Sick Day Guidelines

Managing Acute Illness When You're Pumping

| May 1, 2003

Insulin pump users can get sick, just like everyone else.

An acute illness can lead to out-of-control blood-glucose levels. But it is possible to maintain good control and avoid problems when you're sick.

What do you do about your basal and bolus doses of insulin when you don't feel like eating or cannot eat?

What if you are nauseated or vomiting, either from high blood glucose or from the illness?

Examples of minor illnesses include colds, nausea/vomiting, sore throat, mild infections, diarrhea, fever or the aftermath of dental surgery. A major acute illness could be the flu or appendicitis. Long-term illnesses could include mononucleosis or hepatitis.

What follows are suggestions of what to do if you or your child is under the weather.

Call Your Healthcare Professional If You Have Any of the Following:

  • An illness persisting without improvement for 24 to 48 hours.
  • A temperature over 100 degrees F (37.7 degrees C).
  • Vomiting or diarrhea lasting longer than four hours. Type 1s should seek medical advice when vomiting more than once.
  • Moderate to large amount of ketones in your urine (or blood) tests, which do not decrease with extra bolus doses of insulin.
  • Blood-glucose levels that continue to run lower than 60 mg/dl or greater than 240 to 300 mg/dl (greater than 130 mg/dl during pregnancy), even after taking extra bolus doses as prearranged with your doctor.
  • Signs of ketoacidosis, dehydration or other serious problems such as fruity breath odor; dry cracked lips, mouth or tongue; increasing drowsiness; abdominal or chest pain; difficulty breathing.
  • Uncertainty about how to take care of yourself.

Do Not Omit Your Insulin!

If you are ill and cannot eat, your need for insulin continues and may even increase, depending on the illness.

Some bacterial infections—such as bladder or sinus infections or a sore throat—can increase insulin needs. The higher the blood-glucose and ketone levels, the greater the need for insulin.

Continue your usual basal dose of insulin, along with your insulin correction factor, as prearranged with your doctor or healthcare professional. But don't assume that your insulin sensitivity/correction formula will always take care of lowering higher-than-target blood-glucose levels when you have an illness. During acute illness, this formula may also need to be adjusted.

If you have not used the temporary basal rate increase function of your pump, review it now with your doctor or healthcare professional. You don't want to try to figure it out in an emergency or when you're feeling too ill to concentrate. You might need to temporarily increase or decrease your basal rate by using this feature during an illness.

If you increase your rates, remember that you must also be ready to adjust them downward as you recover from the illness.

Pay Attention to Fluids and Diet

What to eat when you don't feel like eating or can't eat? Let your blood-glucose level be your guide.

If your blood glucose is in your normal target range, you need calories: glucose tabs, nondiet ginger ale or other nondiet, caffeine-free sodas, juices, hard candies and sugared gelatin desserts. You may not need to decrease your normal basal delivery.

If your blood glucose is high—greater than 240 to 300 mg/dl—you need noncaloric fluids: water, tea without sugar, instant broth, diet drinks, ice chips, sugar-free icicle pops, or sugar-free gelatin.

If your blood glucose is lower than your target range, in addition to adding carbs, you might need to reduce your basal rates as long as you are not eating or are experiencing vomiting or diarrhea.

If you are able to eat, don't be surprised if usual—or even smaller—meals require a change in your insulin-to-carbohydrate ratio.

Fluid intake is essential with any illness. You may need to drink 4 to 8 ounces of liquid every 30 to 60 minutes and consume 10-15 grams of carbohydrate every one to two hours, which can be in liquid form.

If you vomit, start fluids one to two hours later and sip slowly. It's a good idea to have anti-nausea/vomiting medications on hand; use them as needed and as directed by your doctor.

Persistent vomiting and diarrhea require medical attention because either condition can lead to serious fluid and electrolyte emergencies.

Test Blood Glucose and Check for Ketones

Test your blood glucose before your usual mealtimes as well as every two to four hours.

Test your urine (or blood) for ketones at least four times a day, or according to instructions from your healthcare team.

Keep Good Records

Try to make notes about what's going on—blood-glucose readings, ketone checks, episodes of vomiting, temperature, and so on. These records will be helpful if you need to speak with your diabetes team.

Play It Safe

The Seacoast Diabetes Institute in Dover, New Hampshire, suggests maintaining a "sick day kit," which should include the phone numbers of your physician and/or diabetes educator; clear liquids that contain sugar and/or electrolytes such as Gatorade; extra testing supplies; syringes and insulin; a medication recommended for fever; a thermometer; sugar-free cough drops or syrup; and anti-nausea/anti-diarrheal medications. (Ask your doctor for recommended brands or prescriptions.) Remember to periodically pay attention to expiration dates and storage conditions of items such as insulin and test strips.

Always follow the sick day guidelines you've worked out with your doctor or healthcare team. Guidelines for children will be specific to the age group. Work closely with your diabetes management team to be sure that you have specific guidance before an illness strikes.

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Categories: Blood Glucose, Columns, Diabetes, Diabetes, Insulin, Insulin Pumps, Motivation, Syringes, Type 1 Issues


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