Important: This article is general information about medication management. The guidance below summarizes FDA label and ADA guidelines, but your prescriber knows your specific situation. Always call your doctor or pharmacist when you're sick, especially if you take other diabetes medications alongside Jardiance.
Stop taking Jardiance if you have vomiting, diarrhea, fever, or can't keep food and fluids down. The FDA prescribing information tells doctors to withhold Jardiance in any temporary situation that could trigger ketoacidosis. Restart only after 24 to 48 hours of normal eating and drinking, with your doctor's sign-off.
Why Sick Days Are Different on Jardiance
Most blood pressure or cholesterol meds are forgiving when you have a stomach bug. Jardiance (empagliflozin) is not. It belongs to a class of diabetes drugs called SGLT2 inhibitors, and it carries a specific risk that lives in the FDA label warnings section: a serious complication called diabetic ketoacidosis (DKA) that can develop even when your blood sugar reads normal.
This is the catch. With most diabetes complications, the warning sign is a high glucose number. With Jardiance, you can be ketoacidotic with a glucose reading under 250 mg/dL, which is below the threshold that usually flags DKA in clinical practice. The condition has a name: euglycemic DKA, first described in detail in a 2015 Diabetes Care paper by Peters et al. After the FDA confirmed 73 reports of ketoacidosis in SGLT2-treated patients by December 2015, every SGLT2 inhibitor label was updated to flag this risk. The MedlinePlus patient guide for empagliflozin now tells patients to check for ketones if they feel sick even when their blood sugar reads under 250 mg/dL.
The American Diabetes Association's 2026 Standards of Care is clear: "SGLT2 inhibitors should be avoided in cases of severe illness, in people with ketonemia or ketonuria, and during prolonged fasting and surgical procedures." That's the rule. The rest of this article is the how.
| Symptom or Situation | What to Do With Jardiance |
|---|---|
| Vomiting (any) | Hold the dose |
| Diarrhea more than mild | Hold the dose |
| Fever and you can't keep fluids down | Hold the dose |
| Stomach flu lasting more than 12 hours | Hold the dose |
| Mild cold, you can eat and drink normally | Continue (check with your doctor) |
| Scheduled surgery or fasting longer than 12 hours | Hold for 3 days before |
| Strenuous exercise event without eating | Hold the day of |
| Severe dehydration or feeling faint | Hold and call your doctor |
| Confusion, abdominal pain, fast breathing | Hold and go to urgent care |
Notice what's not on this list: hold for a headache, hold for a single skipped meal, hold for ordinary fatigue. The rule is built around two specific triggers, dehydration and decreased food intake. Those are the conditions that combine with Jardiance to push the body into ketoacidosis.
Why Your Glucose Reading Isn't Reassurance
This is the part that catches people off guard.
When you take Jardiance, your kidneys flush extra glucose into your urine. That's how the drug lowers blood sugar. When you get sick and stop eating, two things happen at the same time. First, your insulin output drops because your body senses lower carb intake. Second, stress hormones like cortisol and glucagon rise. That combination tells your liver to break down fat for energy, which produces ketones as a byproduct.
In a person not on Jardiance, this process usually pushes glucose up and the high reading becomes the alarm. On Jardiance, the kidney keeps flushing glucose out, so your meter still shows a normal-looking number. Meanwhile, ketones climb. That's euglycemic DKA. The Goldenberg 2016 expert review in Clinical Therapeutics calls this the central reason sick day rules exist for SGLT2 drugs in the first place.
If you forget this, you can talk yourself out of going to the ER because "my sugar is fine." Don't.
Practical Steps During a Sick Day
1. Stop the next dose, then loop in your doctor
Skip your scheduled Jardiance dose at the first sign you can't keep food or fluids down, then call or message your prescriber so they know you're holding. There's no taper, no half dose. Hold. Jardiance has a 12.4-hour half-life per the FDA prescribing information, so the drug clears in about two to three days, but the ketoacidosis risk can linger while glucose handling rebalances.
The rule isn't the same for every diabetes drug in your routine. If you also take insulin, do not stop it without talking to your doctor. Insulin actually helps prevent ketone production. Hold your Jardiance and keep your insulin going. If you take metformin, that has its own sick day story tied to lactic acidosis that's different from this one.
2. Hydrate aggressively, in small sips
Plain water, oral rehydration solution, electrolyte drinks, or broth. Small frequent sips are easier to keep down than large gulps. Aim for steady intake even when you don't feel thirsty, because the drug has already been pulling fluid out through urine all day.
3. Eat carbs if you can
Even a few crackers, plain toast, applesauce, or sips of juice can reduce ketone production. The goal isn't a regular meal. It's enough carbohydrate to give your body something other than fat to burn.
4. Check glucose more often
If you check your sugar daily, switch to every 3 to 4 hours during illness. Per the ADA 2026 Standards of Care, tighter monitoring during illness is standard for anyone on SGLT2 therapy.
5. Check ketones if you have a meter
A blood beta-hydroxybutyrate reading is the gold standard. A urine ketone strip is a workable backup. A 2024 Cureus case review notes that a blood beta-hydroxybutyrate reading of 3 mmol/L or higher is a strong signal for euglycemic DKA, even when glucose looks normal. If you see that number or higher, call your doctor right away.
6. Know when to escalate
Go to urgent care or the ER if any of these show up: ongoing vomiting, fast or deep breathing, fruity breath odor, abdominal pain that won't quit, confusion, or a ketone meter reading above 3 mmol/L. These are euglycemic DKA red flags. Don't wait for your glucose to spike. It may never spike.
When and How to Restart
This is the part where people slip. After a sick day, you feel better and forget to ever resume your Jardiance. The drug is just gone from the routine. Months later, you realize you've been off it the whole time. A short illness can quietly turn into a permanent gap in adherence if there's no system to bring you back.
Per the Goldenberg 2016 review and ADA standards, the restart checklist is:
- 24 to 48 hours of normal eating and drinking.
- No vomiting or diarrhea.
- Fever has resolved.
- You feel rehydrated.
- Ketones are negative or trace (if you checked them).
- Your doctor or pharmacist confirms it's okay to restart.
When all six boxes are checked, take your next scheduled dose at the normal time. No double dose, no catch-up. Just resume.
For surgery or a procedure the rule is different. The ADA recommends holding Jardiance for 3 full days before surgery, and your surgical team will tell you when to restart.
How Pillo Helps
The hard part of sick day rules isn't the science. It's the schedule disruption. You skip Tuesday's dose, then Wednesday's. By Friday, when you're better, your routine has dissolved. The forgetting compounds.
Pillo's persistent reminders fit this pattern. You can pause your Jardiance alarm for the sick day period without losing the schedule. When you're ready to restart, one tap brings the alarm back online. The reminder keeps ringing until you take action, which is what you want after several days of "I'll get back to it tomorrow." Pillo also tracks your dose history, so when your doctor asks "when did you last take it," you have an actual answer instead of a guess.
If you want a tool that handles the restart problem after a sick day, download Pillo on Google Play.
Other Pillo articles you may find useful while on Jardiance: missed dose of Jardiance for forgotten doses, first week on Jardiance for startup side effects, forgot medication on vacation for travel disruptions, and vomited after taking medication for the general re-dose decision tree by drug class. It's also worth knowing which of your other meds you should not skip even on a sick day.
Frequently Asked Questions
Can you take Jardiance if you have a cold?
A mild cold where you can eat and drink normally is usually fine. Continue your dose unless your doctor says otherwise. The trigger for holding Jardiance is dehydration or inability to keep food and fluids down, not the cold virus itself. If your cold worsens to a fever you can't eat through, then hold the dose.
How long should you stop Jardiance when sick?
Hold Jardiance until you have completed 24 to 48 hours of normal eating and drinking with no vomiting, no diarrhea, and no fever. The exact window depends on how long the illness lasts. Some sick days are 24 hours, some are a week. There's no fixed duration. The restart criteria are about your symptoms, not a fixed clock.
Do you need to call your doctor every time you hold Jardiance?
Not for routine short illnesses where you follow the standard sick day rules and recover quickly. Call your doctor if any of these happen: vomiting more than twice, illness lasting more than 24 hours, abdominal pain, fast or deep breathing, confusion, or ketone readings above 3 mmol/L. Also call if you're unsure whether your situation qualifies as a "sick day."
Can you check ketones at home while on Jardiance?
Yes, and the ADA 2026 Standards of Care explicitly recommend that people on SGLT2 inhibitors have access to ketone testing tools. Blood beta-hydroxybutyrate meters are the most accurate option. Urine ketone strips work as a backup. If your home test shows ketones rising while you're sick, that's a reason to escalate, regardless of your glucose number.
Should you restart Jardiance at a lower dose after a sick day?
In most cases you resume at your normal dose once the restart criteria are met. There's no built-in taper. The exception is if your doctor has told you to adjust based on a specific situation, such as a recent change in kidney function or a long illness. If you're unsure, call your prescriber before restarting.
What if you skip Jardiance for a week, do you need to start over?
A week off Jardiance does not require a new titration in most patients. Resume at your normal dose once the restart criteria are met. Your A1C may drift slightly during the off period, but you don't need to "build back up." If you've been off for longer than two weeks, check with your prescriber before restarting because they may want to verify your kidney function first.
This article provides general information about medication management and is not a substitute for professional medical advice. Always consult your doctor or pharmacist before making changes to your medication schedule.
