When you have diabetes, it’s important to know how to cope when you’re unwell. Especially if you have to go into hospital.
Being ill can disrupt your diabetes management, so you need to know what to do to keep your blood glucose (sugar) levels as close to target as possible.
Some people refer to these as diabetes sick day rules.
You’ll need to know how to manage insulin or other diabetes medications, blood or urine tests, and your diet, and how to manage your diabetes when you’re unwell. This is really important if you go into hospital or if you need to take steroids as part of your treatment. Always tell the healthcare professionals treating you that you have diabetes.
How illness affects diabetes
Illness and infections, as well as other forms of stress, can raise your blood glucose (sugar) levels to dangerously high levels. As part of the body’s defence mechanism for fighting illness and infection, more glucose is released into the bloodstream. This can happen even if you’re off your food or eating less than usual.
People who don’t have diabetes simply produce more insulin to cope. But when you’ve got diabetes, your body can’t do this. The symptoms of diabetes can exacerbate those of the original illness or infection and make it much worse.
Feeling or being sick, or having diarrhoea can make your blood sugar levels drop, because you’re not absorbing food as usual.
Being dehydrated when you have diabetes
Having a temperature or being sick can lead to dehydration. In some cases, severe dehydration and very high blood sugar levels can necessitate that you need to go into hospital.
So it’s important to be prepared and follow our advice on coping when you’re sick. You might want to give this information to a friend or family member, so they can help you if you get sick.
Your sick day rules – how to manage diabetes when you’re sick
Keep eating or drinking – if you can’t keep food down try eating little and often. Try snacks or drinks with carbohydrates in to give you energy. Try to sip sugary drinks (such as fruit juice or non-diet cola or lemonade) or suck on glucose tablets or sweets like jelly beans. Letting fizzy drinks go flat may help keep them down. If you’re vomiting, or not able to keep fluids down, get medical help as soon as possible.
- Keep taking your insulin and adjust your dose if you need to
- Test glucose more often than normal
- Drink lots of water or sugar-free drinks to avoid dehydration
- Check for ketones – you can get strips from your care team to test your pee
- Try to eat – if you cannot eat, drink sugary or milky drinks, try ice cream, or suck on sweets
- Contact your care team if you’re not sure what to do
If you’re taking steroids
Some conditions, like Addison’s disease, severe asthma, rheumatoid arthritis, lupus, and coronavirus are treated with steroids. If you have diabetes, taking high doses of steroids for periods of time can make your blood sugar levels rise. This is called steroid-induced hyperglycaemia. Your doctor or nurse will talk to you about this. They may ask you to make some changes to how you manage your diabetes so that you can keep your blood sugar levels within your target range.
Some people with coronavirus are being treated with a type of steroid called dexamethasone. Not everyone with coronavirus will need this steroid – it’s used in hospitals or in virtual wards when someone is really unwell and needs help to breathe. Some people may be treated with dexamethasone at home. It works by reducing the inflammation that coronavirus can cause and supports your immune system to fight it.
While this works well for treating coronavirus, the side effects can affect blood sugar management. Dexamethasone makes your body more resistant to insulin, making your blood sugar levels go very high. If you’re given dexamethasone, you may need insulin to help reduce your blood sugar levels. If you already take insulin, you are likely to need to take more or take a different one that does a better job of bringing your blood sugars down.
If you don’t have diabetes and are prescribed steroids, it’s important to know that taking this medication could cause diabetes to develop later on. This is called steroid-induced diabetes. We’ve got more information about the condition, including the symptoms to look out for. You can also speak to your healthcare team for more guidance and advice.
Protecting yourself against illness
There are things you can do to protect yourself against some illnesses, like flu. This includes getting your flu jab every year. And it may sound simple, but avoiding people who are sick and washing your hands often and thoroughly can help to protect yourself and others too.
If you go into hospital
If you end up in A&E for something that is not diabetes, like a broken bone, tell staff as soon as you arrive that you have type 1 diabetes.
Make sure staff know how important it is for you to have insulin and food containing carbs.
If you cannot eat because you need a test or an operation, you should be able to get a glucose drip.
If you need to stay in hospital, tell anyone who’s treating you that you have diabetes – do not assume they’ll know.
Check your blood glucose levels more than usual. The stress of being in hospital and moving around less might make them higher.
