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Diabetes mellitus
Sick day rules for people on insulin
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Principle: To provide guidelines for use by health care professionals to
assist insulin treated people with blood sugars above 15, resulting from
episodes of intercurrent illness. To prevent diabetic ketoacidosis from
developing.
When insulin therapy is initiated, patients should be taught the 'sick day
rules' and must be prescribed Ketostix and solubi insulin (Actrapid) along with
their usual insulin and blood glucose testing kit. Everyone should have clear
'contact criteria' and contact numbers (covering every hour of every day).
- Normal insulin should never be stopped.
- Additional doses of soluble insulin should be given as necessary to bring
down blood sugars and suppress ketone productia (eg. Actrapid 4 hourly).
- Blood sugars should be checked at least every 4 hours.
- Urine should be tested for ketones if people are unwell or blood sugars
are 15+.
Targets
- Aim to bring blood sugars down to between 4 and 10.
- Aim to suppress urinary ketones to 'small, a trace or negative'.
NB
- If people are unable to eat a normal diet, a list of alternatives is
provided (see over).
- People taking insulin and Metforntin should stop Metformin during episodes
of illness requiring hospital admission or confining them to bed.
- As people get better and blood sugars improve / ketonuria resolves, reduce
insulin back towards usual doses (guided by blood sugars).
Insulin dose adjustment
Ketones large and/or vomiting
Blood sugars 15+ |
- Give Actrapid (20% of total daily dose as a SC bolus)
- Admit to hospital for assessment and treatment.
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| Unwell with ketones (moderate/large) present and/or blood
sugars 15+ |
- Drink ++ (non sugary) to avoid dehydration, but if poor appetite
give sugary drinks
- Give usual insulin PLUS 20% of total dally requirements as fast acting
insulin every 2-4 hours.
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Small, trace or negative ketones
Blood sugars 15+ |
- Drink ++ (non sugary) to avoid dehydration, but if poor appetite
give sugary drinks.
- Give usual insulin PLUS 10% of total dally requirements as fast acting
insulin every 4 hours.
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No ketones
Unwell and/or Blood sugar 8-15 |
- Drink ++ (non sugary) to avoid dehydration.
- Increase usual insulin by 10%.
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| If vomiting on insulin with ketones in urine |
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If using 30units insulin iin 24 hours:10% = 3units, 20% = 6units. We
recommend people are given individualised figures rather than percentages. Once
target BM achieved and if unable to eat normal diet, replace food with small
frequent amounts of the following:
All contain 10 grams of carbohydrate:
- 50 ml / 2 fluid oz Lucozade.
- 1 level teaspoon Complan.
- 100 ml / 4 fluid oz natural unsweetened fruit juice.
- 2 tablespoons ordinary Ribena.
- 100 ml! 4 fluid oz ordinary Coke or Pepsi.
- 2 heaped teaspoons Horlicks / Ovaltine.
- 200 ml / 1 cup of milk.
- 2 oz (approx. 80g) ice cream.
- 200 ml / 1 cup of tomato soup.
Source: Northumbria NHS Health Care Trust diabetes protocol