People whose diabetes is under good metabolic control should not experience more illness or infection than people without diabetes. However, when any illness occurs in someone with diabetes, the potential for hyperglycemia, hyperglycemia with ketosis, hyperglycemia with ketoacidosis, or hypoglycemia exists and requires education and treatment to prevent exacerbation or even possible death. In some parts of the world where access to medical care, insulin, or parenteral fluids is problematic, the added metabolic stress of an illness in someone with diabetes can be life threatening. Many illnesses are associated with higher levels of stress hormones which promote gluconeogenesis and insulin resistance. Education about the effects of concurrent illness ("sick days") is a critical component of diabetes management and must be adapted to the educational abilities and treatment possibilities of the particular situations in different parts of the world.