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!
- Check your blood glucose and keytones (blood or urine).
- Drink plenty of extra fluids.
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
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 |
ACTION NEEDED |
Your dose |
Blood sugar |
__ |
No extra Insulin. Decrease dose of pre-meal insulin as directed. Contact your health team if vomiting! |
|
Blood sugar |
Blood ketones |
Use usual insulin dose (and scale) as for non-sick days. |
|
Blood sugar |
Blood ketones |
Take a 10% supplement of rapid or fast-acting insulin, in addition to baseline usual insulin doses. |
|
Blood sugar |
Blood ketones |
Take a 10% supplement of rapid or fast-acting insulin, in addition to baseline usual insulin doses. |
|
Blood sugar |
Blood ketones |
Take a 15% supplement of rapid or fast-acting insulin, in addition to baseline usual insulin doses. |
|
Blood sugar |
Blood ketones |
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! |
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.