Planning sick-day management for type 1 diabetes
Sick days are defined as periods of an acute illness (usually 1 to 14 days duration) that require changes to a patient’s usual diabetes self-management practices. Fact sheets about sick-day management for patients with type 1 diabetes are available1.
Educate all patients with type 1 diabetes about sick-day management and give them an individualised, written sick-day management plan, including contact numbers for emergency assistance and directions for when to go to hospital. With care and close medical support, most patients do not need hospitalisation during an acute illness.
Patients with type 1 diabetes should monitor blood glucose and blood ketone concentrations frequently (ie every 1 to 4 hours) during an acute illness. Ideally, all patients with type 1 diabetes should have access to a blood glucose meter that can measure blood ketone concentrations. Otherwise, urine ketone strips can be used; however, a strong clinical suspicion of diabetic ketoacidosis (DKA) with a negative urine ketone result should prompt further assessment. See Ketone monitoring.
Blood ketone concentration of 0.6 mmol/L or more (or more than trace ketones in the urine) with hyperglycaemia suggests the need for extra insulin and increased fluids, and could indicate the onset of DKA. Urgent advice is necessary (see Diabetic ketoacidosis for information about management).
To avoid ketosis during an acute illness, patients with type 1 diabetes should:
- maintain adequate insulin
- maintain adequate fluid intake
- eat or drink adequate carbohydrate
- seek treatment for the underlying cause of illness and/or hyperglycaemia.
Off-label treatment of patients with type 1 diabetes with sodium-glucose co-transporter 2 (SGLT2) inhibitors has been associated with the development of DKA, and this risk is increased in the context of acute illness. Patients who become unwell should immediately stop taking the SGLT2 inhibitor and check their blood ketone concentration, regardless of blood glucose concentration (which may not be elevated). If blood ketone concentration results are not immediately attainable and DKA is suspected, it is a medical emergency and should generally be managed in hospital (see Diabetic ketoacidosis for management). See information about SGLT2 inhibitors and DKA in Diabetic ketoacidosis associated with sodium-glucose co-transporter 2 inhibitors.