Diabetes Information Sheet
Sick Day Rules for Patients on Insulin
People with diabetes do not get more illness compared to people without
diabetes. However, if you are feeling unwell you will need to take special care
as illnesses such as ‘flu or a tummy bug can cause your blood sugar (glucose)
level to rise. This can happen even if you are unable to eat or if you are
vomiting.
What should I do if I am unwell?
Your body’s natural response to illness is to make more sugar. Often this
means that you will need to take a higher dose of insulin than usual, rather
than cutting the dose or not taking any insulin. Reducing your insulin dose or
stopping it altogether can lead to serious problems and might cause a
condition called Diabetic Ketoacidosis, which can be fatal in some people (see
later).
The first rule is:
Never stop taking your insulin
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Blood sugars can rise even if you do not eat.
You will need more insulin if your blood sugar goes higher than 13 or
if you have ketones in your urine or blood (see below for how much
insulin to take)
What else do I need to do?
Test your blood sugar more often than usual
 Check this every 2 to 4 hours.
 If you cannot do this yourself, ask a relative or friend to help
Test your urine or blood for ketones regularly
 Use “Ketostix” to test your urine - your diabetes nurse specialist will show
you how to use them.
 Use a meter to test for blood ketones if you have one (MediSense Optium
meters can do this)
 Check for ketones every 2 to 4 hours
© Milton Keynes Hospital NHS Foundation Trust
Produced By: Adapted by Dr S Weatherhead
Date Produced: 11/2004, reviewed 08/2007, 09/2009
Review Date: 09/2012
Version No: ENDO/PI/013/V1
Page 1 of 3
Diabetes Information Sheet
Sick Day Rules for Patients on Insulin
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If you have ketones it is likely that you are lacking in insulin. If you ignore
this, then ketoacidosis may develop (see below). Drink plenty of fluids
You can easily become dehydrated when you are ill, especially if you have
a temperature or have diarrhoea or vomiting
Take at least five pints of sugar free liquids, especially water, a day.
This is approximately one glass every hour
If you cannot manage a whole glass at once, take regular sips of water
Try to eat your normal diet
 If you are unable to do this, replace your meals with sugary fluids such as
milk, fresh fruit juice, soup, Lucozade or ordinary cola - see below.
 Take around 10g Carbohydrate every hour if you can
Each of these contains 10 grams carbohydrate.
Milk
1 cup (200ml)
Fruit Juice (unsweetened)
1 small glass (100ml).
Lucozade
50mls
Coca Cola (not diet)
150mls
Lemonade (fizzy/sweetened)
150mls
Ice cream
1 briquette or 1 scoop
Jelly (ordinary)
2 tablespoons
Yoghurt (fruit)
½ small carton (60gms)
Yoghurt (plain)
1 small carton (120gms)
How much insulin should I take?
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If blood sugar is less than 13 mmol/L, take you usual insulin dose and
remember to check your urine or blood for ketones.
 If you are still unwell check your blood sugar every 2-4 hours until you are
feeling better and eating and drinking normally.
 If your blood sugar is higher than 13mmol/l, take extra insulin - see below.
Remember to test again after 2-4 hours to see if this has worked.
Always check for ketones if blood sugars are increasing
© Milton Keynes Hospital NHS Foundation Trust
Produced By: Adapted by Dr S Weatherhead
Date Produced: 11/2004, reviewed 08/2007, 09/2009
Review Date: 09/2012
Version No: ENDO/PI/013/V1
Page 2 of 3
Blood sugar level (mmol/L)
13 - 22
22 -28
Over 28
What to do
Take an extra 4 units of fast acting insulin (e.g.
Actrapid, Velosulin, Humulin S, NovoRapid) before
mealtime or bedtime
Take an extra 8 units of fast acting insulin (e.g.
Actrapid, Velosulin, Humulin S, Novorapid)
Speak to your Diabetes Team or GP
If Ketones are large +++ in your urine double these extra insulin doses.
NB. These extra insulin doses are for adults. Halve the doses for
children.
You may need to be admitted to hospital. Contact your GP or diabetes
specialist nurse if any of the following happens:
 Unable to swallow or keep fluids down
 Persistent vomiting
 Persistent diarrhoea
 Very high blood sugars (over 28 mmol/L) in spite of taking extra insulin
 Persistently high levels of ketones in the blood or urine in spite of taking
extra insulin
 If you develop abdominal pain, become short of breath or drowsy
Diabetic Ketoacidosis (DKA)
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The symptoms of ketoacidosis are thirst and passing large amounts of
urine, followed by abdominal pain, sickness, vomiting, drowsiness and
heavy laboured breathing.
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It is very important to prevent DKA happening. Never miss out insulin
injections especially when you are unwell. If DKA develops, it must be
recognised and treated quickly.
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Ketoacidosis is a serious condition and may even cause death. You
must seek medical help if you develop the symptoms of DKA.
Contact your Diabetes Specialist Nurse or GP if:
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You are vomiting, not improving or becoming drowsy.
Your blood sugar stays high, even after treatment, or it is low.
You are unsure of how much insulin or fluid to take.
You are worried and need advice.
Diabetes nurse specialists at MK hospital. 01908 243089
‘Adapted with the permission from Tayside Diabetes Clinical Network leaflet’
© Milton Keynes Hospital NHS Foundation Trust
Produced By: Adapted by Dr S Weatherhead
Date Produced: 11/2004, reviewed 08/2007, 09/2009
Review Date: 09/2012
Version No: ENDO/PI/013/V1
Page 3 of 3