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Sick Day Guidelines for Patients with Type 1 Diabetes HF#4505

Any type of illness can raise blood sugar.  You may think that your blood sugar will be low because you are not able to eat or drink. When you’re sick, stress hormones are produced in the body, which raise blood sugar.  Therefore, your blood sugar level may be high when you are ill even without eating.  Blood sugar levels may become hard to control and lead to diabetic ketoacidosis or DKA.

 

Diabetic Ketoacidosis or DKA

DKA comes from not having enough insulin in the body.  It can be life-threatening.  When you are sick, it often develops quickly.  It can even happen within a few hours.  When you do not have enough insulin, the body burns fat for energy.  This breakdown of fat produces ketones (an acid).  DKA can occur when high levels of ketones build up in the blood.  If not treated, it can lead to coma and death.

 

Causes of High Blood Sugars

  • Any illness, infection, surgery
  • Missed or skipped insulin shots
  • Physical or emotional stress
  • Some medicines may increase blood sugar levels

 

Warning Signs and Symptoms

Symptoms of high blood sugars are early warning signs of DKA.  Be careful! Signs and symptoms of DKA are often the same as the flu.  If you live alone, you should tell a family member or close friend that you are ill and have them call to check on you several times each day.

 

 

Signs and Symptoms of High Blood Sugars

  • Increased thirst
  • Increased urination
  • Fatigue
  • Weight loss
  • Dehydration 


Signs and Symptoms of DKA

  • Nausea or vomiting
  • Abdominal pain
  • Rapid, labored breathing
  • Fruity odor to the breath
  • Severe dehydration

 

Monitor More Often

 

___ Check your blood sugar every 2 hours.

 

___ Check your urine for ketones every two hours when you check your blood sugars. 

___ Keep a supply of foil-wrapped ketostix at home so you have them when you are sick.

 

Adjust Insulin Doses

 

Always take your insulin when you are sick to avoid DKA.  Your doses may change when you are sick.  See the tables below to learn more.

 

Guidelines When Not Eating

 

Types of Insulin You Take

Doses To Take When Sick and Not Eating

 

NPH

  • Take ½ dose of NPH

Levemir® (detemir)
  • Take usual dose of Levemir®

Lantus® (glargine)

  • Take usual dose of Lantus® (glargine)

Regular
  • Take Regular insulin every 4 hours using chart below after checking your blood sugar, even through the night.

Novolog®, Apidra®, Humalog®
  • Take Novolog® Apidra®, or Humalog® insulin every 2 hours using the chart below after checking your blood sugar, even through the night.

 

Guidelines When Eating

 

Take your usual dose of basal insulin (NPH, Levemir®, or Lantus® ).  Keep taking your Regular, Humalog®, Apidra®, or Novolog® to cover your meals.  Add extra using the chart below if your blood sugars are 120 mg/dl or higher.

  

Correction Insulin Chart



Blood Sugar

Regular, Humalog or Novolog Insulin

Less than 120

no insulin, but recheck blood sugar in 2 hours

120 – 170

1 units

171 – 220

2 units

221 – 270

3 units

271—320

4 units

321 – 370

5 units

greater than 370

6 units and call doctor or health care provider

 

DKA Prevention

To prevent DKA follow these guidelines when you are sick.

  • Monitor more often
  • Adjust your insulin doses
  • Prevent dehydration

 

Nutrition Guidelines

 

Prevent dehydration

  • Drink water and other liquids.
  • Take small amounts of fluid every 10 minutes (8 ounces per hour is best). 
  • With vomiting and diarrhea, your body loses electrolytes like potassium and sodium.  Replace these losses with bouillon, soups, sports drinks, and juices.

 

If you cannot eat your normal meals, replace carbohydrates with foods that have sugar.  These foods must have sugar (regardless of your blood sugar level) to prevent the breakdown of your fat into ketones which leads to ketoacidosis.

 

  • Non-diet soda
  • Jell-O
  • Pudding
  • Juices
  • Popsicles
  • Sports drinks
  • Cooked cereals
  • Soups or bouillon
  • Crackers or toast
  • Sherbet or ice cream

 

Hint: Sodas that are warm and flat are better tolerated than cold, carbonated sodas. 

 

When To Call Your Health Care Provider  

 

  • If your blood sugar is greater than 250 mg/dl and you have moderate to large urine ketones.
  • If you have symptoms of ketoacidosis and are unable to control your blood sugar.
  • If your health care provider is not available, go to the nearest Emergency Room.
  • Do not delay treatment.  Ketoacidosis needs to be treated right away.  This can be a life-threatening condition.

 

When I call, what information should I have ready?

  • How long you have been sick
  • Current symptoms (especially those related to DKA)
  • Blood sugar levels
  • Urine ketone levels
  • What you have been able to eat and drink
  • Your temperature (whether or not you have a fever)
  • Amount of insulin taken

 

Health Care Provider’s Name & Telephone Number: ________________________________

 

Discuss with your health care team what to do when they are not available and when to use the Emergency Room.

 

The Spanish version of this Health Facts for You is #7150. 



The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 02/08/2011

Copyright © 04/28/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4505

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