Sick day rules
for type 1 diabetes
How does illness effect my blood glucose?
When you are unwell your body releases stress hormones which can trigger your body to release stored glucose from your liver and cause a rise in blood glucose levels. This means that even if you are eating less, you will usually need the same or more insulin than usual.
If you do not get enough insulin, then the body will start to break down fat for energy and, when this happens, ketones are produced. If ketones accumulate in the blood, this can quickly lead to a serious condition called diabetic ketoacidosis (DKA).
How to look
after yourself when you are unwell
It is often possible to manage your diabetes effectively when you are unwell, keep your blood glucose levels in or near to target, and prevent the development of ketones by following sick day advice.
Get some rest: avoid strenuous exercise
Why? People need rest when they’re sick. It helps your body focus its energy on fighting illness.
1) Treat your symptoms
- Use basic over-the-counter medicines such as painkillers and cough syrups. These do not have to be sugar-free varieties as they contain very little glucose and are taken in small quantities. Ask your pharmacist for advice
See your GP if you think you have an infection as you may need antibiotics
Remember to eat and drink.
- Try and drink at 100-200 ml of sugar free fluid every hour.
- If you do not feel like eating normal meals, try to eat foods that are easy to digest, e.g. soup, ice cream, milk puddings.
- If your blood glucose falls below the normal range, sip full-sugar drinks, fruit juice, sweetened tea or Lucozade, or suck an ice lolly.
Why? High blood glucose can lead to dehydration. Not eating whilst unwell can lead to more ketones as the body breaks down fat to make fuel.
2) Monitor your blood glucose
Monitor your blood sugars levels 2 – 4 hourly during illness.
Why? The results will help guide you with how to adjust your insulin.
- If you have a gastro-type bug your blood glucose levels are more likely to be low because you’re not eating or not absorbing the food that you are eating. There regular blood glucose check is also important to avoid hypo.
3) Test for Ketones
- Make sure you always keep ketone strips for testing during illness and check that they are ‘in date’.
- Check your ketones every 2-4 hours.
Why? If you have ketones in your blood or urine it is a sign that your body is short of insulin and that you need to increase your insulin dose (see chart below). Increasing levels of ketones means an increased risk of DKA.
Follow the sick day guidelines below for insulin adjustment.
Why? Extra insulin will correct hyperglycaemia and clear ketones
4) Seek medical help if:
- Your illness lasts longer than two days
- Vomiting or diarrhoea lasts more than eight hours
- Your blood glucose is over 15mmol/L and you can’t bring it down
- You have ketones in your blood or urine and they don’t go away within a few hours
- You can’t keep any food or liquid down