Insulin dose on sick days: more, less, or skip entirely?

Answered byDr. Pavan Kumar UppulaMBBS, MD (General Medicine), DM (Endocrinology)

Fact checked byDiabetes.co.in medical review team

Asked on

Answered on

Patient's Query

When I'm sick, especially if vomiting or not eating well, I'm unsure whether to lower my insulin dose to avoid lows or keep it the same to prevent highs. What’s the safest approach?

Doctor Answers

Dr. Pavan Kumar Uppula

Endocrinologist

During illness, never skip insulin entirely, even if your food intake decreases. Illness typically increases stress hormones, raising blood glucose levels.

Recommended approach:

Continue basal insulin (long-acting) as prescribed to control glucose released by the liver.
Adjust rapid-acting insulin (mealtime insulin) based on food intake and glucose levels.
Check blood sugars frequently (every 2–4 hours) to guide dose adjustments.
Maintain hydration with fluids, preferably sugar-free drinks.

Contact your healthcare team if:

Vomiting or inability to tolerate fluids persists.
Persistent high glucose levels (>250 mg/dL) or presence of ketones.

A tailored sick-day management plan from your endocrinologist is crucial for safe and effective diabetes management during illness.

References:

Kitabchi, A. E., et al. (2009). Management of hyperglycemic crises. Diabetes Care, 32(7), 1335–1343.
American Diabetes Association. (2023). Sick-Day Management. Diabetes Care, 46(Suppl 1).
Colberg, S. R., et al. (2016). Physical Activity/Exercise and Diabetes. Diabetes Care, 39(11), 2065–2079.