(con’t)
Sick Day Management of Type 1 Diabetes
Minor illnesses such as a cold or flu can temporarily increase both the amount of
glucose released by the liver and your body’s response to insulin, leading to high
blood sugar levels.
Prevention is key!
- Get the influenza vaccination every year – the vaccine is different every year, so it is
-
important to get the most recent vaccine formulation annually
Get a pneumococcal vaccination – talk to your doctor about whether you need to get
another pneumococcal vaccine
Eat a healthy diet
Get plenty of rest
Stay hydrated
Avoid smoking
Wash your hands regularly
Important things to do to while sick:

Continue taking insulin and/or oral diabetic medications

Check your blood sugars every 3-4 hours, even if you feel okay

Continue eating
What if I’m not hungry?
Your body
still needs
nutrition
fordrink
energy,
you1may
it difficult
eat. every
If this ishour
the case, try substituting
 Keep
hydrated
and
atbut
least
cupfind
(250
mL) oftofluid
meals withj sugar drinks and/or carbohydrate servings including:
- ½ cup of orange juice
- ½ cup pudding
- 1 small banana
- Continue
taking
- 1 cup skim milk
- ¾ cup sugar free yogurt
- ½ cup regular Jell-O®
- ½ cup regular pop
- 1 slice of toast
- ½ cup applesauce
- 1 cup Gatorade®
- 6 soda crackers
Each of these servings is equivalent to about 15g of carbohydrates.
 Stay hydrated - Being ill can cause dehydration, especially with vomiting and/or diarrhea.
Drink at least 1 cup of water and/or sugar-free, caffeine-free fluids every hour
o If your blood glucose > 12 mmol/L, choose sugar-free drinks like water, diet
ginger ale, Crystal light® and caffeine-free tea
o If your blood glucose < 12 mmol/L, choose liquids with sugar in them like apple
juice, regular ginger ale and regular popsicles
 Consult your health care professional about using any over the counter medications
(eg. cough and cold remedies), and make sure they know you have diabetes
 Avoid exercising when sick – exercising will affect your blood sugars, so it is best to avoid
exercise until you are well
Mosaic Primary Care Network
www.mosaicpcn.ca
(con’t)
Sick Day Management of Type 1 Diabetes
 If your blood glucose > 14 mmol/L, check your ketone levels
What are ketones?
When the body cannot use blood sugar for energy because of a lack of insulin and/or insulin resistance, it will
break down fat. Ketones are toxic by-products of fat breakdown that can cause a life-threatening condition
called diabetic ketoacidosis (DKA). Signs of DKA include rapid breathing, fruity breath, nausea, vomiting and
stomach pain. Ketone strips (Ketostix®, Keto-Diastix®, or Chemstrip® uG/K strips) can be purchased from your
pharmacy for urine ketone testing, or blood ketone levels can be tested with the Precision Xtra diabetic
monitor. Always check the expiry dates!
Your rapid or short acting insulin dose may need adjusting because of high blood sugar. Use the following chart
under the guidance of your doctor or pharmacist for dosing based on blood glucose and ketones:
Blood sugar
(mmol/L)
13-16
16.1-22
≥ 22.1
Ketones
Rapid-acting or short-acting insulin dose
adjustment
Urine
Negative – Small
Blood (mmol/L)
< 0.6
Moderate - Large
> 0.6
Usual dose + 10% of total daily units of insulin*
Negative – Small
< 0.6
Usual dose + 10% of total daily units of insulin*
Moderate - Large
0.7-1.4
Usual dose + 15% of total daily units of insulin*
Negative – Small
< 0.6
Usual dose + 15% of total daily units of insulin*
Usual dose
Moderate - Large
1.5-3.0
Usual dose + 20% of total daily units of insulin*
*Total daily units of insulin = all your different types of insulin doses added together
(eg. intermediate/long acting = 36 units at breakfast + 15 units at bedtime and 12 units rapid/shorting acting at each meal = 87 units daily)
My total daily units of insulin = _____units
10% of my total daily units of insulin = _____ units
15% of my total daily units of insulin = _____ units
20% of my total daily units of insulin = _____ units
When should you go to the hospital?
-
-
blood glucose >14 mmol/L for two tests in a row, 4 hours apart AND urine ketones are
moderate to large or blood ketones ≥1.5 mmol/L
you are unable to keep your blood sugars above 6 mmol/L
you experience signs of diabetic ketoacidosis (DKA) which include: rapid breathing, fruity
breath, nausea, vomiting and stomach pain
you are unable to eat or drink for more than 24 hours due to vomiting
you are unable to take your insulin
ketones are rising despite taking extra rapid or short-acting insulin
you develop signs of dehydration such as: dry mouth, tongue, cracked lips, sunken eyes
If you have an y questions regarding yo ur health, please call :
HealthLink at (403) 943 -5465 or toll free at 1 -866-408-5465
for 24/7 telephone acces s to advic e an d information from a register ed nurse
Mosaic Primary Care Network
www.mosaicpcn.ca
References:
1. Calgary Health Region. Illness Management for Adults with Type 1 Diabetes. October 2004.
2. Fraser Health Diabetes Education. Type 1 Diabetes: Sick Day Management and Insulin Guidelines. September 2009.
3. www.lmc.ca. Type 1 Diabetes Sick Day Guide.