TYPE 1 DIABETES - SICK DAY RULES

TYPE 1 DIABETES - SICK DAY RULES Information Leaflet Your Health. Our Priority.

of 6 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 Frequently passing urine Thirst 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 Never stop taking your insulin. You may require more insulin than normal even if not eating Monitor your blood glucose levels at least every 2-4 hours Monitor your blood ketone levels every 2-4 hours Use the table for advice on altering your insulin doses Drink plenty of non-sugary fluids (4-6 pints per day) between meals to avoid dehydration

of 6 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 you cannot keep drinking If you have persistent vomiting If you become drowsy 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 you continue to be unwell with elevated blood glucose levels for more than a day

of 6 If you do not carbohydrate count, follow the advice below: Blood Glucose Level <4mmol/l 4-11mmol/l 11-17mmol/l 17-22mmol/l >22mmol/l Quick Acting Mealtime Insulin Dose Treat as a hypo. If experiencing persistent episodes of hypoglycaemia contact your diabetes care provider for advice regarding reduction of your insulin doses. Take insulin as normal. Add 2 units to each mealtime insulin dose. Add 4 units to each mealtime insulin dose. 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 1.5-3mmol/l (and blood glucose level >11mmol/l) >3mmol/l (and blood glucose level >11mmol/l) Quick Acting Mealtime Insulin Dose Give 10% of usual total daily insulin dose every 2 hours in addition to usual mealtime insulin dose if eating 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. 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 more than a day. As your illness resolves adjust your insulin doses back to normal. NB If you use a pre-mixed insulin which you take twice daily contact your diabetes care provider for advice regarding adjustment of your insulin doses during illness.

of 6 Contact details Diabetes Specialist Nurses 1st Floor Kingsgate House Wellington Road North Stockport SK4 1LW Tel: 0161 426 5408 E-mail: snt-tr.diabetesteam@nhs.net

of 6 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: PCS@stockport.nhs.uk. 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. Leaflet number MED127 Publication date July 2015 Review date July 2017 Department Diabetes Location Kingsgate House, Stockport