Managing glucose during illness, ketone monitoring, hydration, and when to escalate
Illness is one of the most dangerous periods for diabetic clients. Stress hormones released during any illness raise blood glucose — even when the client is eating less than normal. Without proper sick day management, a simple cold or stomach virus can rapidly progress to diabetic ketoacidosis or hyperosmolar hyperglycemic state. Every diabetic client and their caregivers should know these rules.
During any illness — infection, fever, injury, surgery, even emotional stress — the body releases counter-regulatory hormones (cortisol, glucagon, epinephrine, growth hormone) that raise blood glucose and promote ketone production. This occurs even if the client is eating less than usual. The critical teaching point: illness typically increases insulin need, not decreases it, despite reduced food intake.
Check blood glucose every 4–6 hours during illness, or more frequently if values are above 240 mg/dL or the client is symptomatic. Document all values with time. Notify the supervising clinician when glucose exceeds 240–300 mg/dL (per physician protocol) or is not responding to correction.
Clients with type 1 diabetes and insulin-dependent type 2 clients should check urine or blood ketones every 4–6 hours when glucose is above 240 mg/dL or during any illness. Trace/small ketones: increase fluid intake, recheck in 2–4 hours. Moderate ketones: notify the clinician. Large/high ketones with symptoms: this may be DKA — call 911.
General rules (always defer to physician orders): Continue basal (long-acting) insulin — illness raises blood glucose, so basal is typically maintained or increased. Adjust rapid-acting insulin doses based on glucose levels and actual carbohydrate intake — do not simply skip if the client cannot eat; consult the clinician. Many oral medications (especially metformin) may need to be held during illness causing dehydration or when contrast dye is used — follow physician orders.
Adequate fluid intake is critical during illness to prevent dehydration (especially important with hyperglycemia, which causes osmotic diuresis). If unable to eat solid food, encourage: broth, sugar-free popsicles, water, and — if blood glucose is below 70 mg/dL — regular ginger ale or juice. Aim for 8 oz of fluid every hour if tolerated. Record fluid intake and urine output.
Call 911 for any diabetic sick day client with: inability to keep fluids down for more than 2–4 hours (dehydration risk), blood glucose above 300 mg/dL unresponsive to treatment, large/high ketones with nausea/vomiting/abdominal pain (DKA), altered mental status or loss of consciousness, rapid or labored breathing (Kussmaul respirations). DKA requires IV fluids and insulin — it cannot be managed in the home.
Complete this 5-question quiz with 80% or higher to earn your CEU credit for this lesson.