Sick Day Rules for People with Diabetes

1 Sick Day Rulesfor People with DiabetesIssued by the Diabetes ServiceNorthumbria HealthcareNHS Foundation Trust157331 PIN451 Sick Say Rules A5 16p 01/10/2014 11:38 Page : How illness may affect your Diabetes 3 What to do for Type 1 Diabetes5 What to do for Type 2 Diabetes9 Working out your extra Insulin doses Table 12 Eating & Drinking12 Notes157331 PIN451 Sick Say Rules A5 16p 01/10/2014 11:38 Page 23If you have a cold, flu or any other illness, here are a few simple Rules you should always remember thatwill help you copeBackgroundIllness and infections cause your body to be more stressed. Whenyou have Diabetes your blood glucose (sugar) levels often riseduring illness especially if you have a fever (high temperature).

2 The kind of illnesses most likely to have an effect on your bloodglucose are, the common cold or flu, sore throats, urine infections,bronchitis or chest infections, stomach upsets and diarrhoea, is important for you and anyone who may help you when youare ill to learn what to do, because when the blood glucose levelsgo up this can make it more difficult to keep your Diabetes undercontrol. Extra insulin is sometimes necessary, so you need toknow how to manage the sick day Rules . Your blood glucose may rise even if you are unable to eatyour normal food or your GP or clinic: If you are not sure what to do If you are persistently vomiting (not able to hold down any foodor drink for more than 6 hours), as you can quickly becomevery dehydrated If your blood glucose stays high 157331 PIN451 Sick Say Rules A5 16p 01/10/2014 11:38 Page 3 Contacts for adviceGP Practice Tel.

3 Diabetes Team Tel: ..Out of Hours Tel: ..Other:Tel:..4157331 PIN451 Sick Say Rules A5 16p 01/10/2014 11:38 Page 4 DAFNE:For People using the DAFNE (Dose Adjustment ForNormal Eating) regime use the DAFNE sick day rule guidelinesType 1 Diabetes Important Points Your Insulin should never be stopped. You may need an increased insulin dose and/or additionaldoses of fast acting insulin may be necessary to bring down the blood sugars (for example Novorapid insulin 4 hourly) seeinsulin adjustment table. Blood glucose levels should be checked at least every 2 - 4hours. If you are worried you might go hypo sip sugary drinks, or suckboiled sweets or glucose tablets Try and drink clear sugar free fluids to avoid dehydration Your food can be taken in alternative forms (see page 12) What blood glucose level should you aim for when you re ill?

4 Aim:Blood glucose target between 6-10mmol/LTesting:If your blood glucose levels stays above 10mmol/L follow theguidelines for increasing your blood glucose testing will be necessary. You will need to testevery 2-4 hours and especially every 2 hours if your bloodglucose is high (over 15mmol and if you have ketones in yoururine, or you are using a quick acting analogue insulin (Novorapidor Humalog), because this insulin will only last in your body for ashort period of time. 5157331 PIN451 Sick Say Rules A5 16p 01/10/2014 11:38 Page 5 Ketones:Everyone with Type 1 Diabetes should have ketostix at home foruse during illness and other times when the blood glucose levelsare high.)

5 You can test for ketones with a simple urine test. Thetest strips (Ketostix) are available on prescription from your blood glucose meters can also test for ketones with adifferent test strip available on prescription. Having ketones atlevels of moderate or large amounts will usually indicate that yourblood glucose levels are high and you need extra insulin. Ketoacidosis (also known as DKA):When you have Type 1 Diabetes you need insulin in your body inthe correct amounts all of the time. The extra demands of illnessmean your need for insulin will increase, even if you are not ableto eat. If there is not enough glucose getting into the cells of thebody, fat stores are used as an alternative source of the body can t burn up fat very efficiently, by-productsknown as ketones are given off.

6 Ketones are acids and thereforemake the blood acidic . Not getting enough insulin at this timeand if it is left untreated can result in ketoacidosis, where you canbecome seriously unwell. If it doesn t respond to treatment athome within 6 hours it may need to be treated in of ketoacidosis are: Blood glucose over 15 mmol/L Ketones in your urine Thirst Passing large amounts of urine (this leads to dehydration) TirednessSeek urgent help if you have: Vomiting Rapid breathing Reduced level of consciousness (drowsiness)6157331 PIN451 Sick Say Rules A5 16p 01/10/2014 11:38 Page 6 Insulin adjustment during illness for Type 1 diabetesRemember - never stop taking your insulinTypes of quick acting insulin.

7 If your blood glucose is between 10mmol/L 13mmol/LIf your blood glucose is above 13mmol/L Analogue Insulin Novorapid (Aspart)Humalog (Lispro)Soluble Insulin Humulin SActrapid (only available in 10ml vials for use with insulin syringes)Increase yourusual insulin by 10% Blood glucose is over13mmol/L or has notresponded following anincrease in insulinIncrease usual insulin by 10%and give extra dose of quickacting insulin (approximately10% of total daily insulin) repeatevery 2 to 4 hoursIncrease your insulin and test urine for ketonesIf the result is moderate or large amount, testevery two hours until they reduce Try to drink at least 2 litres a day (5 pints) of sugar free liquidsCheck bloodglucose every4 hours.

8 If no improvement after 24 hours increase by afurther 10% If no improvement after 48 hours follow theguidelines PIN451 Sick Say Rules A5 16p 01/10/2014 11:38 Page 7In case of severe illness10% of my usual totaldaily insulin dose = _____ units(use the table on page 12 to work this out)20% of my usual totaldaily insulin dose = _____ units(use the table on page 12 to work this out)Your blood glucose is over 15mmol/L and you have moderate orlarge amount of to take your usual insulin, and follow the guide for extraquick acting insulin:Try to drink at least 2 litres of sugar free fluids over 6 hoursIf blood glucose is not controlled below 15mmol/L after 48hours you may need to contact GP/Specialist Service to reduce your insulin back to your usual dose whenyour blood sugar is back to your normal levelsandExtra quick actinginsulin dose:if bloodglucose is over 15mmol/Lyou may need to give alarger dose.

9 Considergiving 20% of total dailyinsulin (use the table onpage 11 to work this out)Test your blood glucoseand test your urine forketones every 2 hoursand repeat extra quickacting insulin dosesuntil blood glucoselevels reduce to below15mmol/L and theketone level PIN451 Sick Say Rules A5 16p 01/10/2014 11:38 Page 8 Type 2 Diabetes Recognising when your blood glucose (sugar) is high:When your blood glucose is high you usually get the followingsymptoms Thirst/dry mouth Passing large amounts or urine (this can lead to dehydration) Tiredness Weight Loss Type 2 Diabetes on tablets: Try and keep taking your medicationMetformin onlyIf you are taking Metformin tablets you may be using urine testing (for glucose) to monitor your Diabetes .

10 This form of testing will onlygive you a guide but could alert you to possible high blood glucoselevels if there is large amounts of glucose passing into your urine,more than ++. If you are taking Metformin tablets, you may need totemporarily stop these tablets. This is usually if you have a severeinfection or are becoming dehydrated and your GP or Diabetes Team will advise you. If this is necessary you will need a differenttreatment for your Diabetes until you can re-start your and a Sulphonylurea or Sulphonylurea only The most commonly used Sulphonylurea tablets are called may have been provided with blood glucose testing equipmentmainly to be able to confirm that your blood glucose has gone toolow (hypoglycaemia) and to routinely monitor your Diabetes , but youmay not test very often.