6.5 Sick day management

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6.5 Sick day management12

Period of illnesses e.g. fever, vomiting or diarrhoea, often cause hyperglycemia and ketosis, and sometimes hypoglycemia. To prevent these, certain management principles are followed:

  • The person needs to test his/her blood for glucose 4 hourly at home and if possible test urine Ketones. The blood glucose measurements should be written down in a diary.
  • The aim or target to maintain between 6-10 mmol/L.
  • Be aware of signs of hypoglycemia. Manage Hypoglycemia at home promptly and test more frequently.
  • Fluid balance needs to be maintained; during illness sufficient intake is necessary. If the blood glucose is low, sweetened fluids, e.g. fruit juice can be given. If blood glucose is elevated, low calorie soft drinks, soup or broth may be given. Drink 120-180 ml of water or calorie free fluid each half hourly when awake. Try to eat normal meal schedule.
  • Contact by telemedicine if required.
  • The OADs should never be stopped altogether; dose may need to be reduced. If there is acute illness, specially in vomiting and diarrhoea, stop Metformin temporarily. Stop SGLT2 inhibitor to avoid ketosis and dehydration. DPP4 inhibitors can be continued. SU should be used cautiously, dose may be readjusted.
  • Do not stop insulin. Intermediate or basal insulin should be continued; the dose may need to be readjusted. If blood glucose remains above 10 mmol/L, increase insulin by 2 units. If decreased below 6 mmol/L, reduce insulin dose by 2 units. Shorter acting insulin should be adjusted according to blood glucose values and food intake. If necessary, short/rapid acting insulin can be given after meal, seeing the amount of intake or vomiting.
  • Sometimes the OADs may need to be replaced by shorter acting ones or insulin. If OAD need to be discontinued, the alternative is insulin.
  • These principles are to be followed until the blood glucose is <12 mmol/L and ketone diminishes or disappears.
  • Regular exercise and physical activity should be postponed during sick days.
  • Following conditions require hospitalization:
    • Vomiting or diarrhoea persisting for longer than 6 hours
    • Sick for 3 days and not getting better
    • Blood glucose remains above 14 mmol/L for 6 hours
    • Presence of ketonuria
    • Very young individual, individuals with T1DM and pregnant ones
    • Abdominal pain
    • Hyperventilation or breathing difficulties
    • Confusion or feeling drowsy
    • Co-existing serious diseases like ESRD, heart failure etc.