Quick Tour   
Live Help  


Sick Days with Diabetes
  By Nicole Johnson, MA, MPH

‘Tis the season for the flu!  We know people with diabetes should get flu shots, but what should you do if you still get sick?  This is a question I wrestle with every time I get hit with something as the seasons change.  I never can quite remember the “sick day rules,” nor do I have the energy to find them at the time.  So, for my benefit and yours, I have done a little research that will hopefully keep us all well through this cold and flu season. 

First and foremost, you have to check your blood sugar and check it often!  Because of the hormones associated with infection, you may need to check every two hours.  Last weekend as I battled a stomach virus, I tested almost 30 times!  I know it sounds excessive, but I tend to err on the side “it is better to know than to not know.”  The Mayo Clinic recommends that people with type 2 diabetes check their blood sugar four times a day when they are sick.

In addition to blood sugar testing, it might also be in important to check keytones.  Keytones are toxic acids in the bloodstream.    You check for keytones by using a keytone strip and dipping it in urine.  You can purchase these strips in your local pharmacy. 

If your blood sugar is over 300mg/dl, then you need to check for keytones. Excessively high blood sugar can lead to ketoacidosis.  The Mayo Clinic describes diabetic ketoacidosis as a condition where the sugar/carbs ingested can’t enter the cells of the body, therefore the body begins to break down fat for energy.  This process then deposits toxic acids into the blood called keytones.

In people with type 2 diabetes, a similar condition called diabetic hyperosmolar syndrome can result.  Diabetic hyperosmolar syndrome happens when the blood sugar level tops 600 mg/dl.  When your blood sugar gets this high, your blood become thick and syrupy.  This condition can lead to dehydration because the excess sugar passes from your blood to your urine and then triggers a filtering process that pulls large amounts of fluid out of your body. 

Needless to say, both conditions can cause confusion, difficulty breathing, coma and possibly death.  These are the main reasons why people with diabetes must be extra careful when they are sick.

As you have already gathered by the dangers of allowing your blood sugar to get too high, you should not stop your medication when you are ill.  In fact, often you will have to increase the amount of insulin to counteract the infection in your body.  Your healthcare team will be your guide.  Regardless of your food intake, make sure you continue your medication.

My biggest challenge last weekend was food.  As I mentioned, I had some sort of stomach flu and that left me unable to eat.  Then, when I wanted to eat, I couldn’t figure out what was right for me.  Mainly, I relied on Gatorade and applesauce.  Since feeling better, I have searched online for recommendations of other sick day foods. 

The American Diabetes Association has a great list with carbohydrate counts included on their website.  Here is a web snap shot:

     Regular ice cream (1/2 cup) -- 15 grams

     Low fat ice cream (1/2 cup) -- 10 grams

     Fruit juice bar (3 oz) -- 9 grams

     Frozen yogurt (1/2 cup) -- 15 grams

     Sherbert (1/2 cup) -- 22 grams

     Gelatin or Jello® sweetened (1/2 cup) -- 19 grams

     Cooked cereal (1/2 cup) -- 15 grams

     Toast (1 slice) -- 15 grams

     Soup (1 cup) -- 15 grams

     Chicken noodle soup (1 cup) -- 9 grams

     Cream soup (1 cup) -- 9 grams, (made with water)

     Tomato soup (1 cup) -- 16 grams, (made with water)

     Rice (1/3 cup) -- 15 grams

     Applesauce, unsweetened (1/2 cup) -- 14 grams


If you have a fever, and you're throwing up or have diarrhea, it is very easy to become dehydrated, which means your body is losing too much fluid. In small sips, try to drink a cup of fluid each hour. If your blood glucose (sugar) is running too high, try sugar-free liquids like water, tea, sugar-free ginger ale, or even broth (chicken, beef, or vegetable). If you need to raise your blood glucose, try to drink things with about 15 grams of carbohydrate in them. Here are some ideas.

     Apple juice (1/2 cup) -- 15 grams

     Grape juice (1/3 cup) -- 12 grams

     Regular cranberry juice cocktail (1/3 cup) -- 12 grams

     Reduced calorie (light) cranberry juice cocktail (1 cup) -- 10 grams

     Ginger ale (1/2 cup) -- 10 grams

     Milk (1 cup) -- 12 grams

     Sports drink (1 cup) -- 14 grams

   Regular cola or root beer (1/2 cup) -- 14 grams



Remember, taking in fluids is key when you are ill.  If you can’t eat, you can drink fluids that include carbohydrates.  Just beware of climbing blood sugars.  And don’t forget to either take your insulin or bolus it on your pump.  (When you are sick that is so easy to neglect!  Beware.)

Something else that always confuses me is what over the counter medications are safe for people with diabetes.   There is some data to back up that acetaminophen can cause blood sugars to rise.  Talk to your healthcare professional.  If you have kidney or liver problems on top of diabetes, you may want to steer clear of this drug.

I found a great list on www.about.com regarding over the counter medications and diabetes. 

Active ingredients that may affect diabetes:

Pain and fever reducers: acetaminophen is used in cold and flu medications for minor aches and fevers.

     Acetaminophen can be toxic to liver and kidneys. People with diabetes who also have kidney complications should check with their doctor before using acetaminophen.

NSAIDS: (Non-steroidal anti-inflammatory drugs) are used to treat aches, pains and fevers associated with colds and flu.

     Ibuprofen should be used cautiously by people with liver and kidney problems. It also increases the hypoglycemic effect of insulin and oral diabetes medications.

     Naproxen should not be used for people with severe cardiovascular disease, or kidney or liver problems. It may also increase the risk of hypoglycemia with insulin and oral diabetes medications

Cough medications:

     Dextromethorphan is an ingredient in many cough preparations and at recommended doses is safe for people with diabetes.

     Guaifenesin is an ingredient that loosens mucus and makes it easier to cough it up. There are no warnings about guaifenesin and diabetes.


     Epinephrine, phenylephrine, and pseudoephedrine are usually found in nasal sprays, but also some oral cold medicines. They work by drying up secretions in the nasal passages. It is possible that they could decrease the effects of insulin or oral diabetes medications. They can also increase blood pressure and should be used cautiously in people with high blood pressure.

     Phenylpropanolamine (PPA) is a decongestant that has been recalled by the FDA as of 2005, due to an increased risk of strokes.


     Brompheniramine, chlorpheniramine, and doxylamine are used in combination with other active ingredients. These antihistimines do not affect diabetes directly, but elderly people may be more susceptible to side effects. Diphenhydramine is used alone (marketed as Benedryl) or in combination with other drugs. It can cause low blood pressure in some people.

Loratadine is a second generation antihistamine that has recently gone OTC. It does not cause the sedation associated with the older antihistimines. It does not appear to cause problems in people with diabetes.



The information is dizzying.  Or maybe that is a lagging effect of my infection! Nonetheless, it is important for us all to be up to speed on what is recommended when we are sick.  Being sick is never fun, and it is definitely not the time to have to be surfing the net to figure out if you should take Tylenol or Advil or Aleve or Motrin.  Save yourself the aggravation and get your sick day kit together when you are well.  Think of it as your at home emergency preparedness kit.  You might want to include some of the foods listed above and the medications that you and your healthcare team feel are right for you.  My kit has all the pain relievers, Imodium, Pepto-Bismol tablets, cough drops, Nasal spray, glucose tablets and cranberry supplements.  I also keep a bottle of light cranberry juice in my refrigerator along with Gatorade.  After my research for this article, I am going to stock up on some sugar free Ginger Ale as well.

Also, make sure to talk to you family members about your kit and about emergency procedures while you are at it.  Do they know what to do if you are low and can’t respond?  Do they know how to help if you are vomiting and unable to eat?  Others need to be prepared as well.   Since I was sick, I have been getting morning check in calls from my family each day.  Families suffer to some degree as well when the person with diabetes is ill.  Much of it is psychological and emotional, but it is still real suffering.  A little open communication and education will help ease some of that pain. 

During a conversation last evening with my father, I learned of his desire to understand glucagon – just in case.  Maybe that is a foreshadow of a future article!

Stay well this season by being prepared.   


Nicole Johnson, MA, MPH, Miss America 1999, is an international diabetes advocate. She travels extensively promoting awareness, prevention, and early detection of the condition she has shared for fifteen years. She has written four books including her autobiography, Living with Diabetes. Nicole serves on numerous advisory boards including the National Institutes of Health (NIH) Council of Public Representatives, the Florida Governor's Diabetes Advisory Council and the Tampa Bay chapters of the American Diabetes Association and the Juvenile Diabetes Research Foundation. She is also a past national board member for the American Diabetes Association. Over the last nine years, Nicole has helped raise approximately $20 million for diabetes research and programs.

Learn more at www.nicolejohnson.com

Return to Article List