COVID-19 Part 2: Sick Day Guidelines

Having sick day guidelines on hand is vital for people with diabetes. Here’s how to prepare and what to do if you get sick.


By Azumio Inc


In our first article of this series, we covered some basics of COVID-19 including prevention, risks, and how to prepare yourself for the pandemic. In this article, we’ll focus on some important information about sick day guidelines that people with diabetes should be aware of, so they can be prepared to take care of themselves and their diabetes during this pandemic.

Call your doctor

There are some general sick day guidelines detailed below. However, if you feel that you are developing symptoms of any kind, you should call your doctor straight away. They may give you more specific guidelines, such as the frequency you should check blood sugar, whether you should check your ketones, how to treat low and high blood sugar, what you should eat or drink, and when you should seek immediate medical help.

Follow your doctor’s instructions

Blood sugar levels tend to be higher during illness. Therefore, unless instructed otherwise by your doctor, always take your diabetes medicine or insulin as usual, even if you’re not eating well.

Check blood sugar and ketones

When you’re sick, it’s important to check your blood sugar levels more often. Your doctor will advise how often you should check this, as well as whether you should check your ketone levels. People with diabetes, especially those with type 1, are at a higher risk of diabetic ketoacidosis (DKA) when they have a viral infection.

Therefore, when blood sugar is high, it’s crucial to follow your doctor’s instructions regarding if and when to check your ketones, and at what level you should seek medical help.

Use of over-the-counter medications

Check with your healthcare team if you think you need over-the-counter medication. Some medications like cough drops and decongestants often contain honey or sugar, which can raise your blood sugar significantly. There’s also some concern about painkillers. Acetaminophen, another name for paracetamol, can affect the reading of some CGM devices and may also cause liver and kidney problems. Ibuprofen, on the other hand, might lower blood sugar levels and can, in some cases, cause hypoglycemia. Always check with your healthcare team about taking the right medication.

Food and drinks during sick days

Not sure what to eat and drink when you’re sick? Try to keep in mind these sick day tips:

-If you can still tolerate solid foods, try to follow your regular eating pattern as closely as you can.

-Stay hydrated. To prevent dehydration, drink about a cup of carb-free, sugar-free, and caffeine-free fluid every hour. This includes drinks like water, clear diet soda, plain decaffeinated tea, and chicken broth. Sometimes having small sips of fluid every now and then is more tolerable than drinking a whole cup at a time.

-Watch out for signs of dehydration such as a very dry mouth, dry lips, or dark colored urine. Some of the serious signs of dehydration can include fainting, rapid heartbeat, and being confused. It’s important to get medical help right away if you experience any serious signs of dehydration.

-If you are too sick to eat the way you normally would, try to take in some carb-containing soft foods or drinks. Pasta, bread, crackers, oatmeal, yogurt, ice cream, regular gelatin, regular soda, juice, milk, and sports drinks are all good for this. Check the Nutrition Facts label of these foods to find out the amount of carbs per serving size, and eat accordingly.

The CDC recommends eating or drinking about 50 grams of carbohydrates every four hours during sick days, but check with your doctor for more individualized instructions.

-If you can’t keep any solid food down, try a sports drink, regular soda, or fruit juice. You can even try sucking on a popsicle for some fluid and carbs!

Hold off on exercise

Exercise is usually not recommended when you are sick.

Be prepared to treat low blood sugar

While some people with diabetes experience high blood sugar when sick, some may have low blood sugar if they don’t eat well. If you notice you can’t tolerate any food and drinks, it’s important to talk to your doctor, and not adjust your medications unless instructed by your healthcare team.

Low blood sugar is usually defined as less than 70mg/dL, or less than the recommended target range from your doctor. Be sure to treat a dip in blood sugar by following the ADA guidelines or specific low blood sugar treatment instructions from your doctor.

When to get immediate help

Of course, you should contact your healthcare team whenever you have concerns or doubts about how to take care of yourself. Some people with diabetes might be asked to call for medical help right away if they have persistent low blood sugar, abdominal pain, nausea, vomiting, fever, dehydration, ketones, breathing problems, or high blood sugar levels over 250 mg/dL. Check with your healthcare team about when you should call them and when you should call for immediate medical help.

Regarding COVID-19, there are certain warning signs you should watch out for that indicate you need immediate medical attention. These signs include difficulty breathing, persistent pain or pressure in the chest, new confusion or inability to arouse, and bluish lips or face. If you have any of these serious symptoms, you should get immediate medical attention. However, this list does not include all serious symptoms, so if you have any other concerning or serious issues, consult your medical provider right away.

If unsure, you can also refer to the CDC’s Coronavirus self-checker, which can help those with COVID-19 to decide when to receive medical attention.

Emergency care for your diabetes

If you need emergency care for your diabetes or for any other reason whatsoever, do not delay! Hospital emergency departments have special plans in place to protect you from getting exposed to coronavirus in the hospital.


Preparing for the COVID-19 pandemic could be more challenging for those living with diabetes. While there is a lot to arrange and learn, things can stay manageable when taken one step at a time. Consult with your healthcare team if you have any questions.

Again, the guidelines in this article are general recommendations, so remember to check with your doctor for more individualized, specific guidelines for you.

The COVID-19 pandemic guidelines and official recommendations have been quickly evolving, so please refer to the Center for Disease Control and Prevention, American Diabetes Association, USDA Food and Drug Administration, and World Health Organization websites for the most up to date information. In the next article in our series on COVID-19, we’ll look at how to properly manage diabetes during this time. Take care, and we wish you all good health!

Main Photo Credit: Proxima Studio/; Second Photo Credit: Syda Productions/; Third Photo Credit: goodluz/; Fourth Photo Credit: Dragon Images/