Sick days: what keeps going, what pauses

Being sick changes how your body handles insulin and how some of your other medicines act on your kidneys. This page explains what keeps going on a sick day, which medicines usually pause, what to have ready at home, and when to stop managing at home and get help.

What counts as a sick day

A sick day means vomiting, diarrhea, a fever, or not managing to eat and drink properly for about a day. Illness raises your insulin needs even when you're eating nothing — which is why the rule on the first page of this section matters most here: the doses may change, but the insulin does not stop.

What keeps going

What usually pauses while you're dehydrated

Some common medicines strain the kidneys when you're dry. Many people with type 1 take at least one of them, for blood pressure or kidney protection. The usual sick-day hold list:

• SGLT2 inhibitors
• ACE inhibitors and ARBs
• Diuretics (water pills)
• Metformin
• NSAIDs — ibuprofen, naproxen

The hold list is not universal. Someone with heart failure, for example, may be told to keep a diuretic going. That is why it needs to be personalised in advance. Ask your pharmacist to mark your own hold list on paper, before you are ever sick enough to need it.

The sick-day box

Have it ready before you need it. A written plan matters because judgement is harder when you're unwell — and the person reading it may be a parent or partner rather than you.

• Ketone strips, in date — check the expiry twice a year
• Fast sugar, and sugary drinks you can sip
• Something salty — broth or bouillon
• A thermometer
• Your team's number and their after-hours number
• Your written sick-day plan, on paper

When to stop managing at home

Your diabetes team can help you write a sick-day plan that fits your own insulin, your own medicines and your own kidneys. The best time to ask for one is on a day when you feel well.