Diabetes and Sick Days

Diabetes at Work: Tips for Managing Sick Days

Nearly one in five people with diabetes are regularly unable to attend a full day at work due to disruption caused by episodes of dangerously low blood sugar, known as a hypoglycaemic event.1 A new survey, focusing on productivity loss following hypoglycaemic events, was published today in the journal Value in Health. The survey was conducted with 1,404 people with type 1 and type 2 diabetes who had reported a hypoglycaemic event in the preceding month, in the US, UK, Germany and France.1

You don’t have to be burdened with sick days and down time. By being aware of how diabetes affects your body and the special needs you have during an illness, you can help avoid the loss of productivity from sick days.

Illness and Blood Glucose

When you are sick, your body releases certain hormones to help fight the illness. The down side of this immune response is that the hormones also increase your blood glucose, making it harder for insulin to work properly and for you to control your blood sugar. Type 1 diabetics are at risk of developing diabetic ketoacidosis, a serious condition caused by elevated levels of glucose and ketones in the blood. Ketones are waste products produced in type I diabetics when the body uses fats as the primary energy source rather than sugars. This occurs when there is not enough insulin for the body to use sugars for energy. Type 2 diabetics are at risk of developing a similar condition called hyperosmolar hyperglycemic nonketotic coma. Both conditions can lead to hospitalization and even death if not treated.


All people with diabetes should receive a yearly flu shot. The best time to receive the shot is between the middle of October and the middle of November. To further reduce your risks, people you live with or come in close contact with should also receive a flu shot. Do not get a flu shot if you have an allergy to eggs or egg products.

All older people with diabetes should also receive a pneumonia vaccine. This is especially important if you also have kidney disease. One shot is enough for most people, but some people with diabetes may require shots every 5-6 years. Be sure to talk with your physician about receiving these important, life saving vaccines.

Being Prepared

Work with your physician or diabetes educator to develop specific instructions for you to follow when you get sick. Your plan should include instructions on medication use, eating, and glucose and ketone monitoring. Being prepared in advance can help keep your blood glucose under control. The remainder of this article will provide suggestions on how you can better manage your diabetes during an illness. However, this information cannot replace the advice of your physician or diabetes educator.

Monitoring Your Blood Glucose and Urine Ketones

When you are sick, you will need to monitor your blood glucose more often than usual. You will also need to monitor for the presence of ketones in your urine. If you are a type 1 diabetic, you may need to measure your blood sugar and urine ketones as often as every 2 to 4 hours. Urine ketone test strips report readings in terms such as negative, trace, small, moderate or large rather than specific numbers. Moderate to large amounts of ketones in the urine should be reported to your physician immediately, as this could lead to ketoacidosis. People with type 2 diabetes may be able to measure blood sugar less frequently, and may not have to measure for urine ketones.

Diabetes Medications

Continue all of your diabetes medications during your illness, even if you are not able to eat. If you already take insulin, your physician may have you take more than usual while you are sick. If you take oral medications only, you may be able to continue them, or you may have to use insulin for a short time. Do not take additional doses of diabetes medications or insulin unless specifically instructed by your physician.


While you are sick, you should avoid strenuous exercise and get plenty of rest. This will help your body recover from the illness.


If possible, do try to stick with your regular diet. If you can not tolerate your regular diet, you must try to consume your normal amount of calories through soft foods or liquids. Consult with your physician or nutritionist for a list of foods that provide the calories you need and are easier to digest during your illness. It is also important to drink extra fluids while you are sick to prevent dehydration. Try to drink 8 ounces of calorie free liquids every hour when you are awake. Be sure to tell your physician if you are unable to keep foods or liquids down without vomiting.

Cough and Cold Medications

Many cough and cold products contain sugar, but there are also a number of sugar-free options. Read labels carefully to be sure. Sugar-free cough drops are available from Robitussin and Halls. Cold-Eeze offers sugar-free tablets for cold relief. Scot-tussin, Diabetic Tussin, and Tussin DM Clear are popular sugar-free cough syrups. Ask about sugar-free cough and cold products at your local pharmacy.

Decongestants such as pseudoephedrine can raise blood sugar and blood pressure; generally nasal spray decongestants are safer than pills. Popular nasal sprays include Afrin Nasal Spray. Acetaminophen (Tylenol) is the preferred pain reliever, since high doses of aspirin can cause low blood sugar.

Try to avoid products that contain alcohol and caffeine as ingredients. Consult with your physician or pharmacist if you are not sure about a product.

When to Call Your Physician

Be sure to consult your physician if you:

  • Have been sick for two days and are not getting better
  • Have been vomiting or having diarrhea for more than 6 hours
  • Have moderate to large amounts of ketones in your urine
  • Have a blood glucose more than 240mg/dl even after taking extra insulin
  • Have blood glucose readings more than 240mg/dl for 24 hours if taking only oral medications and not insulin
  • Have a blood glucose less than 60mg/dl
  • Have signs of dehydration such as dry skin or mouth, sunken eyes or weight loss
  • Have difficulty breathing, chest or stomach pain, loss or changes in vision
  • Have temperature higher than 101 F
  • Have any changes in mental status
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Constance Brown-Riggs, MSEd, RD, CDE, CDN—an award-winning RD, certified diabetes educator, and past national spokesperson for the Academy of Nutrition and Dietetics, is the author of The African American Guide to Living Well With Diabetes, which received the Favorably Reviewed designation from the American Association of Diabetes Educators, and Eating Soulfully and Healthfully with Diabetes.

Dr. Lori Shemek, PhD, CNC, CLC, the best-selling author of “Fire-Up Your Fat Burn! and leading health and weight loss expert, is also known as “The Inflammation Terminator.” She has made it her mission to educate the public on the toxic effects of certain foods and lifestyle choices and how they create inflammation in the body. She is a leading authority on inflammation and its role in weight loss, preventing disease and optimizing health.

Rebecca Bitzer – MS, RD/LD, CEDRD is an award-winning Registered Dietitian, writer, speaker, blogger, and REBEL Dietitian business owner. Rebecca and her team of six Registered Dietitians have counseled thousands of clients struggling with diabetes for over twenty-five years. They work closely with each other along with internists, endocrinologists, therapists, and families.

Maureen Sullivan – RN, CDE has worked for many years as a Registered Nurse, most of them in emergency and trauma services. She is a Certified Emergency Nurse, Certified Diabetes Educator, and the former manager of a hospital stroke program. Maureen’s wealth of knowledge, passion for nursing and education, and ability to engage people makes her an excellent teacher and a captivating lecturer. Recently, Maureen has been concentrating on writing, speaking and teaching, as well as working on her award-winning weekly podcast, “The Health and Humor Show.”

Lauren Harris-Pincus, MS, RDN is a nutrition communications specialist, registered dietitian in private practice, social media consultant, speaker, spokesperson and corporate consultant. She is currently the owner of Nutrition Starring YOU, LLC and www.NutritionStarringYOU.com. Lauren strongly believes that we should “Think Healthy, not Skinny”, and “EveryBODY is unique, your diet should be too”. Lauren was co-host of the Family Food Experts Kitchen radio show, available for listening on iHeart Radio and iTunes. Also known as one of the “NutritionBabes”, Lauren co-founded NutritionBabes.com, a popular Health and Wellness website in 2009. NutritionBabes.com was voted one of Healthline’s Top 100 Health Blogs in 2011, 2012 and 2013.

Mark Heyman, PhD, CDE is a clinical health psychologist and the director of the Center for Diabetes and Mental Health (CDMH). In addition to treating patients with type 1 and type 2 diabetes, Dr. Heyman provides training for health care providers on how to identify and address the emotional and behavioral aspects of diabetes in their patients. He also works with pharmaceutical and medical device companies to help them understand these issues and incorporate this information into their sales, marketing, and patient education materials. He is particularly interested in empirically supported behavioral interventions that promote behavior change and improve physical and mental health in people with diabetes.

Katie Ferraro, MPH, RD, CDE is a nationally-recognized registered dietitian, certified diabetes educator and author with an expertise in nutrition communications and curriculum development. She is the co-author of “Diet Therapy in Advanced Practice Nursing” (McGraw Hill, 2014) and an Assistant Clinical Professor of Nutrition at the University of California San Francisco and University of San Diego’s graduate schools of nursing.

Dr. Beverly S. Adler, PhD, CDE (aka “Dr. Bev”) is a clinical psychologist and certified diabetes educator, author and speaker. She specializes treating the emotional issues of people with diabetes. In her private practice, she provides individual, family and/or group therapy utilizing a cognitive behavior therapy orientation, combined with a spiritual approach. Her goal is to empower her patients to manage their diabetes.

Dr. Bev is the author of two self-help diabetes books. She has written numerous articles which are published in print and online – always focused on diabetes from the emotional perspective. She also speaks to audiences of people living with diabetes, as well as, to audiences of healthcare professionals and diabetes educators. Dr. Bev, herself, has been living successfully with type 1 diabetes for 40+ years.

In August 2016, Dr. Bev was honored to receive the “CDE Entrepreneur of the Year” Award from her Metropolitan NY Association of Diabetes Educators.

Jill Weisenberger, MS, RDN, CDE, FAND is an internationally recognized nutrition and diabetes expert with more than two decades experience. Through writing, speaking and one-on-one coaching, Jill empowers people to grab control of their health. She has worked as both a nutrition counselor and a diabetes educator in the hospital and research settings, and now in private practice in Newport News, VA. Jill is known for her practical approach and caring attitude. Her no-nonsense strategies to eating well include foods that both taste good and are good for you.

Marlene Koch (pronounced ‘cook’) is a nationally recognized nutritionist, popular TV personality and New York Times bestselling author. She graduated Magna Cum Laude from UCLA with a Bachelor’s degree in Nutritional Science. She is a registered dietitian and one of a select group of dietitians to hold an advanced certificate in Child and Adolescent Weight Management from the Academy of Nutrition & Dietetics.

Marlene has taught professional chefs from the American Culinary Federation the principles of healthy cooking and eating. She has been adjunct Nutrition professor and cooking instructor for Columbus State College and the Columbus State Culinary Academy, and she is a nationally recognized expert in weight loss, diabetes, child and adolescent nutrition, and sugar substitutes.

Marlene has sold over one million cookbooks, and is a regular guest on QVC.

Barbara Ruhs – MS, RDN is a Registered Dietitian Nutritionist and owner of Neighborhood Nutrition LLC, a consulting firm focused on providing solutions to help food companies and supermarkets improve consumer health & wellness. She’s a former supermarket dietitian and has run a successful business for 17 years. A leader in the field of nutrition, her mission is to help people by impacting the way food is produced, marketed and sold. She’s a strong advocate for supermarket dietitians and believes the retail food industry has the greatest potential to impact public health.

Cheryl Orlansky has over 25 years of experience in health promotion and chronic disease prevention and management. Her first career as a registered dental hygienist led her towards a path of wellness and nutrition! Her expertise is in diabetes, weight management and cardiovascular disease for individuals and groups. She works in a large private practice including endocrinology, internal medicine, rheumatology, neurology and sleep medicine. She is an award winning dietitian with current leadership positions in state and local dietetics organizations.

She has been interviewed and quoted in media outlets for WebMD, Atlanta Sports and Fitness, Georgia Public Broadcasting, and the Atlanta Journal and Constitution. She has partnered with V-103 Radio to lead supermarket tours as part of a community outreach during National Nutrition Month.

Cheryl helps her clients reach balance through lifestyle choices: cooking and eating, activity and purpose in life.

Jackie Newgent, RDN, CDN, is a registered dietitian nutritionist and classically-trained chef. With a passion for helping people (including her father) with diabetes, she’s author of The With or Without Meat Cookbook: The Flexible Approach to Flavorful Diabetes Cooking and the award-winning The All‐Natural Diabetes Cookbook, both published by the American Diabetes Association. Jackie is also author of 1,000 Low-Calorie Recipes and Big Green Cookbook. Her next book, The All-Natural Diabetes Cookbook—2nd Edition, was published in 2015.

Nutritionist Rania Batayneh, MPH is the author of the best-selling book, The One One One Diet. She holds a master’s degree in public health nutrition from the University of Michigan School of Public Health and is also a Wellcoaches Certified Health and Wellness Coach endorsed by the American College of Sports Medicine (ACSM).

OmnichannelHealth Media, publisher of DiabetesDigest.com, does not provide medical advice, diagnosis or treatment. See additional information.