Should I adjust my insulin when sick?

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

Fact checked byDiabetes.co.in medical review team

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Patient's Query

42 years old • male

Whenever I'm sick, my sugars fluctuate dramatically. Should I stop or reduce my insulin or medications during illness, or should I actually be increasing them?

Doctor Answers

Dr. Pavan Kumar Uppula

Endocrinologist

Sickness often raises blood sugars due to stress hormones, meaning you usually shouldn't stop insulin or diabetes medications entirely.

Important sick-day steps:

Continue insulin—sometimes you may even need increased doses.
Check glucose levels every 2–4 hours to manage fluctuations.
Drink plenty of fluids to avoid dehydration.
For type 1 diabetes, test for ketones if glucose stays above 250 mg/dL.

Contact your healthcare provider urgently if you experience vomiting, persistent hyperglycemia, or positive ketones. Individual management varies—work with your diabetes team for tailored instructions.

References:

Kitabchi, A. E., et al. (2009). Hyperglycemic Crises in Adult Patients With Diabetes. Diabetes Care, 32(7), 1335–1343.
ISPAD Clinical Practice Consensus Guidelines. (2022). Management of sick days in diabetes. Pediatric Diabetes, 23(Suppl 27), 105–112.
American Diabetes Association. (2023). Sick-Day Management. Diabetes Care, 46(Suppl 1).