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Purpose of this pamphlet

People with diabetes must be diligent about following their recommended diet and taking any prescribed medications and/or insulin as scheduled. However, there will be days when you won't be able to follow your usual food plan. You may have a cold, "24-hour flu", infections, etc. The suggestions outlined in this pamphlet are intended for short-term use during mild illness only. During such illnesses, it is important to remember:

1. Continue your usual insulin or medication dosage (your need for insulin may even increase if you have a fever or due to the stress of being ill) unless otherwise advised by your physician.

2. IF YOU USE INSULIN, test your blood sugar at least every 4 hours. If your blood sugar is at or above 240 mg/dl for 4 hours, test your urine for ketones. Continue to test for ketones every 4 hours until your blood sugar drops below 240 mg/dl. If you have moderate to large ketones in your urine, CALL YOUR PHYSICIAN.

IF YOU DO NOT USE INSULIN, test your blood sugar before each meal, at bedtime, and during the night. If your blood sugar is at or above 240 mg/dl for 24 hours, CALL YOUR PHYSICIAN.

3. When you have taken your insulin or oral medication, you must have some food to cover your carbohydrate needs. The foods in your food plan which contain carbohydrate must be replaced with foods you can tolerate, such as liquids and soft foods. Carbohydrate containing foods include fruit, milk and starch/bread.

4. If fever or vomiting are present, it is important to drink large amounts of non-caffeinated liquids (6-8 cups) each day, 4-8 ounces every hour, if tolerated. Take your food in small amounts and frequently during the day. If vomiting persists, call your doctor. If diarrhea is present, do not drink milk which may worsen diarrhea. Include solids as diarrhea improves.

IT'S TIME TO CALL THE DOCTOR WHEN:
  • Vomiting for several hours

  • Diarrhea recurring for six hours

  • Temperature stays over 101 F

  • Trouble breathing

  • Moderate to large amounts of ketones in urine
  • Unable to think clearly or increased fatigue

  • Stomach or chest pain

  • Signs of dehydration such as dry skin or mouth, sunken eyes, or weight loss
  • Sickness that continues over 48 hours without improvement
  • Acute loss or changes in vision

  • Blood sugar levels below 60 mg/dl

  • If taking insulin: Blood sugar levels over 240 mg/dl for two consecutive tests (four hours apart)

  • If using oral medicines for diabetes:
    • Blood sugar levels over 240 mg/dl for 24 hours

Carbohydrate exchanges

When you are ill, you may not feel like eating anything. Although you can stop eating your normal fat and protein calories while you are sick, it is important to maintain your carbohydrate intake while you are ill.

In the space provided below, please fill in the number of carbohydrate servings from your food plan.

Breakfast

Carbohydrate Choices

Morning Snack

Carbohydrate Choices

Lunch

Carbohydrate Choices

Afternoon Snack

Carbohydrate Choices

Supper

Carbohydrate Choices

Bedtime Snack

Carbohydrate Choices

Now, select foods from the list of carbohydrate choices below which will meet your carbohydrate needs. These food suggestions are frequently well tolerated even if you have nausea and vomiting.

CARBOHYDRATE CHOICES (15 grams)

1 slice bread or toast

4 pieces Melba toast

½ cup cooked cereal

½ cup ice cream

¼ cup sherbet

1 cup noodle or vegetable soup

1 cup cream soup

¼ cup regular pudding (not sugar-free)

6 saltine crackers

3 graham crackers

½ cup orange or grapefruit juice

_ cup grape or cranberry juice

½ cup regular pop (not diet)

_ cup regular fruit flavored drink (not diet)

1 cup (8 oz.) Gatorade

6 lifesavers

½ cup regular Jell-O (not diet)

1 tablespoon honey

4 teaspoons sugar

1 cup milk

1 cup artificially sweetened yogurt

1 regular frozen fruit bar or popsicle

1. When you feel too sick to check your blood sugar, that's when you need to check it.

2. Take your insulin or oral medication as usual.

3. Test more frequently.

4. Drink plenty of fluids.

5. Eat or drink your carbohydrates as scheduled on your food plan.

6. Call your doctor if symptoms persist.

 
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