Sick day management Like everyone, people with diabetes can get sick with the flu, a cold or other common infections or illnesses. When you have diabetes, everyday illnesses or infection can affect your blood glucose levels. It’s important to be prepared and to know what to do if you get sick. This includes having a personalised sick day action plan and sick day management kit ready to use at the earliest sign of illness. You should discuss your sick day action plan and kit with your General Practitioner (GP), Credentialed Diabetes Educator (CDE) and diabetes team. Sick days Coronavirus has many of the symptoms as the flu. These symptoms can affect your blood glucose levels and that’s why now is a good time to review your diabetes sick day management plan. It’s important to be prepared before you get sick – have a personalised sick day action plan and sick day management kit ready to use at the earliest sign of illness. Make an appointment with your CDE or another member of your diabetes healthcare team to help you prepare your plan. Our factsheets have all the information you need to get ready for a sick day. Factsheet for people with type 1 diabetes Factsheet for people with type 2 diabetes What is a “sick day”? A sick day is when you have an illness or infection to manage as well as your diabetes—such as a common cold, influenza, gastro or a respiratory infection. You may need to make changes to your usual diabetes management plan to help prevent your blood glucose levels from going too high or too low. These changes are usually only needed until you are well again. Why it’s important to manage sick days Being unwell (e.g. with an infection) can make it more difficult to manage your diabetes. This is because your body releases stress hormones when you are sick. These hormones make your liver increase the amount of glucose in your bloodstream, and they can also make it difficult for insulin to do its job. This can cause your blood glucose levels to rise. If you are sick and have high blood glucose levels, you may be at risk of severe dehydration. This can result in you feeling drowsy and confused, and needing urgent medical attention. What to do when you are sick Follow your sick day action plan Start following your plan if you feel unwell or have any signs of sickness or an infection. If your blood glucose levels are higher than 15mmol/L for 8-12 hours or more, start following your sick-day action plan even if you feel ok. Let a friend or family member know that you are unwell. Tell them about your sick day action plan in case you need any help. Check your blood glucose levels more often When you are sick, check your blood glucose levels every two to four hours until levels are back in the target range recommended by your GP or CDE or other health professionals. Keep taking your diabetes medications or insulin dose(s) If you have vomiting or diarrhoea, most diabetes medications can continue, with some exceptions. If vomiting and diarrhoea is significant (multiple episodes, or lasting more than a few hours), consult your GP or other health care professional. There are two types of oral medicine that you may need to stop taking—these are Metformin and SGLT-2 inhibitors. So ask your doctor or pharmacist about these if you have significant vomiting or diarrhoea. Taking insulin when sick If you are taking insulin, you may need extra insulin when you are unwell, even when you are not eating much, and even with vomiting or diarrhoea. You should monitor your blood glucose levels regularly and this will help indicate if you need extra insulin. If you do, it will be an additional dose of short-acting insulin*. Refer to your sick-day action plan or talk to your GP or diabetes health professional for advice on making changes to your insulin dose or type of insulin when you are sick. It’s very important to keep up your fluid and carbohydrate intake when you are feeling unwell, to avoid dehydration and low blood glucose levels (hypoglycaemia, or hypo). Try to eat normally. If you can’t, have some easy-to-manage carbohydrate drinks, snacks or small meals, such as dry toast, plain rice, dry biscuits or crackers, mashed potato, plain ice cream or custard. Try to have a cup of fluid (250 mL) every hour. If your blood glucose levels are 15mmol/L or lower and you can’t eat, drink one cup of fluids containing carbohydrate every hour. These include regular cordial or soft drink, juice, sports drinks, weak tea with sugar/honey, jelly or sweet ice blocks. If your blood glucose levels are higher than 15mmol/L, drink one cup of fluids that does not contain carbohydrate every hour, such as water, diet cordial or diet soft drink, weak tea with no sugar/ honey, diet jelly or broth. If you are vomiting or have diarrhoea, oral rehydration fluids such as Gastrolyte® or Hydralyte® can help replace fluid and electrolytes *Occasionally blood glucose levels may be low during illness. In this case, a reduction in insulin doses may be needed.