Sick day management
Everyday Illness
Managing your diabetes when you are unwell is important. An ‘everyday illness’ can affect your blood glucose levels, making it more difficult to manage your diabetes.
A ‘sick day’ – when you have an illness or an infection – means you’ll need to make changes to your usual diabetes management regime to keep your blood glucose levels in the target range.
What happens when you are sick?
When you’re sick, your body releases stress hormones to help you fight the infection or illness.
These stress hormones can cause your liver to release glucose into your blood. They can also make it harder for insulin to work effectively.
This can cause blood glucose levels to rise.
People who do not have diabetes are able to keep their blood glucose levels in a normal range as their body releases more insulin when they are sick.
Everyday illness & type 1 diabetes
Even a minor illness can lead to a major rise in blood glucose levels.
This will increase the amount of insulin you need to keep blood glucose levels within your target range.
If blood glucose levels remain high for several hours the body will start to produce ketones.
Ketones are acidic, and if they build up to moderate to high levels, diabetic ketoacidosis (DKA) can develop. This is a life-threatening condition.
Your healthcare team can provide you with a sick day action plan that you need to put in place when you become ill.
Careful monitoring of blood glucose and ketone levels, and adjusting your insulin will form part of your plan.
You need to put your plan into action if:
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- You are unwell or have any signs of illness, even if your blood glucose levels are normal.
- Your blood glucose levels are greater than 15mmol/L for 6 hours or more, even if you feel well.
- You have ketones in your blood or urine.
Diabetic ketoacidosis (DKA) is a Life threatening condition and requires urgent medical attention.
Symptoms of DKA may include:
- Nausea and vomiting
- Abdominal pain
- Increased thirst or dry mouth
- Reduced or no urine output
- ‘Fruity’ smelling breath
- Difficulty breathing
- Drowsiness or coma
Everyday illness & type 2 diabetes
Managing everyday illness when you have type 2 diabetes is important.
Any illness can cause a rise in your blood glucose levels and put you at risk of dehydration.
Severe dehydration can lead to you feel drowsy and confused. Severe dehydration requires urgent medical attention.
You and your diabetes healthcare team can work together to develop a sick day action plan before you become ill, to make it easier to take care of your diabetes when you are not feeling well.
Put your plan into action if you feel unwell or have any signs of illness.
If you monitor your blood glucose levels and they are higher than 15mmol/L for 8-12 hours or more, start following your sick day plan even if you feel well.
Sometimes people who manage their diabetes with diet or oral medicine alone, need insulin to help keep their blood glucose levels in a target range until they are well again.
Your doctor will advise you if you need to start or change medicines or insulin.
Important: Do not take more insulin or medicine without your diabetes nurse educator or doctor’s advice.
What is a sick day action plan?
A sick day action plan provides step-by-step written instructions on how to manage your diabetes when you are unwell.
A sick day action plan is tailored to you as an individual, and it should be reviewed every 1 to 2 years.
Information in a sick day action plan includes:
- A target range for your blood glucose level
- When to check your blood glucose levels – and how often
- When and how to make changes to your medication (including insulin)
- How often and how much to drink to avoid becoming dehydrated
- When to seek medical help
For sick day action plan templates, click here and select the heading ‘Sick Day Action Plan’ to expand the menu. There are different templates to suit the type of diabetes you have and how it is managed.
Be prepared before you get sick – have a personalised sick day action plan and sick day management kit ready to use.
What are the signs of illness?
Typically signs of illness can include:
- Nausea or vomiting
- Diarrhoea
- Shaking chills or fever
- Muscle or joint aches
- A strong to severe headache
- Stomach cramps
Surgery & Hospital Stays
Most people will require a medical procedure or surgery in their lifetime.
If you’re living with diabetes, you and your doctor will need to do extra planning and take more care than usual.
Before you have any surgery or procedures that require fasting, you will need a diabetes management review.
Your doctor will establish a plan with you: to manage your diabetes prior to, during and after your procedure.
There are a number of things to consider if you are about to have a hospital stay or surgery.
For most hospital procedures, you will probably need to fast (nothing to eat or drink for a set time beforehand) and you may need an anaesthetic.
A hospital stay may lead to changes being made to your medications, activity levels and eating patterns, which can affect your blood glucose levels.
Also, your blood glucose levels may increase if you feel stress, anxiety or pain.
Managing your diabetes before and after a procedure or surgery can help prevent complications, such as delayed wound healing and infections.
In hospital, both high glucose levels (hyperglycaemia) and low glucose levels (hypoglycaemia) are associated with delayed healing, poorer immune response, inflammation and thrombosis (blood clots) and an increased length of stay in hospital.
Hospitals promote the shortest, safest hospital stay and provide an effective transition out of the hospital.
Guidelines for the care of people with diabetes in hospitals include:
- Diabetes should be well managed prior to planned surgery
- Anticipate increased insulin requirements
- Hypoglycaemia must be avoided
- The person’s diabetes care provider should be directly involved in the management of the patient after surgery
- Clear written instructions about the individual management of a person’s diabetes should be provided
