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

15. Sick Day Management

Sick day management is important for people with diabetes in order to avoid hospitalization. Those not normally requiring insulin, may need insulin during times of illness.

Sick Day Guidelines

• Always take insulin or diabetes medication (often extra insulin is required, but if vomiting or diarrhea are present, less insulin may be needed.) Omission of insulin is a common cause of ketosis.
• Test blood glucose frequently. For those with type 1, check every 4 hours and for those with type 2, check 2-4 times a day. All people with diabetes should test their blood glucose at home when ill, even if they do not monitor at home at other times.
• Test for urine ketones every 4 hours. (type 1 diabetes)
• Try to eat usual amount of carbohydrate (CHO), may be divided into smaller meals and snacks. Soft food or liquids may be easier to consume.
• If having difficulty eating, eat or drink 15 grams of CHO every hour or 45-50 grams of CHO every 3-4 hours.
• Hypoglycemia is rare, yet may occur with nausea and vomiting of short duration without fever.
• OTC and prescription medicines, along with herbal therapies can contribute to hyperglycemia and hypoglycemia.
• Record weight changes (loss may signal dehydration) and breathing problems.
• Drink extra water or sugar-free, caffeine-free fluids (8oz every hour when awake).

Foods for Sick Day Management

	1/2 (4 oz) cup juice		1/2 cup sugar-free pudding
	1 cup (8 oz) Gatorade		1 cup (8 oz)skim or low-fat milk
	1/2 cup (4 oz) regular pop		1/2 cup ice cream or frozen yogurt
	1/2 cup regular gelatin		6 oz light yogurt
	1/2 cup unsweetened applesauce		1/4 cup sherbet
	1 slice toast		1/2 - 1 cup cold cereal (unsweetened)
	1 cup soup		1/2 cup hot cereal (unsweetened)
	6 saltine crackers		1/3 cup rice
	3 squares graham crackers		1/2 cup mashed potatoes

Nausea/Vomiting

Adjusting Insulin for Illness (no nausea/vomiting)

• Continue usual dose of intermediate-acting (NPH, Lente) or long-acting insulin (Ultralente, 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 > 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 patient.
• If hyperglycemia persists, additional doses of rapid or short-acting insulin may be needed throughout the day.

When to Call a Physician

• Fever greater than 100 degrees for 24 hours
• Persistent hyperglycemia (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 (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 revaccination at age 65 if 5 or more years have lapsed since the previous dose.
• Eat a healthful diet.
• Get plenty of rest.
• Stay hydrated.
• Don't smoke.