Everyday illnesses or infection will nearly always cause a rise in blood glucose levels when you have type 1 diabetes. Therefore, at the earliest sign of any form of illness such as a cold or virus, it is important to follow your personalised sick day management plan. Be prepared before you get sick! It is essential to discuss and prepare a sick day management plan with your diabetes team.
What do I do when unwell?
There are five important steps for you to take:
1. Always take your insulin When unwell, you must continue to take your insulin. Contact your diabetes specialist, credentialled diabetes educator or your hospital emergency department for advice before you make any changes to your insulin dose. Only in rare cases is the insulin dose reduced during illness. In most cases, even during gastrointestinal illness, the insulin dose needs to be increased.
2. Test your blood glucose levels more frequently If your blood glucose level is more than 15mmol/L and you have ketones, you need extra insulin and hourly blood glucose testing. When blood glucose levels are 15mmol/L and under, it is recommended to continue testing blood glucose levels 2 hourly until levels are back to normal.
3. Test for ketones Test for ketones regularly, using either ketone urine test strips (available from your pharmacy or through the National Diabetes Services Scheme) or a meter that checks blood ketones. Ask your diabetes educator for more information about this.
4. Rest and let someone know you are unwell If possible have a friend or relative either stay with you or check on you frequently.
5. Keep drinking and (if possible) eating Drink and eat fl uids and food containing carbohydrate if your blood glucose levels are 15mmol/L or under. Drink and eat non-carbohydrate containing fluids and food if your blood glucose levels are above 15mmol/L.
When do I need to call my doctor?
There are certain times during illness when you need to contact your diabetes health professional for management and insulin dose adjustment advice. Contact your doctor or diabetes educator if: • Urine ketones are moderate/large and blood glucose level is over 15mmol/L. • Blood ketones are more than 0.6mmol/L (moderate to high when using urine testing strips) and blood glucose level is over 15mmol/L.
When to contact your doctor IMMEDIATELY!
> If you can’t keep food or fluids down and have persistent vomiting, diarrhoea and/or abdominal pain
> If you have deep rapid breathing or breathlessness
> If you are extremely drowsy
> If you have a ‘fruity’ odour to your breath (See ketoacidosis below).
What are ketones?
When there’s not enough insulin in the body, glucose can’t enter cells to provide energy. The body then begins to break down fat as a source of energy. This process causes ketones to be produced. Ketones can be used as an alternative form of energy but they also need insulin to enter the cells.
If there is a lack of insulin, ketones build up in the blood and are eventually passed through the kidneys and into the urine. While large quantities of ketones can be serious, small amounts of ketones are not harmful. Ketones can also be present in people who do not have diabetes, for example at times when they are unwell or losing weight.
What is ketoacidosis?
Ketoacidosis is a life-threatening condition that can occur when you are ill or have a very high blood glucose level resulting from a lack of insulin. The presence of large amounts of ketones in the blood or urine indicates ketoacidosis.
Signs of ketoacidosis can include:
• Nausea, vomiting and/or abdominal pain
• Deep rapid breathing or breathlessness
• Extreme drowsiness
• A ‘fruity’ odour to the breath.
Seek urgent medical attention if you have any of these symptoms! on. Urgent medical attention is required! 3 Guidelines for carbohydrate and fluid replacements
To avoid dehydration and hypoglycaemia when you are ill, it is very important to keep up your fluid and carbohydrate intake. If you can eat normally
• If you are able to eat normally, do so and sip extra fluids each hour, about ½ – ¾ cup, a little less for children.
To prevent dehydration, drink unsweetened fluids such as water, diet soft drinks, diet cordial, weak tea or broth. If you can’t eat normally • Have some easy to manage carbohydrate drinks, snacks or small meals.
If you are unable to eat at all and your blood glucose levels are under 15mmol/L, drink carbohydrate-containing fluids.
See the list below for ideas.
To prevent dehydration, drink unsweetened fluids such as water, diet soft drinks, diet cordial, weak tea or broth, about ½ – ¾ cup each hour.
Remember, if you can’t keep food or fluids down and have persistent vomiting or diarrhoea, seek urgent and immediate medical advice.
Here are some suitable carbohydrate fluids and snacks that you can have to provide 15 grams of carbohydrate if your blood glucose levels are 15mmol/L or under.
Drink or eat one of these each hour when you are unwell:
Drinks providing approximately 15 grams of carbohydrate
Milk 1 cup (250ml) Milk + fl avouring ¾ cup milk + 1 tablespoon of Milo®, Actavite® or Quik® Fruit juice* ¾ cup Tea Add 1 tablespoon of sugar or honey Hot lemon juice Add 1 tablespoon of sugar or honey Herbal tea Add 1 tablespoon of sugar or honey Gastrolyte 4 sachets Ordinary soft drink* or cordial* (not diet) ¾ cup Sports drink (eg: Gatorade®) 1 cup
Snacks providing approximately 15 grams of carbohydrate
Crackers or crispbread 3 Sao®/Ryvita® etc Dry toast 1 slice Plain sweet biscuits 3 Milk Arrowroot/Morning Coffee etc Mashed potato ½ cup Rice ⅓ cup Breakfast cereals ½ cup Special K®, 2 Weetbix® Porridge (made with water) ⅓ cup Ordinary jelly or custard ½ cup Ice cream 3 scoops Ice blocks 1½ sticks