Diabetes can be more difficult to control when you are ill. Plan ahead for illness by having individually wrapped Ketostix and special foods (such as regular Jell-O and Gatorade) on hand. When you are ill, the following guidelines can help you keep your diabetes under control.

• Report any illness to your physician when it increases blood glucose levels and causes urine ketones. See your doctor without delay if you need guidance in handling the illness or if there is no improvement in 6–8 hours.
• Test blood glucose and ketones frequently, at least every 2–4 hours, until results are normal.
• Call your physician to ask for guidance, especially if high blood glucose levels (250 mg/dl or greater) last for more than 6 hours, if urine ketones last for more than 6 hours, if you are unable to take fluids or food for 4 hours, if you have a fever (101.5°F), if illness lasts more than 24 hours or if you are dehydrated, have severe abdominal pain, or have other unexplained symptoms.
• When contacting the physician, have handy the results of glucose and ketone testing, symptoms of illness, and body temperature.
• Continue taking insulin even if you are unable to eat solid foods or are vomiting. Your insulin needs may stay the same or increase when you are ill. If you take pills for diabetes, take your usual dose. If the pills will not stay down, call your physician. If you have blood glucose levels less than 70 mg/dl and take a diabetes pill that can cause low blood glucose, call your physician.
• Continue eating foods and drinking fluids even if you are vomiting, having diarrhea, or your blood glucose level is high. Take in at least 45–50 g of carbohydrate every 3–4 hours to prevent low blood glucose while your insulin clears the ketones. If regular foods are not tolerated, try carbohydrate-containing liquids or soft foods. The following foods contain 15 g of carbohydrate in the amount listed.

  1/2 cup regular soft drinks 1 double Popsicle 1/2 cup regular Jell-O 1 cup Gatorade 1 cup soup 1/2 cup fruit juice 1 slice toast 6 soda crackers

• To prevent dehydration, drink at least 8 oz. of fluid every hour. If drinking causes vomiting, limit fluid to 1–2 tablespoons every 20 minutes or suck on a Popsicle. Fluids with minerals, such as broth or Gatorade, help prevent dehydration
• Limit your activity if your blood glucose level is higher than 250 mg/dl and ketones are moderate to large.

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