Sick-Day Rules

Any illness — fever, a stomach infection, dengue, a chest infection, even a bad tooth — raises blood sugar. Your body releases stress hormones that push glucose up and work against insulin, so you need more insulin when ill, not less, even if you are eating less.

This is the single most counter-intuitive rule in diabetes care, and the one that most often leads to hospital admission when it is not followed.

1. Keep taking your insulin. Doses may need to go up, not down. Never skip a background insulin dose because you are not eating.
2. Check blood sugar every four hours, or more often if readings are high.
3. Check ketones if your glucose is above 250 mg/dL or if you are vomiting.
4. Drink fluids steadily — small sips often rather than large amounts at once. Water, nimbu pani without sugar, or ORS.
5. If you cannot eat normally, take carbohydrate in sippable form: juice, khichdi, curd, dal water, milk.
6. Rest, and do not exercise while unwell with high readings.

Contact your doctor if vomiting continues for more than a few hours, if you cannot keep fluids down, if ketones are moderate or large, if blood sugar stays above 250 mg/dL after corrections, or if you feel drowsy or confused.

It helps to agree a sick-day plan with your doctor in advance, while you are well — specifically, how much to increase your insulin and when to call. Working it out at 2 a.m. with a fever is much harder.

Keep a small sick-day kit at home: ketone strips, ORS, a thermometer, and your doctor's number written down where anyone in the house can find it.