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Chapter 16 Sick Day Guidelines
During periods of short-term illness, it may be more difficult to maintain good control of
your diabetes. Examples of minor illness are: dental surgery, colds, nausea/vomiting, sore
throat, mild infections, diarrhea, fever. However, you should call your healthcare team if:
• Illness persists without improvement for 24-48 hours.
• Temperature rises above 100° Fahrenheit or 38° Celsius.
• Vomiting or diarrhea continues longer than 4 hours.
• There are moderate to large amounts of ketones in urine.
• BG levels continue to run less than 60 mg/dL (3.5 mmol/L) or above 250 mg/dL
(13.5 mmol/L) {above 130 mg/dL (7.0 mmol/L) during pregnancy} after taking extra
bolus doses as prearranged by your healthcare team.
• You show signs of ketoacidosis, dehydration or other serious problems such as:
increased drowsiness, abdominal or chest pain, difficulty breathing, fruity odor to
the breath, dry cracked lips, mouth or tongue.
• Any uncertainty as to what to do to take care of yourself.
Never omit your insulin! If you are ill and cannot eat, your need for insulin continues
and may also increase.
• Continue your usual basal dose of insulin along with bolus insulin to cover food
eaten or to correct high blood glucose as prearranged with your healthcare team.
• You may need to temporarily increase or decrease your basal rate by using the Temp
Basal feature as prearranged with your healthcare team.
Medication
Always let your healthcare team know ALL medications you are taking.
Blood and Urine Testing
• Check your BG before your usual mealtime and every 2-4 hours if indicated.
• Test your blood or urine for ketones at least 4 times a day, or according to
instructions from your healthcare team.
Fluids and Diet
Always follow your healthcare team’s sick day guidelines. Fluid intake is essential with
any illness. You may need to drink 8 ounces of calorie-free liquid every 60 minutes.
Examples of calorie-free items are: water, tea without sugar, instant broth, sugar-free
drinks OR eat ice chips, sugar-free Popsicles®, sugar-free gelatin, etc. If vomiting, start
fluids 1 to 2 hours after vomiting and sip slowly. Increase the frequency of BG testing to
every 2 to 4 hours as long as BG is elevated. If BG is over 250, check for ketones every 4
hours until negative results are obtained.
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