• Patient Information

• Sick Day Rules
• Hypoglycemia

SICK DAY RULES

We all have times of illness, but if you have diabetes it requires extra care. Diabetic ketoacidosis (DKA) is a dangerous condition that occurs when your body doesn’t have all the insulin it needs resulting in hyperglycemia (or high blood glucose) and a starvation of energy. This leads to the breakdown of fat for energy into ketones that build-up leading to acidosis. This ketoacidosis makes the body very sick with excessive thirst, frequent urination, abdominal pain, nausea and vomiting, shortness of breath, rapid breathing, fruity-scented breath and confusion.

If you have Type 1 diabetes, you are prone to developing DKA due to your body’s lack of insulin, but the condition can also occur with some people that have Type 2 diabetes.

Follow these guidelines to help you manage your diabetes during this challenging time:

• Extra hydration is important, so drink at least 8 oz. of fluid every 30 minutes to 1 hour. If your blood glucose is >200 mg/dL, drink water or carbohydrate-free fluids.
• Check your blood glucose at least every 2-3 hours.
• Check for ketones at least every 2-3 hours, especially if your blood glucose is >300 mg/dL. Blood ketones are much more accurate than urine ketones and the preferred method for detecting DKA.
• Continue to take your insulin per the following:

No Ketones (<0.6 mmol/L)	Small Ketones (0.7-1.4 mmol/L)	Moderate or Large Ketones (>1.5 mmol/L)
Take correction dose of insulin as prescribed every 3 hours until blood glucose is in target.	Take correctional dose + 5% of your total daily insulin dose* of your short-acting insulin (Apidra, Humalog or Novolog). If you wear a pump, take an injection and change your set site.	Take correctional dose + 10% of your total daily insulin dose* of your short-acting insulin (Apidra, Humalog or Novolog). If you wear a pump, take an injection and change your set site.
		Avoid strenuous activity.
	Continue to check your blood glucose and ketones every 2 hours and take insulin as above every 2 hours until your blood glucose is in target and your ketones have resolved. If your blood glucose decreases to <200 mg/dL, drink carbohydrate-containing fluids such as Gatorade or juice diluted with water to half-strength until your ketones have resolved.

*There are several ways to calculate your total daily insulin dose (TDD). If you wear an insulin pump, use the pump to calculate your average TDD over the last three days. If you take insulin injections, your TDD is approximately double your basal insulin dose (Lantus, Levemir, Toujeo, Tresiba & Basaglar are basal insulins).

If you are vomiting, have rapid breathing or confusion, go to your closest Emergency Room promptly. Call our office at any time if you have questions.

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