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Diabetes Sick-Day Plan: Prepare Before Fever or Vomiting Starts
Fever, a stomach infection or vomiting can upset your diabetes routine quickly. Illness may push glucose up, while reduced food intake can cause lows with some treatments. Prepare written instructions for both situations before you need them.
Ask for a sick-day plan while you are well. Which medicines to pause, continue or adjust depends on your treatment and the illness; a general blog cannot make that decision for you.
Ask for medicine-specific instructions
Take a complete medicine list, including insulin, tablets, injections and non-prescription products. Ask for written instructions using the names on your packets, rather than drug classes you may not recognise.
Dehydration, vomiting or poor intake may call for temporary changes to some medicines. NICE highlights the need to plan for these circumstances with metformin and SGLT2 inhibitors, among others. [1] Insulin requires separate advice, so do not stop it yourself. If you are already ill without instructions, contact the clinical team promptly.
Agree what to monitor and when to call
The body's stress response during illness can raise glucose. The CDC recommends preparing for more frequent checks and knowing when to get medical help. [2] Ask for a schedule, personal action limits and a contact route for times when the clinic is closed.
Note the time, glucose result, symptoms and temperature if relevant. Include what you could eat or drink and which medicines you took. Keep it readable for someone who may need to help; undated screenshots are harder to follow.
Know whether you need ketone testing
Too little available insulin can allow ketones to build up and cause diabetic ketoacidosis (DKA), a medical emergency. Ask whether to keep a ketone meter or urine strips, how to use them and which results need urgent assessment. ADA sick-day advice includes ketone testing and emergency contacts. [3]
SGLT2 inhibitors can be associated with DKA even when glucose is not markedly high. Vomiting, abdominal pain and other concerning symptoms still need attention if the reading looks acceptable. NDSS discusses this in its clinical sick-day guidance. [4]
Prepare a small home kit
- Your written plan and the current medicine list.
- Working glucose-testing supplies and ketone-testing supplies if advised.
- A thermometer and the low-glucose treatment recommended for you.
- Suitable drinks and easy food options discussed with your team.
- Clinic, after-hours and emergency contact details.
Mention heart or kidney disease and any fluid restriction when asking about drinks. If normal meals are not possible, get specific food advice instead of following an internet sugary-drink recipe. Do not double a later dose after missing medicine.
Do not wait out serious symptoms
Seek emergency assessment for difficulty breathing, confusion, severe drowsiness or suspected DKA. Persistent vomiting, inability to keep fluids down, significant ketones or glucose outside the urgent limits in your plan needs prompt medical advice. Do not drive yourself if you are weak, confused or otherwise unsafe to drive.
Key fact: A sick-day plan must match your current medicines and conditions. The useful document states what to do, what to measure and when to seek help.
What to put in the written plan
Ask what to do in specific situations, such as being unable to keep breakfast down or a reading outside your range. "Be careful when ill" does not give you enough to act on. Choose a language and format you can understand when tired or worried.
Medicine names, not assumptions
Use the names and strengths on your packets to confirm which medicines to continue, which might need a temporary change and who to call if unsure. If someone else at home also has diabetes, keep separate plans. Similar-looking boxes can have different instructions.
Monitoring and action limits
Write down how often to check glucose, when to check ketones and which results need a call or urgent care. If you use a sensor, ask when a fingerprick is also required. Check that the equipment works before you become ill.
Fluids, food and practical support
Tell the team about heart disease, kidney disease or fluid restrictions so the advice fits. Ask what to eat if normal meals are difficult and how to handle lows with your treatment. Show a family member where you keep the plan, meter and emergency supplies.
Use symptoms as well as the glucose reading
How you feel and whether you can drink matter alongside the number. Repeated vomiting or increasing confusion needs attention even when a reading looks unremarkable. Some medicines can change how a complication presents.
The ADA explains the link between insufficient available insulin, ketones and ketoacidosis. [5] If ketone testing is in your plan, ask for a demonstration and learn what to do with the result. Strips alone will not tell you the next step.
Use actual times to record symptoms, glucose, any requested ketone test and food or drink you managed. That sequence helps the clinician judge whether you are getting better or worse. One undated photograph may not show it.
Make the instructions usable for a helper
Keep the medicine list, important conditions, care contact and illness record where a helper can find them. If they call for advice, they should be able to say whether you are alert, can swallow and can keep fluids down.
For each number, ask when to use it. Check where to get help outside clinic hours and which symptoms mean going directly for emergency care. Do not assume from this article that MCR offers advice around the clock.
Severe low glucose may need a different response from the rest of your sick-day plan. The CDC says someone who cannot treat themselves needs help; prescribed glucagon may be part of that response. [6] Never give food or drink by mouth if they cannot swallow safely.
Review the plan after illness
Follow the restarting instructions for any medicines temporarily changed during the illness. Feeling a little better may not settle what to do next. Ask the team if intake, hydration or symptoms still leave you unsure about the next dose.
Afterwards, write down anything that made the plan hard to use. It might have named a drug class rather than the packet, left the out-of-hours contact unclear or relied on expired ketone supplies. Bring those problems to the next review.
Review the plan and kit when medicines or devices change, and check them periodically. Old instructions may no longer match your treatment. Keep the current version short enough for you or a family member to use promptly.
Important: Serious symptoms need urgent assessment even when a glucose reading does not appear very high. Do not stop insulin on your own or give oral food or drink to someone who cannot swallow safely.
Preparing your sick-day kit
| Area | What to Remember |
|---|---|
| Before illness | Write medicine-specific instructions and contact routes. |
| During illness | Record symptoms, intake and the checks requested. |
| Ketones | Test when advised and know the action thresholds. |
| Emergency signs | Seek help without waiting for a routine clinic reply. |
| Recovery | Follow restart advice and update the plan if necessary. |
Common questions
Should I stop all diabetes medicine when I cannot eat?
There is no safe blanket rule for all diabetes medicines. Insulin and different tablets need their own instructions. Use the written plan, or contact the team promptly if you are already ill without one. Do not decide to stop or continue everything based on a blog.
Do I need to check ketones?
Ask your team. The need depends on your diabetes, treatment and circumstances. If testing is advised, confirm the method, timing and results that need urgent advice. Buying strips is only useful if you know how to act on them.
Can DKA happen without very high glucose?
It can, including in some people taking SGLT2 inhibitors. Do not dismiss vomiting, abdominal pain, breathing difficulty or other concerning symptoms because a glucose value seems acceptable. Seek advice according to the urgent guidance in your plan.
What if I have been told to limit fluids?
Tell the team about the restriction and why you have it. General advice to drink large amounts may not suit you. Mention kidney or heart disease both when preparing the plan and when asking for help during illness.
Can my family follow the plan for me?
They can help if they know where supplies are and can follow clear monitoring, contact and emergency instructions. Confusion, drowsiness or difficulty swallowing calls for urgent help, rather than an attempt to carry out ordinary self-care steps.
When should I seek emergency care?
Breathing difficulty, confusion, severe drowsiness, suspected DKA or a severe low needs emergency assessment. Persistent vomiting, inability to retain fluids or urgent readings in your plan also require prompt help. Do not delay because a routine appointment is already booked.
Keep the plan current and easy to find
Keep a current plan beside supplies that work, and show a helper where to find it. During illness, use its action limits and contact instructions. Afterwards, ask about any step that was unclear before you need the plan again.
Discuss sick-day preparation in Kannur
Contact MCR Diabetes & Eye Care about appointment availability to prepare or review a sick-day plan. Bring the complete list of medicines you take and any instructions you already have.
Enquire About an Appointment →Related reading
Sources and further reading
- NICE: Type 2 Diabetes, Person-Centred Medicine.
- CDC: Managing Sick Days.
- American Diabetes Association: Planning for Sick Days.
- NDSS: Clinical Guiding Principles for Sick-Day Management.
- ADA: Managing Ketones With Diabetes.
- CDC: Treatment of Low Blood Sugar.
Sources checked on 30 October 2026. General educational information; individual care should be planned with your diabetes team. Cover image generated with AI for editorial use; people and settings are fictional.