Diabetes Sick Day Management

Patient information leaflet brought to you by

Division of Endocrinology & Department of Nursing

National University Hospital

5 Lower Kent Ridge Road, Singapore 119074
Tel: (65) 6779 5555
Website: www.nuh.com.sg
Company Registration Number. 198500843R

The information provided in this publication is meant purely for educational

purposes and may not be used as a substitute for medical diagnosis or
treatment. You should seek the advice of your doctor or a qualified healthcare
provider before starting any treatment or if you have any questions related to
your health, physical fitness or medical conditions.
Information is correct at time of printing (April 2020) and subject to revision
without prior notice.
Copyright (2020). National University Hospital
All rights reserved. No part of this publication may be reproduced without
permission in writing from the National University Hospital.
During an illness such as flu or gastroenteritis, blood glucose levels can
rise due to the stress of the illness. At the same time, poor appetite can
also cause your blood glucose levels to drop and result in hypoglycemia.
It is important for you to know what to do when you are sick, to avoid
high and low blood glucose levels.
If you have Type 1 Diabetes, please discuss with your healthcare team
on an individualised sick day plan. The information in this leaflet may not
apply to you.
 1. Check Blood Glucose 4. Advice for Diabetes Medication
 Check your blood glucose level every 4 hours.  Continue to take your insulin injections.
 Set a timer to remind yourself.
 Continue to take your diabetes tablets (with some exceptions
below).

2. Stay Hydrated
 Drink plenty of water (if you are not on fluid restriction).
 Sip at least half a cup of water or sugar-free fluid every
hour.
 If you are vomiting, having diarrhoea, and/or eating or drinking
very poorly, STOP SGLT-2 inhibitors (canagliflozin,
dapagliflozin, empagliflozin).
 If your appetite is very poor, do speak to your healthcare
provider regarding adjustments to your diabetes medication.

3. Take Regular Meals

 Take your meals as per usual as much as possible. Here
are suggestions of easy-to-ingest meals to help maintain Seek medical attention
your blood glucose levels:
• 1 bowl of rice porridge if you are experiencing
• 1 bowl of oatmeal porridge any of the following symptoms
• 1 bowl of macaroni soup
• 6 pieces of plain cracker with a beverage  Fever of more than 37.5⁰C for 2 days
• 2 slices of bread with soup
• Oral nutritional supplements formulated for diabetes  Recurrent low blood glucose (less than 4 mmol/L)

 If you are unable to eat, and your blood glucose is  Recurrent high blood glucose (more than 20 mmol/L)
between 4 and 10 mmol/L, take any of the following every 1
 Severe or persistent vomiting and inability to take in food
to 2 hours to maintain your blood glucose levels:
• Half a cup of fruit juice  Severe or persistent abdominal pain
• Half a cup of cordial
 Feeling of breathlessness
 If your blood glucose drops to below 4 mmol/L, treat
 Persistent diarrhoea
hypoglycemia according to the 15/15 rule. Refer to the
patient information leaflet on hypoglycemia.