Sick Day Management In Type 1 Diabetes
People with Type 1 diabetes need to take extra precautions when they are ill to avoid extreme hyperglycemia. Even minor illnesses like colds and flu; nausea, vomiting and diarrhea; and head and/or lung congestion can cause elevations in blood sugar levels. Having dental work or even minor surgery can create stress on your body and elevate your blood sugars. To complicate matters, many of the medications used for treatment can raise glucose levels as well.
TAKE YOUR USUAL DOSE OF INSULIN WHEN YOU ARE SICK
Illness makes your blood sugar level rise, even if you're not eating. Your health care provider may suggest a supplemental insulin schedule to use on "sick days".
CHECK OUR BLOOD SUGAR FOUR TIMES DAILY (am, mid-day, evening and before bed)
It's important to see if your body needs extra insulin on days when you're not well. When you check your blood sugar at "usual" meal times, you can determine if extra insulin is needed to keep the blood glucose under control and prevent diabetic ketoacidosis.
TEST YOUR BLOOD OR URINE FOR KETONES
Ketones are acids that appear in the blood and urine during starvation and/or when your body lacks sufficient insulin. People with Type 1 diabetes can develop diabetic ketoacidosis (DKA) as a result of common illnesses like a cold or the "flu". Testing your blood or urine for ketones will let you know if you need extra insulin during the illness.
DRINK PLENTY OF FLUIDS
To prevent ketoacidosis, you need to prevent dehydration. Drink at least 1/2 cup of calorie free fluids every hour while you're awake. Examples of calorie free fluids include water, sugar-free soda, tea (regular or herbal), coffee, broth or bouillon.
If you are unable to eat your regular meals, try to take in 15 grams of carbohydrate every hour while you're awake to prevent unexpected low blood sugars. This can be in the form of solid carbohydrates or if you are not eating take your carbohydrates in liquid form. Consult your dietitian as needed.
Foods containing 15 grams of carbohydrate
- 1 cup Gatorade
- ½ cup fruit juice
- ½ cup regular soda (not diet)
- 6 saltine crackers
- 1 slice dry toast (not light bread)
- ½ cup regular (not diet) jello
- 2 cups chicken noodle soup
1 double stick popsicle
5 vanilla wafers
3 graham crackers
½ cup ice cream
¼ cup sherbet
½ cup mashed potatoes
Many people find the "rule of 1800" to be helpful with insulin adjustments on sick days. The formula was developed for use with insulin pump users; however it provides a reasonable guideline for most insulin using individuals. Remember that is it always best to discuss your individual needs with your health care provider. To calculate your insulin dose adjustment, use the following formula: 1800/total daily dose of insulin = anticipated change in blood sugar expected for each 1 unit of rapid acting insulin (e.g. Humalog® or Novolog®).
OVER THE COUNTER MEDICATIONS
Be aware that over the counter cold medicines can raise blood sugars. Check with a pharmacist or health care provider if you have questions about what products to use when you are ill.
CALL YOUR HEALTH CARE PROVIDER
Should you have 3 or more episodes of vomiting or diarrhea in a 24 hour period or if you have 2 consecutive blood sugars over 300. If you have moderate to large ketones in your urine or blood. Notify your provider if you have any difficultly in breathing or if you are running a high temperature over 101.5º F. Most important, call if you have questions about how much insulin you should take or if you have any questions about how to treat your symptoms.
you are a registered University
of Illinois student and you have questions or concerns,
If you are concerned about any difference in your treatment plan and the information in this handout,
you are advised to contact your health care provider.
Visit the McKinley Health Center Web site at: http://www.mckinley.illinois.edu
© The Board of Trustees of the University of Illinois, 2008.
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