Type 1 Diabetes Sick Days: When to Skip Training
There are days when you are too unwell to train. With type 1 diabetes, deciding whether to exercise involves more than how you feel. Glucose, ketones, hydration and the illness itself also matter. A written sick-day plan gives you somewhere to start when those decisions become urgent.
Write the sick-day plan while you are well
In collaboration with the diabetes care team write down how often glucose will be checked, ketones checked, food & hydration strategies and any individual insulin recommendations. Having the instructions in one place can make decisions easier when you are tired or worried. If you do not have a plan, ask your team to help create it while you are well. Include whom to contact outside office hours. Your sick-day plan takes priority over the training schedule.
The ADA’s sick-day guidance emphasizes continuing basal insulin in people receiving intensive insulin treatment. Do not stop background insulin simply because you are eating less during illness. Adhere to your personalized recommendations regarding adjustment. If pump delivery is interrupted, use your established backup plan and contact the diabetes team rather than going without insulin.
Know when to postpone training
Delay in scheduling the day’s training will allow adherence to the sick-day plan and opportunity to recover. That above-the-neck guideline is inadequate consideration of glucose and ketones. Respiratory symptoms alone do not constitute clearance to perform physical activity. Mild symptoms do not automatically clear you to exercise; use the individualized sick-day guidance. Postpone training when experiencing nausea and/or vomiting, significant dehydration, serious illness or with ketones that call for stopping exercise under your individual plan. High glucose and ketone levels preclude participation in any exercise program. Ketones alone do not serve as justification for stopping insulin. Consult with your diabetes care team based on the ketone/sick day plan as directed and seek assistance per plan indications. Vigorous physical activity will not address hyperglycemia induced by illness.
Recognize symptoms that need urgent help
Seek emergency help for suspected diabetic ketoacidosis (DKA) symptoms such as vomiting with inability to retain liquids, shortness of breath, confusion or several alarming indicators simultaneously. The CDC’s DKA guidance explains warning signs and when to call 911 or go to the emergency department. Reach out to the diabetes care team in the event of escalating concerns. Do not delay emergency care while waiting for a routine appointment.
Prepare supplies and tolerable food
Keep a sick-day kit within easy reach. Ensure expiry dates haven’t passed for the test strips. Have emergency contacts for the diabetes care team readily available alongside medication and insulin supplies as needed. Keep familiar food and drink options you can tolerate and that fit your sick-day instructions. Not every drink source needs to be carbohydrate-free – that will depend upon intake, glucose readings and individual instructions.
A useful sick-day kit includes:
- Blood Glucose meter and testing materials
- Ketone-testing supplies
- Prescribed medications
- Delivery systems and related components
- The backup insulin-delivery supplies in your individual plan
Check the kit while you are well so missing supplies do not add another problem. Ask your team about alternatives if ordinary meals become difficult and how to coordinate food intake with insulin. Reduced appetite does not remove the need for individualized diabetes management.
Keep information that will help with a call
Record what you have been able to eat and drink, the glucose and ketone checks requested by your plan, and changing symptoms. If you use a pump, include any concern about the set or insulin delivery.
These details can make a call more useful. Illness, vomiting and interrupted delivery are different problems from an ordinary training-related glucose rise.
A hypothetical morning when training needs to wait
Imagine waking with fever, nausea and little appetite before a planned lifting session. Postpone training, review the sick-day instructions, gather the required monitoring information and contact the team when the plan calls for it. Someone unable to keep fluids down or having difficulty breathing needs urgent evaluation rather than another attempt to finish training. This example illustrates decisions, not a dose or universal testing schedule.
Return to training after recovery
Review whether symptoms and hydration have improved and ordinary food intake is manageable. Inform the coach of recent illness prior to initiating future sessions. Do not cram missed sessions into the first day back. Discuss readiness to resume with your diabetes team when needed.
Use the glucose and ketone guidance in the plan agreed with your diabetes team. The coach can help adapt the exercise workload.
Readiness to return is another decision, not automatic permission to resume the hardest session. Starting below the previous workload may be appropriate, with guidance from the coach and healthcare team.
Keep monitoring supplies accessible and note anything unexpected while re-establishing the routine. The aim is to recover and return to repeatable training, with the food, supplies and support that make it possible.
Read Strength Training With Type 1 Diabetes for the wider overview. For help organizing everyday food around training, contact Enigma Nutrition to ask about individualized nutrition care. For illness or urgent glucose concerns, use your diabetes team’s sick-day contact instructions and emergency services when indicated.