Help Patients With Diabetes Navigate Sick Days

Patients with diabetes will ask how to manage sick days...since acute illness or infection can cause big changes in blood glucose.

Stress on the body can INCREASE blood sugar...but less food intake due to poor appetite or vomiting can DECREASE blood sugar.

Help patients prepare for and navigate these changes or closer monitoring may be needed to keep the patient safe.

Medications. Listen for patients who report stopping their meds due to illness...and notify your pharmacist. Most diabetes meds, including insulin, should be continued while sick...even if the patient can’t eat.

But a patient at risk for low blood sugar due to limited intake should usually hold sulfonylureas (glyburide, etc), repaglinide, or nateglinide...since these meds drop glucose even further.

And some insulin doses may need to be adjusted...depending on the patient’s glucose levels and carbohydrate intake.

You may even see a short course of insulin ADDED to a patient’s regimen...if their blood sugar is too high.

Testing. Ensure patients have enough test strips and supplies.

Testing blood sugar more frequently during an illness can catch problems early. While sick, patients on insulin should test every 2 to 4 HOURS...or about 2 to 4 times a day for patients not on insulin.

If needed, get an override from the insurer or request refills or a new Rx from the prescriber.

Be ready to help with other OTCs. For example, patients may need ketone test strips (Ketostix, etc) check for ketones in urine. High levels can lead to ketoacidosis...which can cause a coma or death.

Referral. Alert the pharmacist of patients complaining of LOW blood sugar...sweating, dizziness, etc. Glucose tabs or gels...or a med adjustment...can help get blood sugar in range.

Also refer patients reporting fruity breath, confusion, or trouble breathing. These are telltale signs that their blood sugar has reached dangerously HIGH levels...and they need emergency care.

Bookmark our Diabetes Resource Hub for our latest diabetes articles, charts, etc.

Key References

  • Am J Kidney Dis. 2023 May;81(5):564-574
  • (5-24-23)
Pharmacy Technician's Letter. June 2023, No. 390601


Get concise advice on drug therapy, plus unlimited access to CE

Pharmacist's Letter includes:

  • 12 issues every year, with brief articles about new meds and hot topics
  • 200+ CE courses, including the popular CE-in-the-Letter
  • Quick reference drug comparison charts
  • Access to the entire archive

Already a subscriber? Log in

Volume pricing available. Get a quote