How to plan for sick days with diabetes

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It’s always a good time to look at the importance of having a diabetes sick day plan. Sick day management isn’t just about managing colds and flu! Many illnesses can make it more challenging to keep glucose levels in the target range.

Illnesses that raise blood glucose levels are often linked with a fever. These can include colds, flu, chest, ear, throat or urinary tract infections. Sometimes, your blood glucose levels can rise a few days before you’re feeling unwell and may also persist for a few days after the illness has passed.

Other illnesses can lower blood glucose levels and cause hypoglycaemia, or hypos for short. These illnesses are more likely to be linked with vomiting and diarrhoea such as ‘gastro’.

Your sick day action plan should cover what to do with both low and high glucose levels.

Your plan will vary based on the type of diabetes that you have and how it is managed. It is therefore important to make an individual plan with the help of your diabetes care team.

Your sick day action plan should include:

• Information on when to start and stop using the plan.
• What to do with your diabetes medications (stop, reduce, continue, increase).
• How often you should check your glucose levels. Some people will also need to check their ketone levels.
• How much fluid to drink to reduce your risk of becoming dehydrated.
• The types of food and fluid that can be used to maintain your glucose levels in the target range.
• When to contact your diabetes care team and their contact details.
• The medical facility to contact or present to if the sick day action plan is not effective, your condition deteriorates and when to call an ambulance.

Along with a sick day action plan, you should also have a sick day kit. The contents of this kit will differ depending on the type of diabetes that you have and what your treatment is.

Items to include in your sick day kit include:

• A copy of your diabetes sick day action plan
• Telephone numbers for support people, diabetes team, GP, local hospital, etc.
• Food and fluid for sick days (both with and without carbohydrate)
• Hypo treatments (if at risk)
• Extra insulin and delivery equipment (if relevant)
• Glucose meter and in-date monitoring strips
• Ketone testing supplies (if needed) – meter, in-date blood ketone strips or in-date urine ketone test strips
• Thermometer
• Glucagon injection (for those at risk of severe hypoglycaemia)
• Scripts for any medications that you may need to start as part of your sick day action plan (e.g. rapid acting insulin for someone with type 2 diabetes using only basal insulin).

This kit should be checked every three months to make sure everything is still in-date.

Remember to review and evaluate your sick day action plan after any illness. Decide if any changes need to be made to the plan or your sick day kit. If not used, your plan and kit should be reviewed at least once a year. It should also be reviewed if there are changes to your diabetes treatment, you develop diabetes complications, you transition from paediatric to adult services, you relocate, become pregnant or travel.

Finally, it’s worthwhile thinking about having a flu vaccination. Flu vaccinations are available either though your GP or one of the many pharmacies offering this service. An appointment is generally required, and the vaccinations are free for all people living with diabetes. Some centres may charge a small administration fee, so please check.

Although effective in preventing the flu, the flu vaccination does not prevent you from getting a ‘common cold’ and the need for having a diabetes sick day action plan.

Nobody plans to get sick, but it is always best to be prepared in case you do.

The National Diabetes Services Scheme (NDSS) has further information about managing sick days.

• Type 1 Diabetes
• Type 2 Diabetes
• Managing hypoglycaemia