TYPE 1 DIABETES - SICK DAY RULES

TYPE 1 DIABETES -

SICK DAY RULES

Introduction

People with diabetes don’t get ill any more often than other people, but illness and infections tend to push up blood glucose and can often make you feel more unwell. This leaflet provides information on what to do when you are unwell and management of ketones.

When you are ill, your blood glucose levels tend to rise, even if you cannot eat or are being sick. However, occasionally your blood glucose levels may be low. Regular blood glucose

monitoring (at least every 2-4 hours) is essential.

Illness and ketone formation

Consistently elevated blood glucose levels can lead to a condition called diabetic ketoacidosis (DKA). This happens when a severe lack of insulin means the body cannot use glucose for energy, and the body starts to break down other body tissue as an alternative energy source. Ketones are the by-product of this process. Ketones are poisonous chemicals which build up and, if left unchecked, and will cause the body to become acidic – hence the name 'acidosis'. DKA is usually, but not always, accompanied by elevated blood glucose levels. It is therefore vital that you monitor for blood ketones regardless of your actual blood glucose level when unwell.

DKA is a life threatening emergency.

Symptoms of DKA

 Feeling tired and lethargic  Blurry vision

 Abdominal pain, nausea, vomiting

 Breathing changes (deep sighing breaths)  Smell of ketones (pear drops) on breath  Collapse / unconsciousness

If you suspect that you have DKA you should seek immediate medical advice or dial 999.

Sick day rules for people with type 1 diabetes

What to eat when you are unwell - General advice

When you are ill you may not want to eat. It may be easier to manage regular snacks and drinks rather than 3 main meals try:

 Ice cream, sugar free jelly and tinned fruit in natural juice  Soup

 Milk, milk puddings or milky drinks  Toast

 Cereal

 Plain biscuits

When to seek help

 If your breathing becomes deep and rapid  If you experience abdominal pain

 If your blood ketone level is elevated and continues to rise / fails to reduce despite corrective insulin doses

 If your blood ketone level is elevated but your blood glucose level is normal or low  If you have any other concerns

 If experiencing persistent episodes of hypoglycaemia

If any of the above apply, immediately seek medical advice from your diabetes care provider or dial 999.

How to alter your insulin dose/s

Blood ketone level less than 1.5mmol/l (you will need to adjust your insulin doses based on

your blood glucose level) and continue to check for blood ketones.

If you carbohydrate count:

 Use usual insulin:carbohydrate ratio if eating

 Use corrective insulin doses (these may need to be increased)

 You may need corrective doses of rapid acting insulin even if not eating

 Take your usual dose of basal insulin but you may consider an increase of 1-2 units if

If you do not carbohydrate count, follow the advice below:

Blood Glucose Level

Quick Acting Mealtime Insulin Dose

<4mmol/l Treat as a hypo. If experiencing persistent episodes of hypoglycaemia contact your diabetes care provider for advice regarding reduction of your insulin doses.

4-11mmol/l Take insulin as normal.

11-17mmol/l Add 2 units to each mealtime insulin dose. 17-22mmol/l Add 4 units to each mealtime insulin dose. >22mmol/l Add 6 units to each insulin dose.

General advice:

Continue to increase your insulin doses or use corrections until your blood glucose levels reduce.

If your blood glucose levels remain persistently low or persistently > 22mmol/l contact your diabetes care provider for advice.

Take your usual dose of basal insulin but you may consider an increase of 1-2 units if you continue to be unwell with elevated blood glucose levels for more than a day.

As your illness resolves adjust your insulin doses back to normal.

Blood ketone level more than 1.5mmol/l (you will need to adjust your insulin doses based on your blood ketone level):

Blood Ketone Level Quick Acting Mealtime Insulin Dose

1.5-3mmol/l (and blood glucose level >11mmol/l)

Give 10% of usual total daily insulin dose every 2 hours in addition to usual mealtime insulin dose if eating >3mmol/l (and blood glucose level

>11mmol/l)

Give 20% of usual total daily dose every 2 hours in addition to usual mealtime insulin dose if eating

If your blood ketone level remains elevated despite additional doses of insulin or you develop signs of DKA seek immediate medical advice or dial 999.

If your blood ketone level is elevated but your blood glucose level is normal or low seek medical advice.

Contact details

Kingsgate House Wellington Road North Stockport

SK4 1LW

Tel: 0161 426 5408

If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact:

Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: 0161 419 5678. Email: [email protected].

Our smoke free policy

Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more.