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
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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