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Sick day and ketone management for injections

  • What should I do if my child’s ketones are greater than or equal to (>) 1.0mmol/L and they use injected insulin?

    Important: Get urgent medical advice if there is persistent vomiting or any change to conscious state or breathing

    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 

    Remember

    • Insulin is essential in the body all the time. Never stop insulin!
    • 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
    • For RCH patients, 24/7 sick day support is available. Call the RCH switchboard 9345 5522 and ask for the “diabetes sick day service”