What is the best way to manage insulin needs during a sick day for individuals with diabetes?

Managing Insulin Needs During Sick Days for Individuals with Diabetes

Never discontinue insulin during illness, as this is essential to prevent diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), which are potentially life-threatening complications. 1

Key Components of a Sick Day Insulin Management Plan

Monitoring Requirements

• Check blood glucose more frequently (every 2-4 hours)
• Test for ketones when blood glucose exceeds 300 mg/dL 1
• Monitor and record:
  • Temperature
  • Respiratory rate
  • Pulse rate
  • Body weight
  • Fluid intake and output 1

Insulin Adjustments

1. For elevated blood glucose levels:

   • Increase basal and bolus insulin doses by 10-20% 1
   • Continue to take basal insulin even if not eating 1
   • Use supplemental short-acting or rapid-acting insulin for correction doses

2. For low blood glucose levels:

   • Hold prandial insulin (bolus) until blood glucose levels recover
   • Do not discontinue basal insulin completely, but consider reducing dose 1

3. For patients on insulin pumps:

   • Continue basal rates
   • Adjust bolus doses based on blood glucose readings
   • Change infusion sets more frequently (every 1-2 days instead of 3) to prevent occlusion 2

Fluid and Nutrition

• Maintain adequate hydration with sugar-free fluids if blood glucose is elevated
• Consume easily digestible carbohydrates and salt when able to eat 1
• If unable to eat solid food, substitute with liquid carbohydrates (broth, juice, regular soda) to prevent hypoglycemia while continuing insulin

When to Contact Healthcare Provider

Instruct patients to contact their healthcare provider immediately if:

• Blood glucose remains >300 mg/dL despite correction doses
• Moderate to large ketones are present
• Unable to keep down fluids for >4 hours
• Experiencing symptoms of DKA (vomiting, abdominal pain, fruity breath, rapid breathing)
• Experiencing symptoms of dehydration (dry mouth, decreased urination)
• Fever persists >101°F (38.3°C) 1

Special Considerations

Type 1 Diabetes

• Never completely discontinue insulin, even when not eating
• Risk of DKA is significantly higher
• May need more aggressive insulin adjustments during illness 1

Type 2 Diabetes

• Continue basal insulin
• Adjust prandial insulin based on carbohydrate intake
• May need temporary increases in insulin doses during acute illness 1

Common Pitfalls to Avoid

1. Discontinuing insulin completely - This is the most dangerous mistake and can lead to DKA or HHS
2. Inadequate monitoring - Failure to check glucose and ketones frequently enough
3. Insufficient fluid intake - Dehydration worsens hyperglycemia
4. Delayed medical attention - Waiting too long to contact healthcare providers when warning signs appear
5. Not adjusting insulin doses - Failure to increase insulin when blood glucose remains elevated 1

Implementation Tips

• Review sick day management periodically with all patients before illness occurs
• Ensure patients have emergency supplies (extra insulin, ketone testing supplies, glucagon)
• Provide written instructions that are easy to follow during illness
• Ensure patients have a way to contact healthcare providers during illness 1

By following these guidelines, patients can effectively manage their insulin needs during illness, significantly reducing the risk of complications and hospitalizations related to diabetes.