Diabetes sick day advice
Sick day management advice for people with Type One and Type Two diabetes.
Sick day advice - type 1
If patients have a current sick day plan, they should follow this. Otherwise:
- make contact with 0800 242 228 for specific advice if in the Waikato
- other localities contact can be made with your local diabetes service/ED.
Remember increased blood glucose testing, blood ketone testing, increase in insulin doses and rehydration may be necessary.
Sick day advice - type 2
If patients are in respiratory distress, at risk of hypoxia, or have vomiting or diarrhoea their Metformin and Jardiance must be stopped at this time.
For patients taking Jardiance, there is increased risk of euglycaemic diabetic ketoacidosis (euDKA) if they develop diarrhoea or vomiting. Anyone prescribed Jardiance who presents acutely unwell to the practice should have their capillary ketone levels checked using the Caresens Dual meter (meter and strips available on MPSO) even if their blood glucose levels are within target range. Ketones ranging 0.6 – 1.5mmol/L may require fluid replacement and correction insulin (Novorapid/Humalog/Apidra) prn, but for those above 1.5mmol/L transfer to hospital may be required.
Patients prescribed Jardiance should be discouraged from following a ketogenic diet strategy as this increases the likelihood of euDKA.
During bouts of illness the blood glucose is likely to be high due to stress, or low due to vomiting or low food intake. It is important patients increase blood glucose monitoring and are helped to make changes to insulin doses in reaction to current blood glucose levels. A correction insulin regimen at mealtimes may be required. Further information can be found on the Ministry of Health website.
Remember people with T2 or undiagnosed T2 can present with hyperosmolar hyperglycaemic state (HHS) and admission to hospital may be necessary in these cases.
Sick day advice resources are below in the files and links section.
Sick day advice - type 1
If patients have a current sick day plan, they should follow this. Otherwise:
- make contact with 0800 242 228 for specific advice if in the Waikato
- other localities contact can be made with your local diabetes service/ED.
Remember increased blood glucose testing, blood ketone testing, increase in insulin doses and rehydration may be necessary.
Sick day advice - type 2
If patients are in respiratory distress, at risk of hypoxia, or have vomiting or diarrhoea their Metformin and Jardiance must be stopped at this time.
For patients taking Jardiance, there is increased risk of euglycaemic diabetic ketoacidosis (euDKA) if they develop diarrhoea or vomiting. Anyone prescribed Jardiance who presents acutely unwell to the practice should have their capillary ketone levels checked using the Caresens Dual meter (meter and strips available on MPSO) even if their blood glucose levels are within target range. Ketones ranging 0.6 – 1.5mmol/L may require fluid replacement and correction insulin (Novorapid/Humalog/Apidra) prn, but for those above 1.5mmol/L transfer to hospital may be required.
Patients prescribed Jardiance should be discouraged from following a ketogenic diet strategy as this increases the likelihood of euDKA.
During bouts of illness the blood glucose is likely to be high due to stress, or low due to vomiting or low food intake. It is important patients increase blood glucose monitoring and are helped to make changes to insulin doses in reaction to current blood glucose levels. A correction insulin regimen at mealtimes may be required. Further information can be found on the Ministry of Health website.
Remember people with T2 or undiagnosed T2 can present with hyperosmolar hyperglycaemic state (HHS) and admission to hospital may be necessary in these cases.
Sick day advice resources are below in the files and links section.