How can you stay well when you get sick? This may sound like a trick question, but if you have diabetes and get sick, it places your body under added stress. Your blood glucose may be harder to control. This can lead to ketoacidosis and diabetic coma if you have type 1 diabetes. People with type 2 diabetes—especially seniors—may be at risk for a similar condition. These dangerous and life-threatening problems can be avoided most of the time by following five steps.

1. Know how to care for yourself on sick days.

Work with your diabetes care team ahead of time to be sure you know what to do the next time you get sick. Write down your plan and share it with your family members and caregivers. You most likely have a diabetes care routine for when you are well. When you get sick, check your blood glucose every 3-4 hours. If you have type 1 diabetes, check your urine ketones at the same time. If you have type 2 diabetes, ask your health care team if you need to check for ketones when you are ill, and keep the strips on hand.

Work with your health care team when you are well on designing a plan to adjust your medicines, and create a sick-day meal plan. Some medicines, including those sold over the counter, can affect your blood glucose levels. Talk with your pharmacist or health care provider for guidance. Read all labels carefully. Avoid medicines that say they are not safe for people with diabetes or that have sugar or alcohol.

2. Know when to call your health care provider.

• Sometimes when we get sick, we don’t want to admit it. We think we can tough it out. We may not want to bother our health care providers because we think they are too busy. But, that may not be in your best interest if you have diabetes.

• Call your health care provider if you have been sick for 1 or 2 days without getting better.

• If you have a fever for more than a day or you have been vomiting or have had diarrhea for more than 6 hours, call your health care provider for instructions.

• Moderate to large amounts of ketones in your urine may be a danger sign your blood glucose is too high.

• If your blood glucose is above 250, even though you may be taking extra insulin based on your sick-day plan, call your health care provider.

• If you take medicine to manage your diabetes, and your blood glucose level rises to more than 250 and stays there for more than a day, it’s time to call your health care provider for further instructions.

• If you have symptoms that are early signs of ketoacidosis or dehydration (i.e. chest pain, difficulty breathing, fruity-smelling breath, abdominal pain, dry or cracked lips or tongue) or you are not sure how to care for yourself, call your health care provider right away. If your family notices you are groggy or confused, they need to take you to the emergency room or call 911.

3. Know how to contact your diabetes care team.

Keep the names and phone numbers of your diabetes team members where they can be easily found. Include how to reach them on days, nights, weekends and holidays.

4. Know what to tell your diabetes care team when you make the call.

Calling your health care provider can sometimes be a stressful experience in itself. They often have limited time, or you have to relay information through the office staff. Make a list of your key discussion points and have it in front of you when you make the call. Your health care provider will ask what you have been doing to care for yourself so far. It will help to keep a log from the start of your illness of the medicines you have taken, how much you have taken, how long you have been sick, your food intake, any loss of appetite, nausea, vomiting, weight loss, temperature, blood glucose level and urine ketone levels. Key behaviors are important, too. Are you sleepier than usual or more irritable?

5. Emergency room tips.

If you have to go to an emergency room, make sure you or your family members tell the staff you have diabetes. Let them know the full list of the medicines you take and have taken for your illness, including prescription, nonprescription and herbal products. Have your diabetes identification in full view.

The most important thing you can do is plan ahead, especially during cold and flu season. These five steps can help you stay well the next time you get sick.