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For anyone with diabetes who is unwell with fever, vomiting, loose motions or an infection.

Drawing: A thermometer, drinking water, a glucometer, your tablets, and a bowl of soup. — A thermometer, drinking water, a glucometer, your tablets, and a bowl of soup.

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Patient's name Date Doctor's number Call if sugar stays above (mg/dL)

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The five rules

Never stop your insulin, even if you are not eating. Illness usually pushes sugar up, and you may need more insulin. Long-acting insulin is needed every day. If you are not eating and your sugar is falling, mealtime or premixed insulin may need reducing: call your doctor.
Test more often. On insulin: every 2 to 4 hours, including at night. On tablets: at least 4 times a day.
Drink. A glass (about 200 ml) every hour while awake, unless your doctor has limited your fluids. Small sips every 15 minutes if you feel sick.
Keep some food going in. If you cannot eat meals, take a small amount every 1 to 2 hours. Any one of: half a glass of fruit juice, a glass of milk, a cup of soup, or two plain biscuits.
Pause the medicines in the table while you are vomiting, have loose motions or cannot drink.

Medicines to pause while you are losing fluid

Medicine	Why
Any medicine ending in -gliflozin (dapagliflozin, empagliflozin, remogliflozin and others, alone or in a combination tablet)	Can cause a dangerous acid build-up (ketoacidosis) during illness, even when the sugar reading is normal.
Metformin	Can build up if the kidneys are affected by dehydration.
Blood pressure tablets ending in -pril or -sartan, and tablets that make you pass more urine (such as furosemide or torsemide)	Can harm the kidneys when you are short of fluid.
Painkillers such as ibuprofen and diclofenac	The same reason. Use paracetamol instead.
Glimepiride, gliclazide and similar tablets	Can cause low sugar if you are not eating. Ask the doctor whether to reduce or skip.

Start them again 24 to 48 hours after you are eating and drinking normally. If you take a weekly injection for diabetes or weight and are vomiting, ask the doctor before the next dose.

Check ketones

If you have type 1 diabetes, are pregnant, or take a -gliflozin medicine, test for ketones whenever your sugar is above 250 mg/dL, you are vomiting, or you feel very unwell. Use a blood ketone meter or urine ketone strips.

Blood ketones (mmol/L)	Urine strip	What to do
Below 0.6	Negative	Normal. Keep testing.
0.6 to 1.5	Trace or +	Drink more. Test again in 2 hours.
1.6 to 2.9	++	Call your doctor now. You may need extra insulin.
3.0 or more	+++ or more	Emergency. Go to hospital.

Go to a hospital now if

You cannot keep fluids down, or have vomited more than 3 times in 24 hours
You have deep or fast breathing, pain in the stomach area, or unusual sleepiness
Your breath smells sweet or fruity
Your sugar stays very high: above 360 mg/dL, or above the number your doctor wrote above
Your ketones are 3.0 or more, or are rising
Your sugar is low and will not come up
You take a -gliflozin medicine and feel very unwell, even if your sugar is normal
You are pregnant and have ketones

Call 108 or go to the nearest hospital with an emergency department.

Questions about this sheet? Call Caspian Healthcare reception on +91 89193 41154. A doctor is on duty at all hours for problems that are not critical. Caspian has no emergency department: in an emergency call 108.

Where this comes from

Prepared by Caspian Healthcare from the sources above. Last reviewed October 2026. General information: your own doctor's written instructions come first.