Illness Strategies for Insulin Users

First off, I am not sure this post is classified correctly.

  • List item Does anyone have any suggestions on BG control methods for when we get sick, such a flu/cold/etc.?

  • List item Is an increased temprate basal preferable to multiple boluses?

  • List item At what point in the cycle of an illness do BG values seem to stabilize? As we start to feel better?

  • List item Are the strategies the same for MDI and pumpers?

I apologize in advance for the questions, but I am now in the throes of my first major illness in a decade, and am woefully under-prepared with a dosing strategy.

I’m sorry you’re not feeling well!! That really sucks. I don’t get sick very often, but when I do, my strategy depends a little on what type of sickness I have.

Most illnesses raise your blood sugar level (as you clearly know), so it’s natural to want to increase your basal insulin temporarily (for the length of your illness). However, if you have a flu where you have a hard time keeping liquid and sugar down, you need to be really careful to not give yourself too much insulin and end up with a low blood sugar that you can’t treat.

For these kinds of flu bugs, it may be helpful to keep a sugar soda (sprite, ginger ale, etc.) or gatorade nearby that you can use in case your blood sugar drops low. Despite this risk of running low, you may still want to increase your basal insulin. Everyone is a little different, so it’s difficult to say by how much. I’d start low and see how that works out.

For a severe cold where you can still keep sugar down, I would definitely adjust my basal insulin on a pump.

I use MDI now, and I would probably not change my basal insulin while sick (but if the illness lingered I might consider it). I would do extra boluses as needed. I have to be pretty sick in order for me to require extra insulin. This rarely happens for me, so I would be willing to put up with a few days of extra boluses until the sickness clears.

I can’t say how long adjustments would be needed, and my guess is that this varies from person to person and by illness. If you’re using a temporarily increased basal on a pump, then once you start running low, you can back off the basal, and it shouldn’t be too difficult to stabilize after that.

I hope you start feeling better!!!


Thank you @Katers87! Sounds like a solid game plan. :slight_smile:


I used to get a stomach bug every winter, and pretty much followed these guidelines. You can print them out for easy reference:

They apply equally to MDI and pumping. If pumping, there’s usually no need to increase basal.

Sorry it’s in Canadian units:
4.0 mmol = 72 mg
16 mmol = 288 mg

Hope you feel better soon! There’s sure a lot of nasty bugs going around.


I wonder why they only recommend changing bolus. Seems like a basal adjustment would allow for much less oscillation than 1 dose every 4 hours of fast-acting.


I wondered the same. My old guidelines were from 2002. When I went online to see if they’d changed, I was surprised they hadn’t. My guess would be they’re thinking that if you’ve got gastrointestinal troubles and can’t keep much down or don’t feel like eating, it can be hard to keep from dropping low, so you’d want to keep your basal where it is and deal with highs and ketones with boluses.

That said, another Canadian hospital does recommend raising the basal:


It’s interesting that the recommendations vary by hospital. I’m sure that’s also very true within the U.S., but I thought Canada might be more standardized.

When I’m sick, I try really hard to keep my blood sugar in range because I think it might help my body fight off the infection faster.

On MDI, I can’t change my basal on an hourly basis, so it’d be hard to adjust it properly without risking running low. On a pump though, I think that’s a huge benefit. You can change your basal levels easily, they take effect in a short period of time, and they can be reversed within a short period of time. IMHO, this is a prime time to utilize that temp basal function and keep your blood sugar as in range as possible while sick.

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I am so sorry! I am on the road right now so unable to look up links and post easily :frowning:

Some considerations, many of which have already been listed:

  • After you have had to bolus 3 or so times in a 4-6 hour period, do consider raising your basal. With a mild virus, we often raise basal 50-80%, sometimes more, with a pump. On MDI, we were more careful, but often raised it 25-35%. Be ready to fight lows as you go back down though.

  • stay super well hydrated. It is all the more important since you will lose your CGM otherwise

  • if you start throwing up, the primary danger is going low, since you might not be able to keep sugars down. If so, the technique is:

    • every 5 minutes, takes a spoonful of sugard water

    • use (sugar-free) rehydrating liquids or powder to make it less likely to throw up again (pure water may make you throw up because of electrolyte balance)

  • remember to test for ketones frequently when you get above 250 or 300. When you get in ketone territory, you will likely need to up your correction factor. It is important to get out of ketone territory quickly.

You might be interested in this thread: BG management when sick: what I know now that I didn't know a year ago

Good luck!