Eating and drinking can be a big problem when you’re sick but it’s important to stick to your normal meal plan if you can. In addition to your normal meals, drink lots of non-caloric liquids to keep from getting dehydrated.
What if you can’t stick to your normal meal plan? Your sick-day plan should contain a meal plan. Try to take in your normal number of calories by eating easy-on-the-stomach foods like regular (non-diet) gelatin, crackers, soups and applesauce.
When your stomach is upset, try to eat small meals. Try carbohydrates, such as:
- Cooked cereal
- Mashed potatoes
- Noodle or rice soup
- Gelatin (such as Jell-O)
- Graham crackers
Many foods have the right amount of carbohydrates (about 15 grams) for your sick-day diet. Remember, on sick days it is OK to eat some foods you might not normally eat, if you cannot eat your regular foods. Some foods to try are:
- ½ cup apple juice
- ½ cup regular soft drink (non-diet, caffeine-free)
- 1 Popsicle (1 stick)
- 1 slice of dry toast
- ½ cup cooked cereal
- 6 saltine crackers
- ½ cup frozen yogurt
- 1 cup Gatorade or sports drink
- ½ cup regular ice cream (if you are not throwing up)
- ¼ cup sherbet
- ¼ cup regular pudding (if you are not throwing up)
- ½ cup regular gelatin/Jell-O
- 1 cup yogurt (not frozen), sugar-free or plain
- Milkshake made with ½ cup low-fat milk and ¼ cup ice cream mixed in a blender (if you are not throwing up)
If you throw up, do not drink or eat anything for 1 hour. Rest, but do not lie flat. After 1 hour, take sips of soda every 10 minutes.
Fluids you can drink if you are dehydrated are:
- Club soda
- Diet soda (caffeine-free)
- Tomato juice
- Chicken broth
If your blood sugar is less than 100 mg/dL or falling quickly, it is OK to drink fluids that have sugar in them. Try to check their effect on your blood sugar, the same way you check how other foods affect your blood sugar.
Fluids you can drink if your blood sugar is low:
- Apple juice
- Orange juice
- Grapefruit juice
- Gatorade or other sports drink
- Tea with honey
- Lemon-lime drinks
- Ginger ale
If you have already taken your insulin and are sick to your stomach, drink enough liquids with the same amount of carbohydrates that you would normally eat. If you cannot keep food or liquids down, go to the emergency room for treatment. You will receive fluids through a tube in your blood vessel (intravenous).
Making a Sick-Day Plan
Prepare a plan for sick days in advance. Work with your doctor, or a diabetes educator. The plan will include when to call your doctor, how often to measure blood glucose and urine ketones, what medications to take, and how to eat.
Also, attach to your plan a list of phone numbers for your doctor, diabetes educator, and dietitian. Make sure you also know how to reach them at night and on weekends and holidays. Then when illness strikes, you will be ready.
When to call your doctor
You do not need to call your doctor every time you have a sniffle. But you will probably want to call if certain things happen.
- you’ve been sick or have had a fever for a couple of days and aren’t getting better
- you’ve been vomiting or having diarrhea for more than 6 hours
- you have moderate to large amounts of ketones in your urine
- your glucose levels are higher than 240 even though you’ve taken the extra insulin your sick-day plan calls for
- you take pills for your diabetes and your blood glucose level climbs to more than 240 before meals and stays there for more than 24 hours
- you have symptoms that might signal ketoacidosis or dehydration or some other serious condition (for example, your chest hurts, you are having trouble breathing, your breath smells fruity, or your lips or tongue are dry and cracked)
- you aren’t certain what to do to take care of yourself
Be ready to tell what medications you’ve taken and how much, how long you’ve been sick, whether you can eat and keep food down, whether you’ve lost weight, and what your temperature, blood glucose level, and urine ketone level are. To be prepared, keep written records of all these things as soon as you become sick.
Everyone with diabetes should be prepared to treat hypoglycemia, but people with type 1 are at the highest risk for hypoglycemia. People with type 2 are less likely to have issues with hypoglycemia during or after exercise, unless they are on insulin or an insulin secretagogue.
If you experience hypoglycemia during or after exercise, treat it immediately. Use the same process as you would any other time of the day:
- Have at least 15-20 grams of fast-acting carbohydrate (sports drinks, regular soda, or glucose tabs are all good ideas).
- Wait 15-20 minutes and check your blood glucose again.
- If it is still low and your symptoms of hypoglycemia don’t go away, repeat the treatment.
- After you feel better, be sure to eat regular meals and snacks as planned to keep your blood glucose level up.
If you want to continue your workout, you will usually need to take a break to treat your low blood glucose, depending on what activity you are doing and how much insulin you have circulating in your bloodstream. If you do stop exercising, check to make sure your blood glucose has come back up above 100 mg/dl before starting to exercise again.
Keep in mind that low blood glucose can occur during or long after physical activity. It is more likely to occur if you:
- Take insulin or an insulin secretagogue
- Skip a meal or don’t eat something within 30 minutes to two hours after stopping
- Exercise for a long time
- Exercise strenuously
If hypoglycemia regularly interferes with your exercise routine, talk to your doctor about adjusting your treatment plan. Your provider may suggest eating a small snack before you exercise or they may make an adjustment to your medication(s).
Here are a few simple things you can do to help prevent injuries, dehydration, and hypoglycemia when exercising:
- Talk to your doctor about which activities are safest for you. Your doctor’s advice will depend on the condition of your heart, blood vessels, eyes, kidneys, feet, and nervous system. Still, many people with diabetes can do the same activities as someone without diabetes.
- Warm up for 5 minutes before starting to exercise and cool down for 5 minutes after. Your warm up or cool down should be a lower intensity than the rest of your time exercising. This helps get your blood flowing and warms up your joints.
- Avoid doing activity in extremely hot or cold temperatures. Choose indoor options when the weather is extreme.
- Drink plenty of water before, during, and after activity to stay hydrated.
- If you feel a low coming on, be ready to test for it and treat it. Always carry a source of carbohydrate with you so you’ll be ready to treat low blood glucose. This is especially important if you are on insulin and have type 1 diabetes.
- If exercising for an extended period (more than an hour or two), you may want to have a sports drink that provides carbohydrates. Be careful to check the nutrition facts though, you may need to water down the drink so that you don’t have too much, which can cause your blood glucose to spike.
- Wear a medical identification bracelet, necklace, or a medical ID tag that identifies you as someone with diabetes in case of emergency, and carry a cell phone with you in case you need to call someone for assistance.
- Activities should be energizing but not overly difficult. Use the “talk test” to make sure you are not pushing yourself too hard. If you become short of breath and you can’t talk, then slow down. This is most important when you are just starting to increase the activity in your routine. As you become fit, you’ll be able to exercise at a higher intensity and chat with others while you do it.
- Take care of your feet by wearing shoes and clean socks that fit you well.
- You should also check inside your shoes before wearing them. Socks that are made out of a material that reduces friction and pulls moisture away from your skin can also help protect your feet.
- Carefully inspect your feet before and after activity for blisters, redness, or other signs of irritation. Talk to your doctor if you have a foot injury or a non-healing blister, cut, or sore.
- Stop doing an activity if you feel any pain, shortness of breath, or light-headedness. Talk to your doctor about any unusual symptoms that you experience.
Exercise is an important part of any diabetes treatment plan. To avoid potential problems, check your blood sugar before, during and after exercise.
Diabetes and exercise go hand in hand, at least when it comes to managing your diabetes. Exercise can help you improve your blood sugar control, as well as boost your overall fitness and reduce your risk of heart disease and nerve damage.
Diabetes and exercise pose unique challenges, too. Remember to track your blood sugar before, during and after exercise. Your records will reveal how your body responds to exercise — and help you prevent potentially dangerous blood sugar fluctuations.
Before exercise: Check your blood sugar before your workout
If you’re taking insulin or medications that can cause low blood sugar (hypoglycemia), test your blood sugar 30 minutes before exercising and again immediately before exercising. This will help you determine if your blood sugar level is stable, rising or falling and if it’s safe to exercise.
Consider these general guidelines relative to your blood sugar level — measured in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L).
- Lower than 100 mg/dL (5.6 mmol/L): Your blood sugar may be too low to exercise safely. Eat a small carbohydrate-containing snack, such as fruit or crackers, before you begin your workout.
- 100 to 250 mg/dL (5.6 to 13.9 mmol/L): You’re good to go. For most people, this is a safe pre-exercise blood sugar range.
- 250 mg/dL (13.9 mmol/L) or higher: This is a caution zone. Before exercising, test your urine for ketones — substances made when your body breaks down fat for energy. Excess ketones indicate that your body doesn’t have enough insulin to control your blood sugar. If you exercise when you have a high level of ketones, you risk ketoacidosis — a serious complication of diabetes that needs immediate treatment. Instead, wait to exercise until your test kit indicates a low level of ketones in your urine.
- 300 mg/dL (16.7 mmol/L) or higher.: Your blood sugar may be too high to exercise safely, putting you at risk of ketoacidosis. Postpone your workout until your blood sugar drops to a safe pre-exercise range.
Diabetic coma is an emergency. You cannot be prepared in advance. If you have the feeling of an extreme high or low blood sugar you should call your local emergency number. You need to ensure help before you pass out.
If there is a person with you instruct him/her about it. If this person is familiar with diabetes care he/she should:
- Test your blood sugar.
- If the blood sugar level is lower than 70 mg/dL (3.9 mmol/L), administer an injection of glucagon. If glucagon isn’t available, rub glucose gel, honey or non-sugar-free syrup on the inside of the unconscious person’s cheek. No insulin should be given!
- If the blood sugar level is above 70 mg/dL, wait for medical help to arrive. Don’t give sugar to someone whose blood sugar isn’t low.
Let the emergency care team know about the diabetes and what steps have been taken, if any.
Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar (shakiness, nervousness or anxiety, sweating chills and clamminess, irritability or impatience, confusion, rapid heartbeat, dizziness, hunger and nausea, sleepiness, blurred vision, tingling or numbness in the lips or tongue, headaches, weakness or fatigue, anger or sadness, lack of coordination, nightmares or crying out during sleep, seizures, unconsciousness).
Eat or drink something that will quickly raise your blood sugar level, fruit juice, etc.
- Consume 15-20 grams of glucose or simple carbs.
- Check your blood glucose level once again after 15 minutes
- If hypoglycemia continues, repeat the actions from the beginning.
Once your blood glucose is normal eat a small snack if the next meal is more than one hour away.
Find more info on low blood sugar here.
HHNS only occurs when diabetes is uncontrolled. In order to avoid HHNS you have to check your blood sugar on a regular basis. Your doctor or a diabetes educator can help you with this: you may learn the techniques and the personal interpretation of results. If sick, you will check your blood sugar more often, and drink a glass of liquid every hour. You can build your sick day plan with your healthcare team.
Call your doctor or seek immediate medical care of you have signs or symptoms of HHNS.
You can easily find ketone tests at your pharmacy. Ask your doctor about testing and recording methods. Urine tests are simple, but to get good results you have to follow directions carefully.
Here’s how most urine tests go:
- Get a sample of your urine in a clean container.
- Place the strip in the sample (you can also pass the strip through the urine stream).
- Gently shake excess urine off the strip.
- Wait for the strip pad to change color. The directions will tell you how long to wait.
- Compare the strip pad to the color chart on the strip bottle. This gives you a range of the amount of ketones in your urine.
- Record your results
Small or trace amounts of ketones may mean that ketone buildup is starting. You should test again in a few hours.
Moderate or large amounts are a danger sign. They can poison the body. Never exercise when your urine checks show moderate or large amounts of ketones and your blood glucose is high. These are signs that your diabetes is out of control.
Diabetic ketoacidosis is a life-threatening medical condition. If you develop mild signs and symptoms, contact your doctor immediately.
If your doctor suspects diabetic ketoacidosis he/she will do some tests. Sometimes additional tests may be needed to help determine what triggered the episode of diabetic ketoacidosis or what damage the ketoacidosis may have caused.
Blood tests used in the diagnosis of diabetic ketoacidosis will measure: blood sugar level, ketone level, and blood acidity. Other tests may include: blood electrolyte tests, urinalysis, chest X-ray, or an electrocardiogram.
If you’re diagnosed with diabetic ketoacidosis, you may be treated in the emergency room or admitted to the hospital. Treatment usually involves a three-pronged approach: fluid replacement, electrolyte replacement, and insulin therapy.
Your blood sugar level is an essential measure for your health. You have to learn how to monitor it and to make it part of your daily routine. Your doctor or a diabetes educator can help you with this.
An appropriate diet and some physical activity can help you lower your blood glucose level.
But there are special cases as well. If you have a high level of blood sugar you may check for ketones in your urine. If you have ketones you should not exercise. This may cause the opposite effect.
If you think you have hyperglycemia contact your doctor.
More info on hyperglycemia can be found here.