Sick Day Rules for People with Diabetes - Northumbria · DAFNE: For people using the DAFNE (Dose...

Sick Day Rulesfor People with Diabetes

Issued by the Diabetes Service

Northumbria HealthcareNHS Foundation Trust

157331 PIN451 Sick Say Rules A5 16p 01/10/2014 11:38

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www.northumbria.nhs.uk

Background: How illness may affect your diabetes 3

What to do for Type 1 Diabetes 5

What to do for Type 2 Diabetes 9

Working out your extra Insulin doses – Table 12

Eating & Drinking 12

Notes


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If you have a cold, flu or any other illness, here are a few simple rules you should always remember that

will help you cope

Background

Illness 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).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, skinabscesses.

It 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 drink.

Contact 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


Contacts for advice

GP Practice Tel:..................................................

Diabetes Team Tel: .................................................

Out of Hours Tel: .................................................

Other: Tel:..................................................

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DAFNE: For people using the DAFNE (Dose Adjustment ForNormal Eating) regime use the DAFNE sick day rule guidelines

Type 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?Aim: Blood glucose target between 6-10mmol/L

Testing:If your blood glucose levels stays above 10mmol/L follow theguidelines for increasing your insulin.

Extra 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.

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Ketones:Everyone with Type 1 diabetes should have ketostix at home foruse during illness and other times when the blood glucose levelsare high. You can test for ketones with a simple urine test. Thetest strips (Ketostix) are available on prescription from your GP.Some 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 energy.Because the body can’t burn up fat very efficiently, by-productsknown as ketones are given off. 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 hospital.

Symptoms of ketoacidosis are:

• Blood glucose over 15 mmol/L

• Ketones in your urine

• Thirst

• Passing large amounts of urine (this leads to dehydration)

• Tiredness

Seek urgent help if you have:

• Vomiting

• Rapid breathing

• Reduced level of consciousness (drowsiness)

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Insulin adjustment during illness for Type 1 diabetesRemember - never stop taking your insulin

Types of quick acting insulin:

If your blood glucose is between 10mmol/L – 13mmol/L

If 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 insulin

Increase usual insulin by 10%and give extra dose of quickacting insulin (approximately10% of total daily insulin) repeatevery 2 to 4 hours

Increase your insulin and test urine for ketones

If 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 liquids

Check bloodglucose every4 hours.

If no improvement after 24 hours increase by afurther 10% If no improvement after 48 hours follow theguidelines below.

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In case of severe illness

10% of my usual total daily 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 ketones.

Continue 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 hours

If blood glucose is not controlled below 15mmol/L after 48hours you may need to contact GP/Specialist Service foradvice.

Remember to reduce your insulin back to your usual dose whenyour blood sugar is back to your normal levels

and

Extra quick actinginsulin dose: if bloodglucose is over 15mmol/Lyou may need to give alarger dose. 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 reduces.

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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 medication

Metformin only

If you are taking Metformin tablets you may be using urine testing(for glucose) to monitor your diabetes. 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 Metformintablets.

Metformin and a Sulphonylurea or Sulphonylurea only

The most commonly used Sulphonylurea tablets are called Gliclazide.

You 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. In illness your blood glucose usually rises.Use your test results as a guide and aim to keep your blood glucosebetween 6 and 10mmol/L. You will need to test more frequently, atleast twice a day.

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You may need to have a temporary increase in your tablets tokeep your blood glucose controlled until you are better.

Type 2 Diabetes and Insulin

People who have Type 2 diabetes on insulin must be providedwith the equipment to test their own blood glucose levels at home.Aim to keep your blood glucose levels between 6 and 10mmol/L.If when you are ill it stays above 10mmol/L follow the guidelinesfor increasing your insulin. Extra blood glucose testing will oftenbe necessary. You will need to test every 4 hours and especially ifyour blood glucose is high (over 15mmol/L)

Ketones: If your blood glucose gets too high, (over 15mmol/L then you mayhave to have a urine test for ketones. People with Type 2 diabetesare not routinely prescribed Ketostix to test for themselves at home.

Insulin and Tablets: If you are taking Metformin tablets, you may need to temporarilystop these tablets. This is usually if you have a severe infection orare becoming dehydrated and your GP or Diabetes Team willadvise you.

If you are taking a sulphonylurea tablet (Gliclazide) continue as usual.

If you are on once daily insulin and need to change to twice dailyinsulin, do this by halving your usual once daily insulin dose: takeyour AM dose with breakfast and PM dose with evening meal.You will be advised by your GP or Specialist Diabetes Team.

The maximum dose of tablets is: Metformin (Glucophage) 500mgs 1g two/three times daily

Metformin (Glucophage) 850mg one tablet three times daily

Metformin SR (Glucophage SR) 2g once daily, or 1g twice daily500mgs

Gliclazide 80mgs two tablets (160mgs) twice daily

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Insulin dose adjustment during illness for Type 2diabetes

If your blood glucose is between 10mmol/L – 15mmol/L

If your blood glucose is above 15mmol/L

If not controlled below 15mmol/L after 48 hours consider makingcontact for advice

Remember to reduce your insulin back to your usual dose whenblood sugar is back to your normal levels

Check blood glucose every 4 hours – if no improvement after 24 hours

Increase insulin by20%

Increase insulin by a further 10%. If no improvement after 48hours follow the guidelines below

Blood glucose isover 15mmol/L orhas not respondedfollowing anincrease in insulin

Increase your usual insulin by 20%andGive extra dose of quick actinginsulin (approximately 10% of totaldaily insulin) repeat every 4 hours

If your blood glucose not below 15mmol/L after 24 hours increaseusual insulin by a further 10%

Quick acting insulin is Novorapid (Aspart), Humalog (Lispro) orHumulin S insulin.



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Table of 10% and 20% insulin units

Eating and Drinking

Here are some food and drinks that can be useful alternatives. Ifyou are unable to eat your normal diet, then you can replace foodwith small frequent amounts of the following:

Travel

It is always helpful to take with you something to treat a hightemperature or diarrhoea in case you become sick when you areaway from home. Ask your diabetes team about more informationwhen travelling.

My usual insulin dose is: 10% = 20% =

1-14 units or less 1 unit 2 units

15-24 units 2 units 4 units







Lucozade 50ml

Natural unsweetened fruit juice 100ml

Ordinary Cola or Lemonade 100ml

Milk 200ml

Tomato Soup 200ml

Complan 1 level teaspoon

ordinary Ribena 2 tablespoons

Horlicks / Ovaltine 2 heaped teaspoons

Ice Cream 2 oz (approx. 80g)

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PIN 451/V3

Review date: August 2017


Sick Day Rules for People with Diabetes - Northumbria · DAFNE: For people using the DAFNE (Dose...

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