” to “preventing emergencies” when I’m sick.
I also make a point to tell at least one support person when I’m sick. Living alone with diabetes adds an extra layer of risk during illness, and having someone check in regularly provides both practical assistance and peace of mind.
Recovery Period: The Often-Overlooked Phase
One thing that surprised me was how long my blood sugar remained affected after the actual illness symptoms had resolved. During my recovery from bronchitis, my numbers stayed elevated for nearly a week after I was feeling better.
I’ve learned to transition gradually back to my regular diabetes routine rather than making abrupt changes. This usually means slowly decreasing any medication adjustments over several days while continuing more frequent monitoring.
The recovery period is also when I’m most vulnerable to hypoglycemia, especially as my insulin sensitivity returns to normal but I’m still taking higher doses. That post-illness low blood sugar can sneak up quickly!
I now consider myself “sick” from a diabetes management perspective until my blood sugar patterns have returned to my normal baseline for at least 2-3 days. This more conservative approach has prevented several post-illness complications.
Conclusion: Preparedness Makes All the Difference
Managing diabetes during illness is one of those skills I wish I’d never needed to learn, but I’m grateful to have now. Each illness has taught me something new about how my body responds and what works best for my particular situation.
The biggest lesson? Preparation makes all the difference. Having supplies ready, a plan in place, and open communication with your healthcare team transforms a potentially dangerous situation into a manageable one.
If you’re reading this while healthy, take this opportunity to get your sick day plan and supplies in order. Talk to your doctor about specific guidelines for medication adjustments during illness. Stock up on appropriate foods and fluids before you need them.
And if you’re reading this while sick – I hope some of my hard-earned lessons make your experience a little easier. Remember that this is temporary, and with careful attention, both your illness and your blood sugar will eventually return to normal.
What strategies have you found helpful for managing diabetes during illness? I’d love to hear your experiences and what’s worked for you!
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