A Crucial Guide for Managing Diabetes When Cold, Flu, and COVID Strike

This winter “unwellness” season, plenty of folks are being sidelined with severe coughs, runny noses, and prolonged fevers thanks to some nasty influenza A and B strains. As if that weren’t tough enough, the common cold and COVID are also making a substantial 2024 appearance nationwide.

Getting sick sucks. But, these illnesses, while inconvenient, are not a significant health concern for most people. For those of us living with diabetes, however, getting sick can have a much more substantial impact on our health. We should take precautions like getting annual flu shots (usually free!), avoiding friends and family members we know are ill, and wearing a medical mask in crowded indoor public spaces.

But let’s face it: taking the necessary precautions is no guarantee that you won’t become sick. The question is, “Are you prepared if you come down with a virus?”

What Happens When Prevention Doesn’t Work?

Having diabetes does not make you any more likely to get a cold or the flu than anyone else. What it does mean, however, is that you are more likely to experience severe symptoms if you do catch a bug. Symptoms that will not only make you feel crummy but can also negatively impact your diabetes management. This is why the American Diabetes Association (ADA) reminds people with diabetes that having a sick day plan can help you stay on track with blood sugar control and avoid severe cold and flu complications.

Tips To Prepare for Those Unwanted Sick Days

The ADA does not alone understand how important having a “sick day plan” is for those with diabetes. The Centers for Disease Control and Prevention (CDC) also offers some helpful tips should you become ill.

It all comes down to being prepared in case you become sick. After all, it’s much harder to get your game plan together once you're feeling symptoms. Here’s what you can start doing right now:

1. Plan with your physician and care team

This is the critical first step in creating your sick day plan. Speak candidly with your doctor and healthcare team about what you should do if you get sick. Ask questions and get as much information as possible. Things to bring up include:

– When should you call your doctor? What symptoms? How severe?

– How often should you test your blood sugar when sick?

– What foods and fluids should you take during your illness?

– If and when you should check for ketones?

– How to adjust insulin and oral diabetes medications, if required.

– Are there any over-the-counter medications you should use? Are there any you should avoid? 

2. Stock up on over-the-counter products

Rule one is to ensure you have plenty of diabetes medication (you should be doing that anyway). But now is also an excellent time to get any over-the-counter products deemed okay by your doctor. These can help ease your symptoms should you get sick. Some possible products include:

– An anti-diarrheal

– Pain reliever

– Thermometer

– Medicine to treat vomiting

– Sugar-free cough drops

– Tissues

3. Food and liquids

When we get sick, we often lose our appetites or don’t eat as regularly as we would if we were feeling our best. For those with diabetes, this can do a number on blood sugar, often leading to sudden drops known as hypoglycemia. That’s why it’s a good idea to stock up on some easy-to-prepare foods and quick blood sugar boosters, including: 

– Juice boxes

– Instant cooked cereals

– Crackers

– Canned soup

– Unsweetened applesauce 

According to the CDC, if you can’t eat meals, you should eat or drink about 50 grams of carbohydrates every 4 hours. That’s about 1 ½ cups of unsweetened applesauce or 1 ½ cups of typical fruit juice.

4. Test blood sugar more often

When you’re sick, it can impact your blood sugar. For one thing, you might not be eating as regularly. Another reason is that when we get ill, our bodies release hormones to battle the illness, which tend to raise blood sugar levels and, thus, increase the need for insulin and other diabetes medications. By testing more often, you’ll be able to spot any potential blood glucose fluctuations earlier and can take the appropriate action. How often should you test, and how should you adjust medication? That’s a question to take up with your diabetes physician and care team when you formulate your sick day plan.

5. Test for ketones and watch for signs of DKA

If your body does not get enough insulin when you are sick, it will break down fat as fuel. This process produces ketones, which can become toxic to the body. If left unchecked, having too many ketones can lead to a deadly condition known as Diabetic Ketoacidosis (DKA). Fortunately, it’s easy to check for ketones with a simple home urine test, and many glucose meters now also allow testing for ketones. The ADA recommends testing for ketones every 4-6 hours when feeling sick. 

Also, watch for the signs of DKA:

  • Elevated blood sugar (240 mg/dl or higher)
  • High ketones when testing
  • Thirst or dry mouth
  • Frequent urination
  • Drowsiness
  • Nausea and vomiting
  • Abdominal pain
  • Fruity odor on breath
  • Difficulty breathing
  • Confusion

DKA is a life-threatening condition and, left untreated, can lead to coma or death. If you experience any of the above symptoms or believe you may be suffering from DKA, seek emergency medical attention.

6. Drink plenty of water

Sometimes, when sick, symptoms like fever, diarrhea, or vomiting can lead to dehydration. It’s essential to drink plenty of water when you get ill and have diabetes. If you’re having trouble keeping food and drink down, try taking small sips every 15 minutes throughout the day. It is crucial you don’t become dehydrated as this can further increase complications. 

7. Create a blood sugar sick-day kit

Ensure all the things you’ll need to manage blood sugar are handy. Some things you might want to include are a glucose meter, test strips, supplies for a CGM or pump, extra batteries, glucose tabs (in the event of a sudden drop in blood sugar), ketone test strips, an additional week’s worth of medication, and flu or cold medicines approved by your physician.


You’ve probably been sick more than once while also living with diabetes. There is no reason to be overly fearful of the flu! But there is good reason to take precautions and ensure you’re ready should you become sick. The time to do it is before you come down with a virus, and we hope the seven tips we’ve offered are helpful. Do you have any comments or helpful sick-day tips of your own? We’d love to hear about them below!