Sick day rules for people on insulin

When you are ill: Sick day information

People with diabetes do not get more illness compared to people without diabetes. However, if you are feeling unwell you will need to take special care as illnesses such as ‘flu or a tummy bug can cause your blood sugar (glucose) level to rise. This can happen even if you are unable to eat or if you are vomiting.

What should I do if I am unwell?

Your body’s natural response to illness is to make more sugar. Often this means that you will need to take a higher dose of insulin than usual, rather than cutting the dose or not taking any insulin. Reducing your insulin dose or stopping it altogether can lead to serious problems and might cause a condition called Diabetic Ketoacidosis, which can be fatal in some people (see later).

THE FIRST RULE IS:

NEVER STOP

TAKING YOUR INSULIN

Blood sugars can rise even if you do not eat.

You will need more insulin if your blood sugar goes higher than 10 or if you have ketones in your urine or blood (see below for how much insulin to take)

WHAT ELSE DO I NEED TO DO?

Test your blood sugar more often than usual

Check this every 2 to 4 hours.
If you cannot do this yourself, ask a relative or friend to help

Test your urine or blood for ketones regularly

Use “Ketostix” to test your urine - your diabetes nurse specialist will show you how to use them.
Use a meter to test for blood ketones if you have one (MediSense Optium meters can do this)
Check for ketones every 2 to 4 hours
If you have ketones it is likely that you are lacking in insulin. If you ignore this, then ketoacidosis may develop (see below). Drink plenty of fluids
You can easily become dehydrated when you are ill, especially if you have a temperature or have diarrhoea or vomiting
Take at least five pints of sugar free liquids, especially water, a day.
This is approximately one glass every hour
If you cannot manage a whole glass at once, take regular sips of water

Try to eat your normal diet

If you are unable to do this, replace your meals with sugary fluids such as milk, fresh fruit juice, soup, lucozade or ordinary cola - see below.
Take around 10g Carbohydrate every hour if you can

Each of these contains 10 grams carbohydrate.

Milk 1 cup (200ml)

Fruit Juice (unsweetened) 1 small glass (100ml).

Lucozade 50mls

Coca Cola (not diet) 150mls

Lemonade(fizzy/sweetened) 150mls

Ice cream 1 briquette or 1 scoop

Jelly(ordinary) 2 tablespoons

Yoghurt(fruit) ½ small carton (60gms)

Yoghurt(plain) 1 small carton (120gms)

How much insulin should I take?

If blood sugar is less than 10 mmol/L, take you usual insulin dose and remember to check your urine or blood for ketones.
If you are still unwell check your blood sugar every 2-4 hours until you are feeling better and eating and drinking normally.
If your blood sugar is higher than this, take extra insulin - see below. Remember to test again after 2-4 hours to see if this has worked.
Always check for ketones if blood sugars are increasing

Blood sugar level (mmol/L)	What to do
10 - 16.9	Take an extra 2-4 units of fast acting insulin (e.g. Actrapid, Velosulin, Humulin S)
17 -28	Take an extra 4-6 units of fast acting insulin (e.g. Actrapid, Velosulin, Humulin S)
Over 28	Speak to your Diabetes Team or GP

YOU MAY NEED TO BE ADMITTED TO HOSPITAL. CONTACT YOUR GP OR DIABETES SPECIALIST NURSE IF ANY OF THE FOLLOWING HAPPENS:

Unable to swallow or keep fluids down
Persistent vomiting
Persistent diarrhoea
Very high blood sugars (over 28 mmol/L) in spite of taking extra insulin
Persistently high levels of ketones in the blood or urine in spite of taking extra insulin
If you develop abdominal pain, become short of breath or drowsy

DIABETIC KETOACIDOSIS (DKA)

The symptoms of ketoacidosis are thirst and passing large amounts of urine, followed by abdominal pain, sickness, vomiting, drowsiness and heavy laboured breathing.

It is very important to prevent DKA happening. Never miss out insulin injections especially when you are unwell. If DKA develops, it must be recognised and treated quickly.

Ketoacidosis is a serious condition and may even cause death. You must seek medical help if you develop the symptoms of DKA.

Contact Your diabetes specialist nurse or GP if:

You are vomitting, not imrpoving or becoming drowsy, your blood suagr stays high even after treatment or it is low, you are unsure of how much insulin or fluid to take, you are worried and need advice.

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