From the Guidelines
Sick day management in diabetic care should prioritize self-monitoring of blood glucose every 4-6 hours, checking ketones if receiving insulin or SGLT2i, and increasing fluid intake with limited caffeine to reverse volume depletion or dehydration and avoid hypoglycemia or ketoacidosis, as recommended by the most recent consensus guidelines 1. When managing sick days in diabetic care, it is essential to consider the symptoms and signs of acute illness that should trigger sick day management, such as vomiting or diarrhea resulting in significant fluid losses, anorexia or nausea resulting in significant decrease in fluid intake, and new lightheadedness, dizziness, or fainting 1. Key aspects of sick day management include:
- Self-management is appropriate when there is an absence of severe symptoms, patients feel they are able to cope, and patients can keep up with their fluid intake 1.
- Assistance or support from healthcare providers should be sought when patients feel they are not coping, signs and symptoms have not resolved within 72 hours, or patients cannot keep up with intake of foods or fluids 1.
- Patients receiving insulin should receive instructions for more frequent self-monitoring of blood glucose and for the duration of symptoms, while those receiving SGLT2i, insulin, or on ketogenic diets should check ketones 1.
- Increasing fluid intake with limited caffeine and considering electrolyte replacement solutions is crucial to reverse volume depletion or dehydration and avoid hypoglycemia or ketoacidosis 1. It is also important to note that certain medications, such as SGLT2i, NSAIDs, and potassium-sparing diuretics, may need to be temporarily stopped during sick day management, and that empirical increases in basal and bolus insulin doses may be necessary if blood glucose is more elevated than usual 1. Overall, the goal of sick day management in diabetic care is to prevent complications such as diabetic ketoacidosis and to ensure that patients receive the necessary support and guidance to manage their condition effectively during times of illness, as highlighted by the importance of early recognition and treatment of hyperglycemic crises in diabetes 1.
From the Research
Sick Day Management in Diabetic Care
Sick day management is crucial for individuals with diabetes to prevent complications such as diabetic crises or hypoglycemia. The key principles of sick day management include:
- Maintaining hydration and carbohydrate intake
- Monitoring blood glucose and ketone levels
- Adjusting diabetes medications according to carbohydrate intake, blood glucose, and ketone levels 2
Importance of Sick Day Management
Elderly patients with diabetes need to take extra precautions on sick days to avoid diabetic crises or hypoglycemia 2. Gastrointestinal illnesses may cause hypoglycemia in individuals treated with insulin, sulfonylureas, or glitinides, while discontinuing insulin or diabetes medications due to appetite loss and reduced food intake may lead to diabetic crises such as ketoacidosis or hyperosmolar hyperglycemic syndrome.
Comparison of Insulin Analogues
Studies have compared the efficacy and safety of rapid-acting insulin analogs, such as lispro and aspart, in the treatment of diabetes. These studies have shown that lispro and aspart have comparable efficacy and safety in adult patients with type 1 and type 2 diabetes 3, 4, 5, 6. The use of these insulin analogs can help manage blood glucose levels and prevent hypoglycemic episodes.
Adjusting Diabetes Medications
Adjusting diabetes medications according to carbohydrate intake, blood glucose, and ketone levels is crucial for effective sick day management. This may involve adjusting the dose or type of insulin, as well as monitoring blood glucose levels regularly 2. Healthcare professionals can provide guidance on adjusting diabetes medications during sick days to prevent complications.