Health Essentials from Cleveland Clinic

Whether you are sick or are just getting older, there are times in life when you don’t feel much like eating. If you’re eating fewer calories because you’ve lost your appetite, you’ll probably need to pay closer attention to your blood sugars and adjust your diabetes medications.

Here are some tips from the experts to help you manage your diabetes:

1. Stay hydrated

You can easily get dehydrated if you have fever, vomiting or diarrhea. Your main risk from dehydration is hyperglycemia (high blood sugar). Taking certain cold medications, skipping diabetes medications and eating food erratically can also sometimes lead to high blood sugar.

“When you’re ill, it’s very important to check your blood sugar regularly, continue to take medications on a schedule and drink fluids regularly,” says diabetes specialist Bartolome Burguera, MD.

If your blood sugar goes over 250, check your urine for keytones, which are produced when your body has difficulty processing blood sugar, and call your doctor, Dr. Burguera says.

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2. Change up your diet

When you’re not able to eat as much as normal or don’t have an appetite, meal replacement drinks are often helpful.

“Nutritional shakes formulated for people with diabetes have a moderate amount of carbohydrate, which is appropriate,” Dr. Burguera says. You can also make homemade meal-replacement shakes using:

• Frozen fruit
• A protein source (e.g., protein powder, Greek yogurt, peanut butter, tofu)
• Milk, soy milk or almond milk

“Noodle soups are also typically well tolerated and the noodles offer carbohydrates, which may help prevent low blood sugars,” he says.

3. Create a sick-day tool kit

Dr. Burguera suggests putting together a “sick-day diabetes tool kit” that includes things you can eat or drink when you aren’t feeling well. Your kit may include:

• Regular soda pop or juice (to prevent low blood sugars)
• Broth-based soups
• Gelatin (regular, not sugar-free)
• Water
• Electrolyte-supplemented beverages

“Some non-food items to include in your tool kit are extra blood-sugar monitoring supplies and a thermometer to check for a fever,” Dr. Burguera says.

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4. Make sure you’re monitoring

“In general, if you’re taking insulin at meals and long-acting insulin once a day, you should monitor your blood sugar four times per day — before each meal and before bed,” says Dr. Burguera.

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5. Talk to your doctor

Whether or not your doctor will adjust your diabetes medications when you don’t have much appetite depends on a couple of things:

• The type of medications you’re taking
• The extent to which your food intake has decreased

“If you’re taking long-acting insulin, which is typically given at bedtime, we usually recommend you continue with the same dose, as long-acting insulin is mainly responsible for insulin needs not related to food intake,” says registered dietician Dawn Noe.

If you’re taking insulin before meals (also called rapid-acting insulin, fast-acting insulin, or mealtime insulin) your doctor may need to reduce your dose, depending on what you’re eating at breakfast, lunch and dinner.

“If you skip a meal, skip the mealtime insulin,” says Ms. Noe.

Your doctor also may adjust your oral medication. Some diabetes medications, such as metformin, SGLT-2 inhibitors or DPP4- inhibitors, rarely cause low blood sugars and will likely not need adjusting.

“These medications usually bring down blood sugar from high to normal, but very rarely drop blood sugar too low,” Dr. Burguera says.

On the other hand, sulfonylureas or acarbose may cause your blood sugars to drop if you are eating less. “These medications should be adjusted based on blood-sugar readings,” he says.

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