From the Guidelines
The correct statement regarding sick-day rules is to monitor blood ketones irrespective of blood glucose concentration. During illness, patients should regularly check for ketones even when blood glucose levels appear normal, as ketone production can occur due to the body's stress response and altered metabolism during sickness. This monitoring is crucial because ketone buildup can lead to diabetic ketoacidosis (DKA), a serious complication, even when glucose levels aren't severely elevated. The other options contain incorrect advice:
- insulin should never be omitted during illness (even with vomiting) 1,
- insulin requirements typically increase during acute illness rather than decrease 1,
- overnight glucose monitoring remains important during sick days, and
- insulin adjustments should follow specific guidelines rather than arbitrary six-hour dosing 1. Proper ketone monitoring allows for early intervention to prevent metabolic decompensation during illness. Key points to consider in sick-day management include:
- Never discontinue insulin, even with severe vomiting or diarrhea 1
- Increase the frequency of blood glucose testing during the day and consider continuous glucose monitoring 1
- Monitor for ketones, especially when blood glucose is high or when symptoms of illness are present 1
- Adjust insulin doses based on blood glucose levels and according to individualized guidelines 1
- Maintain adequate hydration and consider an easily digestible diet containing carbohydrates and salt 1
- Seek professional advice early in the course of illness if symptoms worsen or if blood glucose or ketone levels are not manageable 1
From the Research
Correct Statement Regarding 'Sick-Day Rules'
The correct statement regarding actions patients should take when following the general principles of 'sick-day rules' is:
Incorrect Statements
The following statements are incorrect:
- Administer additional short-acting insulin (dose individualised for patient) every six hours if blood glucose is above target: There is no evidence to support this statement as a general principle of 'sick-day rules' 4, 5
- Omit insulin if the patient has severe vomiting and diarrhoea: Omitting insulin is not recommended, as it can lead to diabetic ketoacidosis (DKA) 2, 6
- Increase the frequency of blood glucose testing during the day but omit overnight to allow patient to rest: There is no evidence to support omitting overnight blood glucose testing 3, 5
- Reduce insulin dose in acute febrile illness as it can lead to a reduction in a patient’s blood glucose: Reducing insulin dose is not recommended, as it can lead to DKA 2, 4