Diabetes Outreach Network
QUICK REFERENCE GUIDE TO DIABETES FOR HEALTH CARE PROVIDERS

Chapter 15
Sick Day Management

Knowing how to manage illness is important for persons with diabetes in order to avoid hospitalization.

Sick Day Guidelines

• Always take insulin or diabetes medication (often extra insulin is required).
• Less insulin may be needed if person is vomiting or has diarrhea.
• Omission of insulin is a common cause of ketosis.
• Test blood glucose frequently. All persons with diabetes should test their blood glucose at home when ill, even if they do not monitor regularly.
• For those with type 1, check every 4 hours
• For those with type 2, check 2-4 times a day.
• Record blood glucose (BG) and response to treatment. Share with the healthcare provider.
• Test for urine ketones every 4 hours (type 1 diabetes).
• Hypoglycemia is rare, yet may occur with nausea and vomiting of short duration without fever.
• Over the counter (OTC) and prescription medicines, along with herbal therapies, can contribute to hyperglycemia and hypoglycemia.
• Record weight changes (loss may signal dehydration) and breathing difficulties.
• Try to eat usual amount of carbohydrate.
• If having difficulty eating, eat or drink 15 grams of carbohydrate every hour or 45-50 grams of carbohydrate every 3-4 hours.
• Soft food or liquids may be easier to consume (see below).
• Drink extra water or sugar-free, caffeine-free fluids (8 oz every hour when awake).

Foods for Sick Day Management (~15 grams carbohydrate each)

Nausea/Vomiting

Adjusting Insulin for Illness (no nausea/vomiting)

• Continue usual dose of intermediate-acting (NPH) or long-acting insulin (Lantus?)
• Supplemental doses of rapid-acting (Humalog?, Novolog?) or short-acting (Regular) insulin may be needed due to elevated BG levels or the presence of large or persistent ketones.
  • Rapid-acting or short-acting insulin may be given every 1-4 hours.
  • Dose is dependent on severity of illness.
  • During most illnesses, 10% of total daily insulin dose can be safely given as a supplemental dose.
  • If BG is greater than 300 mg/dl with large ketones, 20% of total daily dose can be given as a supplemental dose.
• Adjustments need to be individualized for each person.
• If hyperglycemia persists, additional doses of rapid or short-acting insulin may be needed throughout the day.

When to Call Physician

• Fever greater than 100 degrees for 24 hours
• Persistent hyperglycemia (BG over 300 mg/dl)
• Persistent diarrhea (more than 8 hours)
• Vomiting and unable to take fluids for over 4 hours
• Sick longer then 24 hours
• Severe abdominal pain (more common in type 1)
• Difficulty breathing (more common in type 1)
• Moderate to large ketones (more common in type 1)
• Other unexplained symptoms (if in doubt, contact your health care provider)

Preventing Illness

• Get influenza vaccination yearly.
• Get pneumococcal vaccination. If receive first dose prior to age 65, give another single re-vaccination after age 65 (if 5 or more years have lapsed since the previous dose).
• Practice good hygiene and hand washing.
• Eat a healthful diet.
• Get plenty of rest.
• Stay hydrated.
• Don't smoke.

References:
American Diabetes Association (2006). Clinical Practice Recommendations. Diabetes Care, Vol 29 (1).