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Treating high sugar: What do I do about food, fluids & insulin when I feel sick?

When you are sick (blood glucose levels are running high):

  • Always take some insulin! Never omit it!
When ill, your body may release its own stored sugar, causing a rise in blood glucose even though you may not eat as much. You always need to take insulin and you may need extra insulin.
  • Check your blood glucose and keytones (blood or urine).
Test blood glucose & ketones before meals and/or every 4 hours around the clock.
  • Drink plenty of extra fluids.
Your body needs about 9 cups (2200 ml) of fluid daily to prevent dehydration.

If you cannot eat as usual, replace solid food with sugar containing fluid.

  • If you vomit twice or more within 8 hours, call your doctor or go to an Emergency Room.
  • Remember to call your diabetes doctor or nurse if you need help.


Dietary Guidelines: If you cannot eat as usual, replace solid food with sugar containing fluids. Try to take 10 grams of carbohydrate every hour.

Suggested 10 grams servings:


mls.
cups
75 apple or pineapple juice 1/3
125 orange juice 1/2
50 regular Jello 1/4
75 regular pop 1/3
100 ice cream 1/3
50 sherbet 1/4
200 milk 3/4
75 sugar-sweetened Kool-Aid 1/3
125 apple sauce 1/2
1/2 Popsicle

**Avoid milk products if you are vomiting or have diarrhea


Managing your insulin doses when you are ill

Use the ‘sick day’ Diabetes Management Guidelines below for dealing with high blood s sugars when you have a fever, flu or infection, and when your blood glucose levels are running high.
  • Test blood sugar (glucose) and ketones every 4 hours, all day & night.
  • If blood ketones >3.0 mmol/L at any time, go to an Emergency Room immediately - you will need Intravenous (IV) insulin and fluids.
  • The Total Daily Dose (TDD) formula helps you decide how much extra rapid or fast-acting insulin you need to take.
      • Add up the number of units of insulin (all kinds) you usually take each day (use baseline or usual doses). Your TDD =______ units.
      • Calculate 10% = ____ 15% = _____20% =____ of TDD. This is the extra dose (or supplement).
      • Follow the chart to decide how much fast/rapid acting insulin to take every 4 hours in addition to your usual baseline insulin doses. Repeat insulin every 4 hours, if needed, per chart.
      • If not eating as usual, replace the usual carbohydrate with sugar containing fluids.

Your blood sugar tests (mmol/L)

Your blood ketone tests
(mmol/L)

ACTION NEEDED
* Able to take fluids

Your dose

Blood sugar
< 3.9

__

No extra Insulin. Decrease dose of pre-meal insulin as directed. Contact your health team if vomiting!


Blood sugar
4.0 –16.0

Blood ketones
< 0.6

Use usual insulin dose (and scale) as for non-sick days.


Blood sugar
4.0 –16.0

Blood ketones
>
  0.6

Take a 10% supplement of rapid or fast-acting insulin, in addition to baseline usual insulin doses.


Blood sugar
> 16.0

Blood ketones
< 0.6

Take a 10% supplement of rapid or fast-acting insulin, in addition to baseline usual insulin doses.


Blood sugar
> 16.0

Blood ketones
>
0.7 – 1.4

Take a 15% supplement of rapid or fast-acting insulin, in addition to baseline usual insulin doses.


Blood sugar
> 16.0

Blood ketones
>
1.5- 3.0

Take a 20% supplement of rapid or fast-acting insulin, in addition to baseline usual insulin doses. CALL your Health Care Team as soon as possible!


 

Example 1:
    At bedtime your blood glucose is 24.8 and blood ketones are 0.8 mmol/L.

    Recommended action: Take a 15% supplemental dose of rapid or fast-acting insulin, plus bedtime insulin. Recheck blood glucose and ketones every 4 hours during the night! Repeat insulin dose in 4 hours, as needed per chart. Maintain usual carbohydrate and extra fluids.
 

Example 2:
    At lunch your blood glucose is 25.6 and blood ketones are 2.0.
 
    Recommended action: Take baseline lunch dose PLUS a supplement of 20% of TDD as rapid or fast acting insulin. Maintain usual carbohydrate intake and extra fluids. Recheck blood glucose and ketones in 2-4 hours. Discuss cause with physician.