Sick days and diabetes

Somali: Maalmaha jirrada iyo sonkorowga

It is important to remember that illness may cause blood glucose levels to rise.


Monitoring your blood glucose more often when you are sick can prevent problems. It is a good idea to teach someone else to do the test just in case you need help when you are sick.

What to do when you are ill

  • Always take your insulin or oral diabetes medicine. Do not stop taking diabetes medicine without advice from your health care provider, nurse or diabetes educator.
  • For people with type 1 diabetes, test urine for ketones if blood glucose is more than 250 md/dL. If ketones are present, test blood glucose and urine ketones every 3 to 4 hours.
  • If your blood glucose is more than 200 mg/dL, drink at least one-half to 1 cup of sugar-free liquid every hour.

Examples of sugar-free liquids:

  • water
  • diet pop
  • diet gelatin
  • diet Popsicles®
  • unsweetened tea
  • other helpful liquids include salt-containing broth and soup

If your blood glucose is less than 200 mg/dL, some of your liquids should contain carbohydrate.

Examples of liquids that contain carbohydrate:

  • regular pop
  • regular gelatin
  • juices
  • Gatorade®

When you do feel like eating again, the extra liquids should be sugar-free. Start with carbohydrate-containing foods that are easy to tolerate every few hours such as:

  • 1/2 cup cooked cereal
  • 6 saltine crackers
  • 3 graham crackers
  • 1/2 cup custard, yogurt, sherbet or pudding

Test your blood glucose every 4 hours during the day and at least once during the night.

Keep a record of the times and numbers of your blood glucose and urine ketones.

Have someone at home with you or notify someone that you are sick so he or she will check on you.


Ketones are by-products of fat breakdown in your body. When found in your urine, they indicate that you’re not eating enough calories at regular intervals during the day or that your blood glucose is too high. Most people with type 2 diabetes do not need to check for ketones.

Small amounts of ketones in your morning urine can result from:

  • not eating enough the previous day
  • missing your bedtime snack
  • not eating all the carbohydrate choices in your meal plan
  • more physical activity than usual on the previous day

Large amounts of ketones may be seen if you have:

  • extreme morning sickness during pregnancy
  • vomiting and diarrhea so you can’t eat or drink
  • illness or infection

High levels of ketones can poison the body, result in in a condition called diabetes ketoacidosis (DKA). Symptoms of DKA include:

  • abdominal pain
  • nausea (upset stomach) and vomiting (throwing up)
  • decreased appetite
  • weight loss
  • blurry vision
  • increased thirst and more frequent urination
  • dry mouth, eyes and skin or warmth and redness in your face
  • feeling tired and weak
  • confusion
  • fruity, sweet-smelling breath
  • fast, deep breathing and increased heart rate
  • mood changes

DKA can lead to diabetic coma or death. Anyone with diabetes is at risk but it is rare in people with type 2 diabetes.

You may have an increased risk of DKA if you:

  • are not taking your insulin or the right amount of insulin
  • had a stroke, heart attack, surgery, injury, infection or another condition that puts extra stress on your body
  • are taking certain medicines. Talk with your health care
    provider about your medicines.
  • are having your monthly period
  • are taking street drugs

Talk with your health care provider or diabetes educator if you have questions.

When to call your health care provider

  • Your blood glucose is more than 250 mg/dL for two tests in a row and urine ketones are positive for two to three consecutive checks.
  • Your blood glucose is consistently very high (more than 300 mg/dL) even though there are no urine ketones present.
  • You have questions about how much insulin or oral diabetes medicine to take.
  • You are unable to eat or drink because of nausea (upset stomach), vomiting (throwing up) or both.
  • You have been vomiting more than six hours or have had more than five episodes of diarrhea in one day.
  • You have a temperature higher than 101 degrees Fahrenheit or a high temperature that lasts longer than 48 hours.

Related resources

Source: Allina Health's Patient Education Department, Basic Skills for Living with Diabetes, sixth edition
First Published: 11/27/2006
Last Reviewed: 10/23/2019