Sickness is associated with elevated levels of stress hormones that trigger a number of changes that can lead to diabetic ketoacidosis (DKA):
Sick Day Plan
A sick day plan aims to manage the hyperglycaemia and prevent your patient deteriorating into DKA.
It should be used if your patient is:
Overt DKA should be referred immediately to hospital.
Symptoms that indicate DKA include:
A sick day plan instructs your patient to:
It requires a sick day kit that includes:
Call for help or go to the hospital immediately when you are:
What to do when you recover
Now, what can you learn from the experience? How can you make it better for next time you are sick?
Ask yourself these questions:
Sick Day Guide
Use this guide to help you manage your insulin doses, what to drink and how often to check your glucose levels and ketones when you are sick.
Always be guided by your experience and the advice from your diabetes team. When in doubt or you are worried, please call for help – your doctor, your diabetes nurse or your hospital.
Rescue treatment for hypoglycemia
Give fast-acting carbohydrate to raise the glucose level quickly.
Glucose gel, honey or jam can be absorbed from the inside lining of the mouth (mucosa), so these are good options for when someone is unable to cooperate and swallow food or drink.
Don’t give the long acting carbohydrate until the glucose level has come up above 4, because this will slow down the action of the fast-acting carbohydrate. That means it will take longer for the blood glucose to recover.
|Action||You can care for yourself||Unable to follow commands – someone else is helping you||Unconscious or having seizures|
|Step 1||Check the glucose level||Check glucose||
And consider calling the ambulance
Call the ambulance
|Step 2||Immediate treatment||Give a dose of short acting carbohydrate*||Give a dose of short acting carbohydrate in the front part of their mouth or an injection of Glucagon||Give Glucagon injections (intramuscular). If Glucagon is unavailable, give a dose of glucose in the front of their mouth|
|Step 3||Recheck the glucose level||In 15 minutes||In 5 minutes||In 5 minutes|
|Step 4||Glucose level is still below 4||Give another dose of short acting glucose||Give another dose of short acting glucose or Glucagon in the muscle||Give another dose of Glucagon in the muscle|
|Step 5||Glucose level is above 4||Give 15 grams of long acting carbohydrate||If awake and following commands, give 15 grams of long acting carbohydrate||If awake and following commands, give 15 grams of long acting carbohydrate|
|Step 6||Post-hypo care||
Look for causes of the hypo
Adjust insulin doses to prevent further hypos
If hypo was severe, aim for glucose targets 5 – 10 mmol/L
Examples of fast-acting and slow-acting carbohydrates to treatment hypos: Only give one of these options, not all!
|Fast acting carbohydrate options
(15 gram serves)
(15 gram serves)
|You are able to care for self and follow command||You are unable to cooperate or swallow||Able to cooperate|
|4 Dextrose tablets
Glucose gel (15g)
Soft drink (full sugar) 150ml
4 glucose jelly beans
7 regular jelly beans
|Gently introduce gel in the along the gums or over the tongue:
Glucose gel (15g)
Honey or jam (3 teaspoons)
|1 tub yoghurt
1 slice of bread
Medium piece of fruit
1 glass of milk
1 muesli bar
|Short acting carbohydrate options (7.5 gram serves) for children under 30kg||Long-acting carbohydrate
(7.5 gram serves)
|Able to care for self and follow command||Uncooperative patient||Able to cooperate|
|2 Dextrose tablets
Glucose gel (7.5g)
Soft drink (full sugar) 75ml
2 glucose jelly beans
4 regular jelly beans
Gently introduce gel in the along the gums or over the tongue:
|½ tub yoghurt
½ slice of bread
1 Small piece of fruit
½ glass of milk
This is the treatment for a severe hypo when your patient is unable to cooperate or swallow glucose drinks or food. It stimulates release of hepatic glycogen. It is an intramuscular injection and works within 5 minutes. Educate the patient’s family and friends on how to use the injection.
When doesn’t it work – insufficient hepatic glycogen:
See hypoglycaemia section above.