The following advice relates to days when you are unwell

• Insulin is essential in the body all the time. Never stop insulin!
• Insulin doses may need to be changed when you are unwell 
• Monitoring of glucose and ketones will increase
  
• Always check ketone levels when your child is unwell, regardless of what their glucose level is 
• If vomiting and ketones are present and you are unsure of appropriate treatment, call your diabetes treating team early for support with insulin dose adjustments
• You need to bring your child into your closest emergency department for urgent assessment if they have signs of diabetic ketoacidosis (DKA). DKA is a medical emergency and the signs include vomiting, abdominal pain, rapid breathing, drowsiness and ketones 3.0 mmol/L or higher  
  

Sick day management falls broadly into two different categories:

1) Illnesses that cause Hyperglycaemia (HIGH BGL’s)

Illness can trigger stress hormones that cause insulin resistance. This can lead to high BGLs  

• Insulin doses may need to be increased
• Check BGL’s every 2 hours
• Check blood ketones every 4 hours
• See your GP to treat underlying the illness / infection
• Give analgesics to relieve headaches or sore throat

Encourage sugar free fluids to maintain hydration

2) Illnesses that cause Hypoglycaemia (LOW BGL’s)

Vomiting, diarrhoea, nausea and reduced appetite can all lead to Hypoglycaemia.

• Insulin doses may need to be decreased. Insulin can never be stopped but doses can be reduced to minimise the frequency of hypo with decreased appetite.
• Check BGL’s every hour
• Check blood ketones every 4 hours 
  Ketones can be produced during illness even with normal or low BGL’s
• Sip on sugar containing fluids 
• Mini doses of glucagon may be used to treat hypoglycaemia if unable to tolerate food or fluids.
  
  

What should I do if ketone levels are greater than or equal to (>) 1.0mmol/L when using injected insulin?

1. If BGL > 15mmol/L

• Give 10% of total daily insulin dose using rapid acting insulin (NovoRapid or Humalog) immediately
• Check ketones in 2 hours and seek medical advice if ketones remain > 1.0 mmol/L
• Extra insulin may be required if BGL remains >15mmol/L & ketones remain > 1.0 mmol/L after 2 hours
• Seek medical advice if ketones continue to rise, there is persistent vomiting or any change in conscious state

2. If BGL 8.0mmol/L - 15mmol/L

• Consider giving 5 -10% of total daily insulin dose using rapid acting insulin.
• Encourage extra carbohydrate to maintain BGL
• Check ketones in 2 hours and seek medical advice if ketones remain 1.0 mmol/L or higher 

3. If BGL 4.0mmol/L – 7.9mmol/L

• Encourage extra carbohydrate to maintain BGL
• Give normal insulin dose
• Check ketones in 2 hours and seek medical advice if ketones remain 1.0 mmol/L or higher 

4. If BGL < 4.0mmol/L

• Treat hypo and encourage sweetened fluids
• Seek medical advice if insulin is due – reduction in insulin dose may be required
• Check ketones in 2 hours and seek medical advice if ketones remain 1.0 mmol/L or higher 

When to contact the hospital:

It is important to follow the above sick day management and then contact the hospital if you are needing more support 

• You are unsure about how to change the insulin doses for the sick day 
• Your child has had 3 vomits or diarrhoea or has unrelieved abdominal pain, particularly if associated with high BGLs
• Your child is drowsy or lethargic  
• After following the above advice, you are unsure how to manage blood ketones of 1.0 mmol/L or higher

RCH Sick day service phone number 9345 5522 ask for the “Diabetes sick day call” (for RCH patients) 

Last updated March 2023