When you have diabetes, it’s important to know how to cope when you’re unwell. Especially if you have to go into hospital.
Being ill can upset your diabetes management, so you need to know what to do to keep your blood glucose (sugar) levels as close to target as possible. Some people will know these as sick day rules.
You'll need to know how to manage insulin or other diabetes medications, blood or urine tests, and your diet. This is really important if you go into hospital or if you need to take steroids as part of your treatment. Always tell the healthcare professionals treating you that you have diabetes.
How being ill can affect your diabetes
Illness and infections, as well as other forms of stress, can raise your blood glucose (sugar) levels. As part of the body’s defence mechanism for fighting illness and infection, more glucose is released into the blood stream. This can happen even if you’re off your food or eating less than usual.
People who don’t have diabetes just produce more insulin to cope. But when you’ve got diabetes, your body can’t do this. The symptoms of diabetes can add to those of the original illness or infection and make it much worse.
Feeling or being sick, or having diarrhoea can make your blood sugar levels drop, because you're not absorbing food as usual.
Being dehydrated when you have diabetes
Having a temperature or being sick can lead to dehydration. In some cases, severe dehydration and very high blood sugar levels can mean that you need to go into hospital.
So it’s important to be prepared and follow our advice on coping when you're sick. You might want to give this information to a friend or family member, so they can help you if you get sick.
- Don't panic – contact your diabetes team who will help you if you have any queries or if you are unsure about what to do.
- Keep taking your diabetes medications – even if you don't feel like eating. But there are some medicines that you shouldn’t take as much of or stop taking altogether. Make sure you talk to your diabetes team as soon as you’re feeling ill so they can give you the right advice.
- If you check your blood sugar at home you'll probably need to do it more often – at least every four hours, including during the night. If you don't test your blood sugar levels at home, be aware of the signs of a hyper (hypergylcaemia).
- Stay hydrated – have plenty of unsweetened drinks, and eat little and often.
- If you have type 1 diabetes, it’s important to check for ketones. You usually check when your blood sugar level is 15mmol/l or more, or 13mmol/l if you use an insulin pump. But your diabetes team may have given you different targets, so regardless of what your blood sugars are saying – test for ketones. If you find ketones, contact your diabetes team.
- If you take a certain type of diabetes tablet called SGLT2i and become unwell, you should stop taking these. You need to check your ketones and your blood sugars (if you've been told to do this and have the kit), and speak to your healthcare team. There are different types of SGLT2i tablets so check our list for all the brand names. Taking these tablets when you're not very well could increase your risk of developing diabetic ketoacidosis (DKA), so you need to know the symptoms to look out for.
- Keep eating or drinking – if you can’t keep food down, try snacks or drinks with carbohydrates in to give you energy. Try to sip sugary drinks (such as fruit juice or non-diet cola or lemonade) or suck on glucose tablets or sweets like jelly beans. Letting fizzy drinks go flat may help keep them down. If you're vomiting, or not able to keep fluids down, get medical help as soon as possible.
Get information about sick day rules and what to do if you're unwell available in 12 different languages, including Bengali, Hindi, Chinese and Polish.
Some conditions, like Addison's disease, severe asthma, rheumatoid arthritis and lupus are treated with steroids. And now some people with coronavirus are being treated with a type of steroid called dexamethasone. If you have diabetes, taking high doses of steroids for periods of time can make your blood sugar levels rise.
Not everyone with coronavirus will need this steroid – it’s only used in hospital when someone is really unwell and needs help to breathe. It works by reducing the inflammation that coronavirus can cause and supports your immune system to fight it.
While this works well for treating coronavirus, it’s not so good when it comes to diabetes. Dexamethasone makes your body more resistant to insulin, making your blood sugar levels go very high. If you’re given dexamethasone, you may need insulin to help reduce your blood sugar levels. If you already take insulin, you may need to take more or take a different one that does a better job of bringing your blood sugars down.
If you don’t have diabetes and are prescribed steroids, it’s important to know that taking this medication can actually cause diabetes to develop later on. This is called steroid-induced diabetes. Talk to your healthcare team for more advice on this.
You may be in a situation where you need to go into hospital or to a clinic. This may be for something related to your diabetes, like an appointment to treat an existing problem, a routine check, or you might spot something new. Or it may be something unrelated to your diabetes, like an illness or injury.
Many routine appointments for annual diabetes reviews have been delayed or postponed. Don't worry, your diabetes team will send you an appointment when these are up and running again.
But if you're already having treatment for something like a foot problem or for eye treatment, and you don't have coronavirus symptoms, then your clinic appointments should still carry on. If you're worried about going to your clinic or hospital at this time or want to check whether your appointment is still going ahead, call the number on your appointment letter or speak to your GP.
Whether it's a booked appointment or you need to go to A&E for an emergency, the NHS is still open for you.
During the current Covid-19 pandemic, your care in hospital may be a little different to normal, for example, not seeing all your usual diabetes team or not having family with you when you go into hospital. And when you arrive you might be asked to wait somewhere to maintain social distancing. For any problem, regardless of the current Covid-19 pandemic, you should access your local hospital as you would have done before.
When you get to the hospital, tell someone straight away that you have diabetes. This is so staff at the hospital can give you the right care – both physically and emotionally. Getting good care in hospital is one of your 15 Healthcare Essentials, and this is all about working with the healthcare professionals to help them understand what you need. Talk to them if you’re worried about anything.
Remember, if it’s a medical emergency and you need to call an ambulance, dial 999.
You may want to share this information with a family member or friend, so they can be prepared too.
If you need to stay over in hospital (inpatient)
Here’s a handy checklist of what to take to hospital if you need to stay overnight as an inpatient. Don’t worry if you forget some of these, especially if you’re leaving home in an emergency. Tell the hospital staff you have diabetes and let them know what you need to stay well – or ask a family member or friend to let them know.
- Medication – diabetes meds and anything else you take, for example blood pressure tablets.
- Equipment – like your glucose monitor and sensors, or spare needles if you inject.
- Hypo treatments.
- Important numbers – take your phone and a charger.
- Things to pass the time – like a magazine or a book.
Managing your diabetes in hospital
If you are very ill and unable to look after yourself, the staff at the hospital will manage your diabetes as well as any other health issues you have. The more information they have, the easier this will be – so make sure family members or friends know how you manage your diabetes. You might want to write this down for them or share the link to the page.
If you are well enough, there are things you can do to help keep yourself well while you’re in hospital.
One of the first things you might notice is that your blood sugar levels may be higher or lower than normal. This could be because you’re ill, feeling stressed and or because you’re not being very active. If you usually check your blood sugar levels, you may need to do this more often and adjust your treatment. If you’re checking your blood sugars and notice them going high, let the staff know so they are aware.
If you don’t usually check your blood sugar levels, the staff at the hospital may check them for you as part of your care when you are unwell.
If you’re at risk of hypos, make sure you take your hypo treatment with you when you go in and let the staff know that you might need to eat to avoid having a hypo. If you have to be ‘nil by mouth’ before an operation, speak with the staff to agree how best to manage a hypo.
If you use certain diabetes equipment, take this with you. This could be your blood-testing kit, pump supplies and needles – they probably won't be able to provide supplies for your pump. And take your medication with you too. This is so the team looking after you know what you need to take and when. But if you don’t have what you need, the hospital will give you the medication you normally use. If you’re managing your diabetes yourself, let them know when you’ve taken your medicines or insulin so they can keep a record of the time and dose. Depending on what meds you’re on, your healthcare team may suggest the dose needs to change or to stop taking something.
If you need help choosing meals and snacks, the staff can help you and also make sure medications correspond with meal times if needed.
Remember that while you’re in hospital, it’s still important to check your feet regularly. Ask the healthcare team to help you if you need to.
The ward staff will need to involve the diabetes team in your care while you’re in hospital and to make sure you’re ready for when you are discharged. It’s important you know things like your sick day rules – which are steps to take if you get ill for any reason and help you manage your diabetes when you’re sick.