If you have diabetes you know that getting sick (even a cold or flu) can trigger a rise in blood glucose levels. Here are nine steps to help you take control of your blood glucose levels if you get sick this winter.

People with diabetes must be especially careful when suffering from an illness like a cold or the flu. Illness not only affects your eating, sleeping, and exercise, it may cause the liver to make and release glucose into the bloodstream. This increase in glucose provides extra energy to combat the stress of an illness, but in people with diabetes it can cause blood glucose to rise too high, whether or not you are eating.

At the same time, an illness decreases the sensitivity of cells to insulin and makes it more difficult for these cells to remove glucose from the bloodstream. To minimize fluctuations in blood glucose levels, follow these sick-day precautions.

1. Inform your health care professional when you become sick. This precaution is particularly important if you are unable to eat regular foods, have diarrhea or vomiting for more than six hours, or have had a fever for a couple of days.
2. Follow the treatment plan for the sickness. For example, take any necessary medications, such as antibiotics for an infection, according to schedule.
3. Test blood glucose levels more often than usual. If you have type 1 diabetes, test blood glucose and urine ketone levels every four hours, even during the night. If you have type 2 diabetes, testing blood glucose levels four times during the day is probably enough; if blood glucose levels exceed 250 mg/dL, test urine for ketones. Call your health care professional if blood glucose levels are consistently above 250 mg/dL and are accompanied by ketones in the urine.
4. Take your diabetes medication as usual,unless, of course, your health professional advises otherwise. Being sick causes blood glucose levels to rise, even if you are not eating.
5. If you use insulin, keep a bottle of rapid- or very rapid-acting insulin handy. You should take this precaution even if you do not take these types of insulin regularly.
6. Watch for any symptoms of dehydration, ketoacidosis, or hyperosmolar nonketotic state (extremely high blood glucose levels in people with type 2 diabetes). The symptoms of dehydration include dry mouth, cracked lips, and dry or flushed skin. Ketoacidosis symptoms include nausea, vomiting, and lack of appetite, while hyperosmolar nonketotic state is characterized by increased hunger, nausea, or stomach pain.
7. Prevent dehydration by drinking plenty of liquids. You should consume at least one large (8 oz.) glass of clear fluid each hour while awake.
8. Try to consume a normal amount of carbohydrates. Eating many small portions throughout the day may help. Eat easy-to-digest foods such as gelatin, crackers, soup, and applesauce.
9. Rest as much as possible. If necessary, get someone -- such as a family member or friend -- to help care for you.