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University Toolkit: Managing sick days

Being sick while having type 1 diabetes may require some special consideration. Learn what to do.
Content last reviewed and updated: 18.10.2023

A young female student sitting in her pyjamas in bed, blowing her nose and surrounded by tissues as she has a cold

What to do when you’re unwell

Remember to pack the Sick Day Advice from your healthcare team. If you haven’t received these, ask your Diabetes Specialist Nurse.

These will explain exactly what to do if you become unwell. You can also find out more on our main sickness page.

Managing your type 1 when you’re unwell

  • Monitor blood glucose levels more frequently  – how often depends on the seriousness of the illness and whether you have ketones, but a general target is at least every four hours, including overnight
  • Don’t stop taking insulin  – never completely stop taking background insulin, even if you’re not eating anything. Insulin is critical for normal metabolism. Without it, the body starts to burn fat which can cause diabetic ketoacidosis. To determine the proper dose, use your blood glucose and ketone levels to guide you, or call your healthcare team for help
  • Check urine or blood for ketones  – the presence of ketones, regardless of your blood glucose level, shows that the body needs insulin. If you find ketones, take additional insulin and lots of fluids. Ketone testing kits are available from your healthcare team or GP
  • Remember to eat and drink  – drink plenty of fluids and try to eat small amounts of food every three to four hours to keep your blood glucose levels as normal as possible
  • Be careful with over-the-counter medicines  – they may contain ingredients that raise or lower blood glucose levels, or that imitate the symptoms of high or low blood glucose. Read the labels before you take any over-the-counter medication and ask the pharmacist for advice if you’re unsure
  • Have a ‘game plan’ and ask for help  – ideally, you and your healthcare team should develop a strategy for managing sick days before you get sick. Put it in writing and then make adjustments as you gain experience with sick days

Seek medical advice if:

  • Your illness lasts longer than two days
  • Vomiting or diarrhoea lasts more than eight hours
  • Your blood glucose is over 15mmol/L and you can’t bring it down
  • You have ketones in your blood or urine and they don’t go away within a few hours
  • You can’t keep any food or liquid down

If your sickness escalates when your GP is closed, contact your out of hours’ service, go to A&E or visit a walk-in centre.

Keep an updated list of all medication you take and a schedule of when you take them so healthcare providers can quickly review your medication history.

When you’re feeling better it’s a good idea to make a record of how you managed your illness. You can then refer to this next time you ultimately find yourself in similar circumstances.

In partnership with:

Diabetes UK, NHS England and NHS Norwich and Norfolk University Hospitals partner logos