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Sick day rules for pump users

Sickness is an unavoidable part of everyday life. The body’s natural response to illness results in higher blood glucose levels due to the release of stress hormones. During illness, you will need frequent blood glucose monitoring and often more insulin than usual.

What are ketones?

Ketones are acids which can make you feel very sick. They are produced when body is not getting enough food (glucose) or your body is not able to use glucose due to lack of insulin. If you do not get rid of ketones, you can become dehydrated and eventually develop diabetic ketoacidosis (DKA).

Check for ketones whenever you are ill, regardless of your glucose levels as you can have raised ketones with normal glucose levels such as starvation ketones with gastroenteritis.

Sick day rules

Never stop the insulin. Even if you are eating less than normal, your body needs insulin to use glucose and to get rid of ketones.

Check your blood glucoses more frequently for example, every 2 hours including throughout the night.

Check for blood ketones. Give additional fast acting insulin every 2 hours if blood glucose is above target.

If ketones are present when blood glucose is low, they are called ‘starvation ketones and respond to drinking extra fluids containing sugar. This can happen when you are being sick lots or have diarrhoea. Monitor blood glucose very closely, and extra insulin may be needed when blood glucose starts rising. Treat hypoglycaemia (blood glucose less than 4.0 mmol/L) as you usually do. Contact the hospital for advice if struggling to keep blood glucose over 5 mmol/L.

Keep well hydrated by drinking plenty of fluids. Water or sugar-free fluids are probably most appropriate in the majority of cases where blood glucose levels are normal or high. If blood glucose levels are low, sugary drinks are needed or eat carbohydrates if possible. Avoid carbonated drinks if possible.

Inform the diabetes team early to seek advice.

Using an insulin pump

  • Standard checks on the pump should be made for occlusions, disconnection and battery failures.
  • Give correction doses through the pump if blood ketone levels are less than 0.6mmol/L. If 1 correction dose given via the pump has no effect in 1 hour, repeat the correction dose with insulin pen.
  • If blood ketones levels are 0.6mmol/L or more, give correction doses with an insulin pen.

You should contact the hospital if:

  • you are not confident in managing high ketone levels
  • your child is being sick
  • ketones are over 1.5 mmol/L, regardless of blood sugar levels, for 6 hours or more when following the sick day rules advice
Blood glucose is 8.1 mmol/l or more

Ketones less than 0.6

Blood glucose is 8.1 mmol/l or more

Ketones between 0.6 and 1.4

Blood glucose is 8.1 mmol/l or more

Ketones more than 1.5

Continue usual background insulin rate. Increase background insulin rate to 130 percent for 2 hours. Increase background insulin rate to 150 percent for 2 hours.
Corrections: Give usual correction doses for high blood glucose levels (using your pump settings). Corrections: Calculate your total daily dose (TDD) and give 10 percent of TDD with an insulin pen (instead of via your pump). Corrections: Calculate your total daily dose (TDD) and give 20 percent of TDD with an insulin pen (instead of via your pump).
Change your pump cannula if you think there is a problem with your pump. Change your pump cannula if you think there is a problem with your pump. Change your pump cannula if you think there is a problem with your pump.
Food: If you are eating, have your usual amount of insulin for carbs in addition to the correction. Food: If you are eating, have your usual amount of insulin for carbs in addition to the 10 percent of TDD correction. Food: If you are eating, have your usual amount of insulin for carbs in addition to the 20 percent of TDD correction.
Check your blood glucose and ketones regularly if unwell. Check your blood glucose and ketones every 2 hours. Check your blood glucose and ketones every 2 hours.
  • If ketones are less than 0.6 and blood glucose is 8 mmol/l or more, follow this first column of advice again.
  • If blood glucose is 8.1 mmol/l or more, and ketones are between 0.6 and 1.4, follow the second column of advice.
  • If blood glucose is 8.1 mmol/l or more, and ketones are 1.5 or more, follow last column advice.
Information:

If you have followed the last column of advice 2 times, and ketones are still 1.5 or more, ring for advice.

If ketones are more than 1.5mmol/L for more than 6 hours or if your child is being sick with high ketones or having difficulty breathing, bring them to A&E.

Calculating total daily insulin

Total daily insulin (total daily dose) is all the insulin you usually have in a day. This will vary a bit depending on what you eat each day. Follow the points below to work out you total daily insulin:

  1. What is the total basal (background) insulin?
  2. How much insulin do you usually short-acting with breakfast?
  3. How much insulin do you usually short-acting with lunch?
  4. How much insulin do you usually short-acting with tea?
  5. How much insulin do you usually short-acting with supper?
  6. Do you usually have any snacks needing insulin? If yes, write the amount of insulin for each snack down:

You now need to add all the amounts of insulin above up to get your total daily insulin (total daily dose).

To work out 10 percent of your total daily dose, take the total daily insulin, and divide it by 10.

To work out 20 percent of your total daily dose, take the total daily insulin, and divide it by 10, and then times that by 2.

For example:

Total daily dose

(Total Daily Dose includes background and short-acting insulin for a typical day)

 

Sick day dose (in addition to basal and short-acting given) of quick acting insulin

10 percent 20 percent
1 to 10 units 1 unit 2 units
11 to 15 units 1.5 units 3 units
16 to 20 units 2 units 4 units
21 to 25 units 2.5 units 5 units
26 to 30 units 3 units 6 units
31 to 35 units 3.5 units 7 units
36 to 40 units 4 units 8 units
41 to 45 units 4.5 units 9 units
46 to 50 units 5 units 10 units
51 to 55 units 5.5 units 11 units
56 to 60 units 6 units 12 units
61 to 65 units 6.5 units 13 units
66 to 70 units 7 units 14 units
71 to 75 units 7.5 units 15 units
76 to 80 units 8 units 16 units
81 to 85 units 8.5 units 17 units
86 to 90 units 9 units 18 units
91 to 95 units 9.5 units 19 units
96 to 100 units 10 units 20 units

Please download this diabetes sick day rules chart for pump users to keep at home.

Contact us

If you have any questions or concerns, please contact the diabetes team on 0114 271 7320 from 9am till 5pm between Monday and Friday.

Out of hours contact the on-call medical registrar via the switchboard on 0114 271 7000 and tell the switchboard you want to speak to someone for advice regarding your child’s diabetes.

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Disclaimer

Please note this is a generic information sheet relating to care at Sheffield Children’s. The details in this resource may not necessarily reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If you have specific questions about how this resource relates to your child, please ask your doctor.

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NHS

Western Bank
Sheffield
S10 2TH

United Kingdom

Switchboard: 0114 271 7000

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