Sick Day Rules For Type 1 Diabetes

This page describes what to do if you are sick and have Type 1 diabetes.

 

 For detailed treatment advice also read the Flow chart page. 

Treated with Multiple Daily Injections 

It is very important that you know what to do when you are ill.

We refer to this as "sick day rules". 

Remember - Never stop taking your insulin 

When you are ill your body becomes much more resistant to the insulin you produce or take by injection. This means your blood glucose levels can raise. You therefore need to monitor your blood glucose and ketone levels and decide if you need more insulin. It is likely that you will need to increase your insulin dose (see flow chart for guidance).

Although you may not feel like it, it is very important to monitor your diabetes closely to prevent diabetic ketoacidosis developing 

We divide the sick day rules into those for Minor and Severe illness. 

Minor illness – where blood glucose may be within normal range or raised but ketones remain negative (e.g. minor viral infection or minor injury) 

and

Severe illness - where blood glucose is raised and ketones are positive in blood or urine  (may be due to chest or other more severe infection or due to missed insulin injections). Ketones are a sign you are low on insulin. 

Tips for staying safe during Illness: 

  • If you are vomiting, you do not need to eat until you feel well enough to try, but keep sipping fluids to prevent dehydration at least 100 mls per hour.
  • If you 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, lucozade or ice lollies.
  • Adjusting your insulin doses will help to control blood glucose levels (see guidance in the flow charts below)
  • If you have an infection that is not resolving, you should make an appointment to see your GP to determine whether you need further treatment.
  • If you continue to vomit, are unable to keep fluids down, and/ or cannot manage to reduce your blood glucose or ketone levels you must contact the hospital as an emergency.

For information on Interpretation of ketones during illness read the Ketones Page

For further treatment advice read the Flow chart page

Interpretation of Ketones During Illness 

Blood ketone meter range 0.0mmol/L - 8.0mmol/L 

Urine Ketone

Blood Ketone

Action

Negative

Less than 0.6 mmol/L

Within normal range however during illness test again 2-4 hourly

Trace

0.7 - 1.5 mmol/L

Give extra dose of insulin. Refer to sick day rules on previous page. Test blood glucose & ketones 1-2 hourly

Moderate

1.6 - 3 mmol/L

Give extra dose of insulin. Refer to sick day rules on previous page. Seek advice from your diabetes team / Gp / NHS 24: 0845 4242 424. Retest blood glucose and ketones 1 - 2 hourly

Severe

More than 3 mmol/L

Give extra dose of insulin. Refer to sick day rules on previous page. Seek advice from your diabetes team / Gp / NHS 24: 0845 4242 424 or attend accident & emergency urgently

Rate this page