Keeping Your Diabetes Under Control
on Days When You Can’t Follow Your Meal Plan

What about you?

Do you know how to use foods and drinks to control your blood glucose on days you can't follow your meal plan?

 Yes     No      If yes, what do you do?

What do you do when a meal or snack will be delayed or missed?

Do you keep foods, drinks, and supplies in several places for times when you can't eat a meal?

 Yes     No      If yes, what place?

Why learn what to do when you can't eat?

• Some days you just can't follow your meal plan.
• Delayed meals and snacks, an unexpected change of plans, or an emergency can happen any time - you need to be prepared.
• Flu and other minor illnesses can become major problems if you do not know how to keep your diabetes under control.
• You need to know what to do if you have surgery, dental work, or other medical procedures.

What will you learn?

• What's different about these situations when you have diabetes.
• What to do when a meal or snack is delayed or when you are ill.
• How to count the carbohydrate in foods and drinks when you can't follow your food plan.
• When to call your health care team, and what to tell them.
• How to prepare for sick days and emergencies.

Diabetes is different

• If you use insulin injections or diabetes pills, you need to know how to control your blood glucose when you can't eat.
• Your blood glucose often goes up when you are ill or have an infection. This is because your body is under stress, not because you ate too much.
• Anyone can get dehydrated when he or she has a fever, vomiting, or diarrhea. You are even more likely to get dehydrated if you have diabetes and your blood glucose is high. Your kidneys work to get rid of the extra glucose in your blood and you make more urine than usual.
• Over-the-counter medicines may affect your diabetes. Check with your pharmacist or health care team before you take any medicine.

When you can't eat on time

• Eat or drink something with 15 grams (g) carbohydrate for every hour your meal or snack is delayed. The chart on the next page gives examples of foods with 15g carbohydrate.
• If your meal and/or snack are delayed more than one hour, you may need to adjust your food plan and diabetes pills or insulin. Ask your educator for guidelines.

What to do when you are ill

• Take your usual dose of insulin or diabetes pills, even if you can't eat.
• Check your blood glucose more often - every one to four hours.
• If you inject insulin, check your urine for ketones every time you go to the bathroom. Ask your educator how much extra insulin you should use when your blood glucose and urine ketones are high.
• Drink plenty of fluids - four to six ounces (oz.) every hour for adults and two to four oz. every hour for children.
• If you can't follow your food plan, try to eat foods or drinks with the same amount of carbohydrate as your food plan. If you use exchanges, have 15 grams of carbohydrate for each starch, fruit, milk, or other carbohydrate exchange (including starch, fruit, and milk). If you can't eat at your usual meal and snack times, have 15g carbohydrate every hour.
• It's OK to use sugar-sweetened foods and drinks. The main goal is to feed your body easy-to-eat foods to keep your blood glucose under control.
• Sip on clear liquids, like apple juice, sports drinks, or regular soda, if you can't keep anything else down.
• Keep your health care provider's number near in case you need it in a hurry.

Foods with 15 grams carbohydrate

• ½ cup fruit juice or regular soda
• ½ cup unsweetened applesauce or ice cream
• 1 cup milk or sugar-free yogurt
• 1 cup sports drink
• 12 pretzels
• 1 small frozen juice bar (3 oz)
• 3 graham crackers
• 1 small piece of fruit
• 6 saltines
• ½ cup regular jello

When to call your health care team

• Ill for one or two days and are not getting better.
• Moderate to large amounts of ketones in your urine.
• Take diabetes pills and blood glucose before meals is above 240 mg/dl.
• Using insulin and blood glucose is over 240 mg/dl, even after extra insulin.
• Blood glucose is less than 60 mg/dl.
• Dehydrated or having trouble thinking or breathing.
• Vomiting or diarrhea for more than eight hours.

What to tell your health care team

• Your blood glucose and urine ketone results.
• How much and what type of insulin or diabetes pills you have taken and at what time.
• Other medicines you have taken.
• How long you've been sick.
• Your temperature.
• What you have eaten and drunk and if you have vomiting or diarrhea.
• If you have lost weight while sick (a sign of dehydration).

An ounce of prevention

• Make sure you have blood glucose testing strips, urine ketone testing strips, and a fever thermometer. Have them ready to take on vacation and use for emergencies.
• Carry an emergency supply of snacks, such as individual packages of crackers and cheese or peanut butter, canned meals, ready-to-eat instant breakfast, fruit juice or glucose tablets.
• Ask your health care team what to do if you have surgery or tests and are told not to eat for several hours before the test.

The above information is reprinted by permission of: American Diabetes Association and American Dietetic Association.