Managing diabetes when you are unwell
What happens to my diabetes when I become unwell?
It is likely that you will become unwell at some point in the future and it is important to know what to expect and what to do when you have diabetes and you are unwell.
If you get a cold or flu or other infection in the body, your blood glucose levels are likely to be higher than usual because the body sends more glucose out into the blood to help fight off the illness.
If you have diarrhoea and or are being sick, you might have lower blood glucose levels as your body is struggling to absorb food and drink you take in, but you might not feel like eating as well.
What should I do when I’m unwell?
When you are unwell, it is really important to:
- Keep drinking plenty of water or other sugar free drinks in small amounts every hour, especially if you are being sick, have diarrhoea or have a high temperature.
- Do more blood glucose testing than usual to see how high or low they are going.
- If your blood glucose levels are higher than usual or you are having more hypos (blood glucose levels less than 4mmol/l), you will need some changes to your diabetes medications or insulin.
- Try eating small snacks of crackers or biscuits or toast or milk
Who to contact if I’m worried
If you are unwell and you need help with managing your diabetes medications or insulin because your blood glucose levels are higher or lower than usual, get in touch with:
- Your GP or
- Diabetes team or
- Out of hours you can contact 111 for advice
Being prepared
We don’t always know when we are going to be unwell, so make sure that you have read through the illness leaflets you have been given by your diabetes team or GP before you get sick so you know what to do when you are poorly. Ask your team any questions you might have about being unwell when you have diabetes.
Ask a trusted family member or friend or neighbour to read the same leaflets as you so that they know how to help you if you are unwell.
Click on the link below for more information of managing diabetes when you are unwell:
Diabetic ketoacidosis (DKA)
Diabetic ketoacidosis or DKA, is a dangerous condition where there is a severe lack of insulin. This causes the body to break down fat stores to create more energy, but this also causes ketones to form and build up in the blood. Ketones make the blood more acidic which can be dangerous.
DKA is most likely to happen in a person with type 1 diabetes. It can also happen in Type 2 Diabetes or other types of diabetes.
SGLT2 inhibitors (such as Dapagliflozin, Empagliflozin, Canagliflozin) are a type of medications used to treat Type 2 diabetes, and they can increase the risk of DKA developing, even if blood glucose levels are not much higher than normal.
When you have diabetes, you may be more likely to get DKA if you become ill, especially if unwell due to a significant infection. A bad infection stops insulin working as effectively so those on insulin injections may need higher doses even if you are eating less than normal. In this situation blood glucose levels are likely to be higher than usual and ketones levels may be raised in the blood.
Discuss how to manage your diabetes when you are unwell with your practice nurse, Diabetes team or doctor so you know what to do when when you become ill and know when to seek help.
We need people to be aware of the symptoms of DKA so you know what to look out for and what to do if you think you might have ketones.
Symptoms of DKA may include:
- Increased thirst
- Passing a lot more urine than normal
- Tiredness
- Pain in your stomach
- Feeling sick or being sick
- Confusion
- Pear drop (sweet) smell to your breath
When you are unwell, if your blood glucose levels are higher than normal or you have symptoms to suggest diabetic ketoacidosis, then check your blood or urine ketones if you have the equipment to test.
See more resources on NHS: Diabetic ketoacidosis
If you are taking an SGLT2 medication and you become unwell with abdominal pain and vomiting, then stop this medication and seek immediate medical advice.
If you think you might have ketones or DKA, you need to get urgent help from:
- Your GP or
- Your Diabetes team or
- Telephone 111 for advice and support or
- Go to A&E at your local hospital
They can help you with managing your diabetes medications and insulin doses when you are unwell and if you have ketones.
