Managing Diabetes When You're Sick and Taking Insulin

When you're sick:

• Take your regular dose of long-acting insulin (Lantus, Levemir, Basaglar, Tresiba, Toujeo, etc.)
• Take HALF your regular dose of NPH, 70/30, 75/25, or 50/50.
• Reach out for instructions for U-500.

If you're not eating:

• Do not take your mealtime insulin (NovoLog, Humalog, Apidra, Fiasp, etc.).
• Use your rapid-acting insulin to correct high blood sugar every 3 to 4 hours (based on your correction scale) but do not take it more often than that.

If you cannot eat or drink or are at risk of dehydration (have a fever, diarrhea, vomiting, etc.), stop these medications until you feel better:

• Metformin
• Jardiance (empagliflozin)
• Farxiga (dapagliflozin)
• Invokana (canagliflozin)

If you are at risk of dehydration, you may also need to adjust your diuretic ("water pill") and blood pressure medications.  Reach out if you have questions about this.

When you're sick, check your blood sugar at least every 3 hours.

Check your blood sugar every hour if:

• Your sugar is rising quickly.
• You are not eating well, and you use NPH, 70/30, 75/25, or 50/50.

Keeping yourself from becoming dehydrated is especially important if you're vomiting or have diarrhea.

Every hour, drink a glass of sugar-free liquid, such as:

• Water
• Broth or bouillon
• Gatorade ZERO
• Crystal Light

Over-the-counter cough and cold medicines may have ingredients that increase your blood sugar.  When possible, choose sugar-free options.

If you have nausea or vomiting and can't eat usual meals, try to eat or drink 15 grams of carbohydrates every hour you're awake.

Try:

• 6 Saltine crackers
• 1/2 cup regular soda
• 1/4 cup sherbet
• 1 slice of bread
• 1/2 cup apple juice
• 1/3 cup Jell-O (not the sugar-free kind)
• 1/4 cup tomato soup

Let us or another medical provider know if you:

• Cannot keep down medication, fluids, or liquids.
• Have a fever over 101°F that does not get better with a fever-lowering medication (Tylenol, ibuprofen, etc.).
• Have blood sugar that is consistently over 250 or below 70.

Go to your local emergency room (ER) immediately if you have any of the following:

• Vomiting that won't stop
• Confusion
• Severe abdominal (belly) pain
• Blood sugar over 500