Winter woes: T1D and the flu


When the days grow shorter and the snow starts to fall, there’s no mistaking winter’s arrival. Most people look forward to this season filled with holidays, sledding, and hot chocolate, but there’s one aspect of winter that no one enjoys—the flu. Getting sick with a cold or the flu can sideline anyone, but when you have type 1 diabetes (T1D) it’s even harder to manage. Here are some common challenges and helpful solutions for battling cold and flu season this winter.

Challenge: Keeping blood-glucose in your target range

The biggest challenge when you’re under the weather is maintaining healthy blood-glucose levels. You may think that since you’re feeling crummy and have no appetite that you’ll have to watch for low blood-glucose levels. In fact, the opposite is true: when you’re sick, the body produces stress hormones that actually raise blood-glucose levels.

Solution: Eat regularly and check your blood glucose often

You may have no desire to dig into a big meal, but it’s important to at least nibble every few hours. Try to take in your normal number of calories by eating foods like crackers, soups, regular gelatin, and applesauce. And if solid foods are too hard to eat, try drinking liquids that contain carbohydrates like juice, sherbet, pudding, fruit-flavored yogurt, and broth. Aim for 50 grams of carbohydrates every three to four hours.

You’ll also need to monitor your blood-glucose levels more frequently than usual to stay in your target range. Experts suggest testing every two hours until you are feeling better. It’s important that you continue to take your insulin when you are ill. In fact, often you will have to increase the amount of insulin to counteract the infection in your body. Work with your healthcare team to develop a plan that covers how much extra insulin to take when you’re sick.

Challenge: Steering clear of complications

Excessively high blood-glucose levels can lead to a serious complication called diabetic ketoacidosis (DKA). This condition occurs when the sugar and carbohydrates ingested can’t enter the body’s cells. Instead, the body breaks down fat for energy and deposits toxic acids called ketones into the blood. Ketones poison the bloodstream and are a warning sign that your blood glucose is too high or that you are getting sick.

Solution: Test for ketones

If your blood glucose is over 240mg/dl, you need to test your urine or blood for ketones. The simplest way is to dip a ketone strip—available at your local pharmacy—into urine. If you have ketones, you will need to take quick- or rapid-acting insulin so your body can use the glucose in the blood for energy, rather than for burning fat. Ask your healthcare provider when and how you should test. Most physicians advise checking your urine for ketones every four to six hours, or if you exhibit any DKA symptoms.

Challenge: Avoiding dehydration

It’s easy to become dehydrated if you have a fever, are throwing up, or have diarrhea. When the body loses vital electrolytes such as potassium and sodium, they need to be replaced to avoid adverse effects like low blood pressure, dizziness, and unconsciousness.

Solution: Up your fluids

Try to drink at least one 8-ounce cup of fluid every hour. Soups, juices, and sports drinks are good sources of sodium and potassium. The type of fluid you drink will depend on your blood-glucose levels. If you are normal to low, you should drink regular soft drinks or some other drink with sugar. If your blood glucose is high, all you need is the fluid, so water or a diet drink is a far better choice. You may also need to take less insulin.

Challenge: Finding medications to manage symptoms

Over-the-counter (OTC) medications can be used to manage common flu symptoms like aches and pains, nasal congestion, or cough, but people with T1D need to make sure the medications don’t interfere with the effects of their insulin or oral diabetes medications. Some OTC medications, like acetaminophen or ibuprofen, can be toxic to people with T1D with liver and kidney problems.

Solution: Talk to your healthcare provider before you take medications

Many OTC medications can be perfectly safe for people with T1D to use, but you should always check with your healthcare provider. Before you buy any medication, also check the label for sugar—small doses with sugar are usually okay. You can ask your pharmacist or healthcare provider about sugar-free medicines, which are popular with many people with T1D.

Tackling cold and flu season is never easy. But if you’re extra vigilant about glucose testing, monitoring for ketones, and managing your symptoms, you’ll be okay, and the flu will be a minor annoyance—until, of course, next year’s flu season!


The information in this article is offered for general educational purposes and is not intended to replace professional medical advice. You should not make any changes to the management of type 1 diabetes without first consulting your physician or other qualified medical professional.


By Lindsey Bewley McCann