This guide will help you answer 6.2 Outline how treatment for diabetes may be required to change in response to intercurrent illness.
Diabetes is a long-term condition that affects blood glucose levels. People with diabetes need to carefully manage their blood sugar each day. When someone with diabetes develops an intercurrent illness the balance of blood glucose can become more difficult. An intercurrent illness is any additional short-term condition or infection that comes up while someone is living with diabetes. Common examples include flu, a cold, chest infection, urinary tract infection, vomiting or diarrhoea, and even minor infections such as a tooth abscess.
These illnesses can put extra strain on the body. Even a minor illness can affect the body’s normal response to insulin and medication. The risk of very high or very low blood sugar rises when the body is unwell, so it is important for both the person and their support team to recognise the need for changes in diabetes treatment during this time.
How Intercurrent Illness Affects Blood Glucose
When someone with diabetes is unwell, physical stress and infection cause the body to release stress hormones, such as cortisol and adrenaline. These hormones make it harder for insulin to work and cause the liver to release more glucose into the blood. This often leads to higher than expected blood sugar readings. In some illnesses, especially vomiting or diarrhoea, blood sugar may drop too low if food cannot be kept down.
This means that treatment plans that work on ‘normal’ days often do not work in the same way when a person is ill.
Key points:
- Stress hormones make blood sugar control more difficult during illness
- Blood sugars can rise or fall depending on the illness and ability to eat
- Normal routines, such as medication and meals, may be disturbed
Why Treatment Changes May Be Needed
During an intercurrent illness, diabetes management often has to change to keep the person safe.
Main reasons for change:
- Illness can increase insulin needs, even if a person is eating less
- Some illnesses stop a person from eating, which increases the risk of low blood sugar
- Symptoms like vomiting, diarrhoea, and fever can lead to dehydration, which is dangerous for anyone but especially people with diabetes
If the person does not adjust their diabetes treatment, they risk both short- and long-term problems such as diabetic ketoacidosis (DKA), hypoglycaemia, or hyperosmolar hyperglycaemic state (HHS).
General Principles for Managing Diabetes During an Illness
When a person with diabetes becomes unwell, their treatment plan should be reviewed and adjusted.
Key steps include:
- Checking blood sugar more often than usual, as the person’s sick day plan advises
- Taking diabetes medicines as set out in the person’s sick day plan or as their diabetes team advises
- Changing insulin or other medicines only as set out in the person’s plan or as advised by their diabetes team; support workers should not change doses unless this is in the care plan and they are trained and authorised
- Keeping hydrated with sugar-free fluids
- Eating small amounts regularly, even if appetite is poor
This approach can help reduce the risk of complications.
Monitoring Blood Glucose and Ketones
Frequent monitoring of blood sugar is vital during illness. Blood sugar can swing much more than usual, so sticking to normal routines or usual testing patterns can put health at risk.
Key points about monitoring:
- Test blood sugar more often than usual, as set out in the person’s sick day plan
- Watch for high blood sugars (hyperglycaemia): act as set out in the person’s plan, and contact the diabetes team if unsure
- Watch for low blood sugars (hypoglycaemia): this can happen if the person cannot eat
- People at risk of diabetic ketoacidosis should test for ketones when their blood sugar is high and when they are ill, as their diabetes care team has advised
- Keep a record of readings for health professionals
Ketones are acidic chemicals produced when the body burns fat for fuel, often when there is not enough insulin. Ketone results need acting on according to their level, and the person’s diabetes care team will advise which levels to look for. High ketones, or symptoms of diabetic ketoacidosis (DKA), are an emergency: call 999 or go to A&E. See the NHS information on diabetic ketoacidosis.
Changing Medication and Insulin Doses
One of the most common changes during illness is an adjustment in diabetes medication, especially insulin. Illness usually increases the body’s need for insulin.
Points to consider when changing doses include:
- Whether extra insulin is needed is decided under the person’s own sick day plan or with their diabetes team (see the NHS guidance on living with type 1 diabetes)
- Some diabetes medicines may need to be paused when someone is ill and at risk of dehydration, so ask the diabetes team, GP or pharmacist rather than guessing
Insulin should not be stopped during illness, even if the person is not eating, unless their diabetes team has told them to (see the NHS information on diabetic ketoacidosis). Stopping insulin can lead to dangerous blood sugar levels and the risk of ketoacidosis.
Managing Food and Fluid Intake During Illness
Illness often affects appetite. Vomiting, nausea, and diarrhoea make it difficult to eat and drink normally. It is important to avoid both dehydration and low blood sugar.
Suggestions include:
- Sip fluids regularly, following the advice in the person’s sick day plan
- If the person cannot eat normally, follow the food and drink advice in their sick day plan or ask their diabetes team
- For people at risk of low blood sugar, keep glucose tablets or sugary drinks to hand in case of hypoglycaemia
- If unable to keep foods or fluids down, medical advice is needed, especially for people who take insulin, as serious complications can develop quickly
Sick Day Rules for Diabetes
Most diabetes care teams provide ‘sick day rules’ for times of illness. These are simple steps to follow to prevent problems and keep blood sugar under control.
Main elements of sick day rules:
- Never stop taking insulin: dose may need to go up or down but should not be missed
- Test blood sugar more regularly
- Check ketones if feeling unwell or if blood sugar is high, as the person’s plan advises (see the NHS information on diabetic ketoacidosis)
- Keep drinking fluids even if unable to eat usual meals
- Contact the diabetes team or GP if:
- Blood sugar stays high and the person’s insulin treatment is not bringing it down
- There are moderate or high ketones
- Vomiting continues
- There are signs of dehydration
These rules help the person and caregivers know when to increase monitoring or call for help.
Recognising and Preventing Complications
There is a higher chance of complications during illness for people with diabetes. The two most concerning problems are:
1. Diabetic Ketoacidosis (DKA):
This happens mostly to people with type 1 diabetes and is triggered by lack of insulin. Fat is used for energy, producing acidic ketones which lead to dehydration and a dangerous rise in blood acids.
Early signs:
- High blood sugar
- Ketones in blood or urine
- Nausea, vomiting, abdominal pain
- Rapid breathing, confusion
2. Hyperosmolar Hyperglycaemic State (HHS):
This mostly affects people with type 2 diabetes and happens during prolonged high blood sugar and severe dehydration.
Early signs:
- Confusion, drowsiness
- Very concentrated urine, little urine output
- Rapid breathing
Both are medical emergencies. Quick action can save lives: call 999 or go to A&E if DKA is suspected, and follow the person’s sick day plan.
When to Seek Medical Help
Not every illness can be safely managed at home. It is important to ask for help from the GP, diabetes nurse, or NHS 111 if:
- The person cannot eat or drink and is becoming weaker
- Vomiting or diarrhoea lasts more than a few hours
- Blood sugar remains high after extra insulin doses
- Ketones are present: follow the ketone action levels in the person’s plan, and call 999 or go to A&E if ketones are high or DKA symptoms develop
- The person becomes confused, very sleepy, or is struggling to breathe: this is an emergency, so call 999 or go to A&E (see the NHS information on diabetic ketoacidosis)
Support workers should encourage the person to keep their sick day information close, and know who to call for help.
Supporting People with Diabetes During Intercurrent Illness
Support from care staff can make a big difference to the outcome during a period of illness.
Ways to help:
- Encourage regular blood sugar checks and help record the results
- Help the person to take their medication correctly and at the right times
- Prepare suitable foods and offer fluids often
- Watch for changes in behaviour or warning signs of complications
- Support the person in contacting their nurse or GP if needed
- Listen to the person’s concerns: illness can be stressful and frightening
Any worker supporting a person with diabetes should know the basics of sick day rules and the main warning signs that mean urgent help is needed.
Adjustments for Different Types of Diabetes
People manage diabetes in different ways and the changes needed during illness depend on their usual treatment.
- People with Type 1 diabetes: Always need extra care, as insulin is essential for survival. Danger of DKA and insulin must always be continued
- People with Type 2 diabetes on tablets: Follow the person’s sick day plan, as what needs to change depends on their treatment. Blood sugar may need to be checked more often
- People with Type 2 diabetes on insulin: May need higher insulin doses during an illness, with more careful monitoring for low or high blood sugar
- People using insulin pumps: Extra attention needed: follow the plan from the person’s pump or diabetes team
Care support should always be based on the advice given by the diabetes team or the person’s own sick day plan.
Role of Health and Social Care Workers
Workers play a key role during periods of illness by:
- Reducing anxiety, helping the person feel safe
- Spotting early signs that blood sugar is out of control
- Making changes promptly, such as helping with drinks, meals, or medication
- Recording all observations accurately
- Monitoring for side effects of medicines or signs of complications
- Working with other professionals to keep the person well
- Respecting the person’s right to make choices about their own care
A well-informed worker can pick up subtle signs that would be lost in a busy setting, and help prevent emergency hospital admission.
Diabetes and Other Medications
When someone with diabetes is ill, other prescribed or over-the-counter medications may affect their glucose control.
Examples include:
- Some medicines can affect blood sugar, so tell the GP, diabetes team or pharmacist about any new medicine
- Antiemetics (drugs for sickness): Can be needed so that food or drink can be kept down
It is important to tell the GP or pharmacist if a person with diabetes needs any new medicines during illness.
Care Planning and Communication
A good support plan for someone with diabetes will include specific instructions for managing illness. This plan should be kept up to date and reviewed after any illness episode.
Features include:
- Contact numbers for diabetes professionals
- Clear guidance on sick day rules
- How to record blood sugar and ketone monitoring results
- Steps for recognising when help is needed
- Instructions about medication changes during illness
- Space for workers to record observations and actions taken
Good communication within the team makes sure that everyone knows what action to take if the person becomes unwell.
Final Thoughts
Managing diabetes during an intercurrent illness needs flexibility, attention, and good teamwork. The approach is always based on the individual’s needs, with the aim of preventing complications and making sure the person feels cared for and safe.
Care workers have a responsibility to notice changes, listen to the person, and act quickly when blood sugar control is disrupted by illness. By encouraging self-care, following sick day rules, and knowing when to call for help, you play a vital part in keeping people healthy and comfortable during times of illness.
Staying up to date with guidelines provided by healthcare professionals, and supporting the person to communicate their needs, helps avoid serious problems and supports recovery. Frequent, kind reminders and practical help can make illness less frightening and help people with diabetes feel much more in control.