T1 Sick day rules

There are a number of variants on sick day rules for Type One diabetics available.  Most are similar to those found on this page (which also includes a link to T2 sick-day rules).

The Dafne course is a little more explicit, and the essential points are reproduced here:

During illness, never stop taking your insulin. Your body is likely to become more insulin resistant during illness, so you need to monitor bg closely and may need more insulin.

Dafne uses two categories of illness: minor, where blood glucose levels are not too elevated and ketones don’t appear as more than a trace, and severe, where bg levels are over 13 or ketones are present.

For both types of illness, Dafne stresses the importance of testing bg and ketones.

Minor

If bg is less than 8mmol/l and ketones are negative
Maintain usual ratios of bolus insulin.
Maintain usual basal doses
Monitor 4-6 hourly.
(If you are not eating, you may only need the basal insulin.)

If bg is more than 8mmol/l and ketones are negative or trace
Maintain usual ratios of bolus insulin.
Add corrective doses of bolus.
Increase basal doses by 1-2 units
Monitor 4-6 hourly.
(If you are not eating, you may still need corrective bolus insulin.)

If bg is more than 13mmol/l and ketones are more than trace follow the “severe illness” rules.

Severe

If bg is 10-13mmol/l and ketones are “small” or “moderate”
Calculate the total insulin (basal and bolus) in the previous 24 hours, calculate 10 per cent of that.
Bolus: take take equivalent of 10 per cent of that daily total every 2 hours
Plus normal bolus ratio for anything you eat.
Maintain usual basal doses
Monitor bg and ketones 2 hourly.
Have 100ml of sugar-free liquids per hour.

When bg drops below 10mmol/l AND ketones are negative or trace:
Eat/drink 10-20g carb
Use normal bolus ratios
Use normal basal dose.
Monitor bg and ketones 2-4 hourly.

If bg is over 13mmol/l and ketones are “moderate” or “large”
Calculate the total insulin (basal and bolus) in the previous 24 hours, calculate 20 per cent of that.
Bolus: take equivalent of 20 per cent of that daily total every 2 hours
Plus normal bolus ratio for anything you eat.
Maintain usual basal doses
Monitor bg and ketones 2 hourly.
Have 100ml of sugar-free liquids per hour.

When bg drops below 10mmol/l AND ketones are negative or trace:
Eat/drink 10-20g carb
Use normal bolus ratios
Use normal basal dose.
Monitor bg and ketones 2-4 hourly.

General notes:

During illness, if you are vomiting you don’t need to eat until you feel well enough to do so, but try to keep sipping fluids.

If you continue to vomit, cannot keep fluids down and/or cannot reduce your blood glucose or ketone levels (or if you are unsure what to do) call your GP, diabetes team or hospital as an emergency.

 
 

Sick Day Rules for Insulin Pump Users

Sick Day Rules for Insulin PumpForum member Liam kindly shared this handy flowchart-style guide to sick day rules for insulin pump users. It is based on an Animas pump, but should be adaptable for other brands.

If in any doubt, please contact your healthcare provider or pump manufacturer for guidance.

Download as an Adobe Acrobat PDF file: Sick Day Rules