Monitoring when unwell

Whatever your usual pattern of blood glucose monitoring, it is important to realise that blood sugar levels can be dramatically affected by illness, running usually much higher (although occasionally lower) than usual.

These changes in sugar levels can make you feel worse than you would otherwise do from the illness alone, delay recovery from the illness and in extreme cases can cause drowsiness, nausea and eventually coma.

Awareness of blood sugar levels when unwell is therefore something that can help avoid unnecessary illness and is thus encouraged (even if you don’t test much or at all) at other times. Suggested monitoring plans are listed below based upon the treatment of your diabetes.

Type 2 Diabetes, treated with diet (and/or tablets), little or no monitoring usually undertaken:

Occasional testing eg daily in the morning whilst unwell is sensible, with additional action if the blood sugar level when tested is above 15 or more than 1.5times your usual levels.

If you do not generally undertake glucose monitoring and/or do not have a meter or supplies to do so, it is sensible to discuss with your usual diabetes team provision of some if required ‘emergency’ testing equipment in the form of a box of test strips with a disposable meter in the lid of the box (Tru One testing strips) as this can provide reassurance in times of illness, or advance warning that usual treatment requires assistance.

Type 2 diabetes on stable treatment with tablets (and/or insulin) testing regularly (at least daily):

You should not stop testing, and if you notice sugar levels that are higher than usual you should look to test more often 2-4 times daily in the run up to food. If your blood sugar levels run more than 1.5times your normal level or if they are running >15mmol/L you should seek management advice from your usual care team (or if this has happened before discuss how to make adjustments when unwell in case of future illness at one of your routine visits.

Type 1 diabetes

When you are unwell, in addition to sugar levels rising, if there is inadequate insulin there is also a risk of ketone development. It is thus important to use regular monitoring to ensure you do not run short of insulin (you may require much more than usual).

You should therefore monitor at least 4 times a day whilst unwell (before each meal and before bed) and take corrective action with insulin doses if blood sugar levels are running higher than usual.

How to take such corrective action is something you should discuss as a routine at a visit when you are well and keep a record of the discussion (in the pouch with your meter!) so you don’t have to try and remember it all when you’re not feeling well.

If you have had problems with development of ketones (ketoacidosis) in the past you should discuss the option of monitoring for ketones when you’re not well (either in the urine or the blood) with your usual care team.