Managing Illness and Diabetic Ketoacidosis (DKA) when
taking a mixed insulin twice daily
When you are ill, your body becomes more resistant to the insulin you are
taking so you will always require more. In addition, you will produce stress
hormones that will cause your glucose levels to rise.
At these times increasing your mixed insulin to reduce your glucose levels
can be problematic as the extra insulin will not necessarily work quickly
enough and has a longer duration than desired. To try and overcome this
you have been supplied with ……………… which is a very short acting
insulin which has an immediate effect and will hopefully assist you to
manage your illness more effectively. This dose will be based on a
“correction dose calculation” -see below
The following gives you guidelines on when the ……………insulin maybe
be needed as well as your regular………… mixed insulin twice a day.
Correction Dose
This varies between people based on the amount of insulin they require
daily, but is usually calculated using the formula below:
100
total daily dose of insulin
=
correction dose
The correction dose tells you how many mmols your blood glucose will
change for every 1 unit of rapid-acting insulin you inject.
My correction dose is100
total daily dose of insulin
=
So 1 unit of rapid-acting insulin changes my blood glucose by …………
mmol
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Symptoms of hyperglycaemia
Symptoms of high blood glucose levels (hyperglycaemia) may
include:
 Passing lots of urine
 Thirst
 Weakness/tired
 Blurred vision
 Abdominal pain
 Leg cramps
 Nausea and vomiting
 Acetone/pear drop breath
Possible causes:
 Illness
 Infection
 Stress
 Hormonal
 Steroids
 Insulin degradation (inadvertent freezing, out of date etc.)
 Omitting insulin
Implications of ketone levels
In the absence of sufficient insulin, the body’s cells cannot use glucose for
energy. The cells will switch to an alternative energy source and body fat
will be broken down to supply the necessary energy
.
This rapid breakdown of fat can cause the build-up of substances known as
ketones. Eventually, the blood glucose and ketones rise to levels that cause
the blood to become acidic and this is known as diabetic ketoacidosis
(DKA). The only treatment for DKA is insulin and fluids.
Ketones can be measured in urine by various brands of ketone stix or in
blood by using a MediSense Optium or Glucomen LX plus meter. It is
advisable to check the expiry date on urine and blood strips before use.
As DKA can develop and progress quickly and makes you feel very unwell,
please use the following guidelines if you are ill.
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Managing illness if glucose levels are high
It is recommended that you test your blood or urine for ketones if your blood
glucose levels are over 14 mmol/l.
What should I do if I have a positive ketone test?

You should take ………. (rapid acting insulin) as soon as you can.
Take double your correction dose
My doubled correction dose is:
2 units of ………………. will lower blood glucose by ………… mmols

Drink plenty of water and sugar-free fluids

Test blood glucose every 2 hours and repeat the above dose until
blood/urine is negative to ketones

Try to identify cause of high blood glucose level and seek treatment if
necessary

Contact diabetes team if high glucose and ketones levels persist
Diabetes Specialist nurse contact details:
Office: ……………………………………
Mobile………………………………………
Email……………………………………..

Contact GP/ Accident and Emergency Dept if you are vomiting as
dehydration may occur

Urgent hospital admission required if ketones persist with either any
shortness of breath, abdominal pain or continuous vomiting

Continue with usual amount of …………… mixed insulin at breakfast
and evening meal
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What should I do if I’m ill and my blood glucose levels
are high but I do not have ketones?

You should continue to test for ketones every 2 hours if your blood
glucose levels remain above 14 mmol/l. If you have a positive ketone test,
treat as above

If your ketone test is negative, but your blood glucose levels remain
above 14 mmol/l, take your usual correction dose and this can be repeated
at each mealtime
My usual correction dose is:
1 unit of ……….rapid-acting insulin will lower blood glucose by ……mmols

Drink plenty of water and sugar-free fluids

Try to identify cause of high blood glucose level and seek treatment if
necessary

Continue with usual amount of……………… mixed insulin at breakfast
and evening meal
Safety advice for illness
 Always continue taking your mixed insulin and use the rapid acting
insulin to compensate for high glucose levels.
 Use guide for correction doses based on being no ketones or
hyperglycaemia/illness with ketones
 Test for ketones if your blood glucose levels are above 14 mmol/l
 Positive ketone tests always require treatment
What if I cannot eat?
 If you are feeling unwell and off your food then healthy eating is not a
priority and so you may prefer foods with a higher sugar or fat
content.
 Try soups, milky puddings or fruit and ice cream rather than full meals
 It maybe easier to have regular small snacks rather than three main
meals
 If you are unable to eat, you can obtain carbohydrate from alternative
sources such as fizzy soft drinks, milky drinks,soups, fruit juice or ice
cream
 If you are vomiting try to sip small amounts of non diet coke or
lemonade
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The below table gives examples of foods that contain 10g carbohydrate per
portion that could be taken in 2-3 servings 4-5 times per day when you are
unwell and unable to manage proper meals.
Type of drink
Ribena original
Fruit Juice
Amount=10g carbohydrate per
portion
2
Diluted in water
tablespoons
100ml
4floz ½ glass
Cola
(not diet)
Lemonade
(not diet)
Milk
100ml
4floz ½ glass
200ml
8floz 1 glass
Soup
200ml
8floz 1 mug
Ice cream
50g
2oz
150 – 200ml 6floz ¾ - 1 glass
1 large scoop
Complan
3 level tsp
Drinking
Chocolate
Ovaltine or
Horlicks
Dextrose tablets
2 level tsp
2 level tsp
3 tablets
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A Quick Guide to Calculate Correction Doses
1 unit ………….(rapid acting insulin) will bring my blood glucose level
down by ……..mmols in the absence of ketones
2 unit ………… (rapid acting insulin) will bring my glucose levels down
by ……………mmols when ketones are present
My blood
glucose level is
I need this much
extra insulin to
bring me down to
…………mmols
I need this much extra
insulin when I have
KETONES to bring me
down to
…………mmols
11 mmols
12
13
14
15
16
17
18
19
20
21
22
23
24
25
If regularly giving corrections doses as well as normal mixed
insulin (when ketones are not present), this is likely to suggest that
the mixed doses need to be increased. Please seek help from
your Diabetes Specialist Nurse for advice on how to increase the
doses appropriately.
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