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THE GOLDEN RULE: Insulin should NEVER be omitted due to the risk of Diabetic Ketoacidosis (DKA)

ALWAYS check for ketones

EXTRA DOSES of rapid acting insulin are often required during illness.

This advice applies to adults.  for children contact the Paediatric Diabetes Team.

Food and Fluids 

• Maintain an adequate fluid intake (sugar free) of 100-200mL (approximately 1 glass) every hour
• Maintain a regular intake of carbohydrate, regardless of blood glucose. It may be difficult to persuade some patients or relatives of this!
• At mealtimes, if unable to eat, but tolerating fluids, take carbohydrate in the form of 200mL of the following: pure fruit juice, ribena, milk, milk with drinking chocolate or ovaltine, Flat Coca Cola or Lemonade (sugary).
• If vomiting, consider an anti-emetic injection.  Provide with 'Dioralyte' or 'Rehidrat'.  Instruct to reconstitute as directed and to take an egg-cupful every 10 minutes.
• Hospital admission is indic ated if unable to swallow or keep fluids down (see below).

Blood Glucose Monitoring

• Ensure that glucose monitoring technique and equipment is accurate and available.
• Increase blood glucose monitoring to at least 4 hourly.
• Arrange to review results with patient.  See contact numbers for Diabetes Specialist Nurses

Ketone Monitoring

• Ketonuria/Ketonaemia is an early sign of decompensation and if acted upon promptly, it will often prove possible to avert hospital admission (view below).
• Ketones should be checked 2 - 4 hourly during acute illness.
• Ketostix reagnet strips for uring testing
• Optium B-ketone test strips for blood ketone testing with Optium Xceed meter (MediSense Abbot).
• All people with Type 1 diabetes should be informed and educated in ketone monitoring.

Interpretation of ketone results during illness

 Insulin Management

•  NEVER OMIT INSULIN
• More insulin is often required during illness
• Increase routine insulin if the trend of recent blood glucose levels are elevated link to basic insulin adjustment
• During illness extra insulin can be administered 2-4 hourly to address elevated blood glucose levels (in addition to routine insulin doses)
• Insulin is required to correct ketosis
• If ketosis is evident with low or normal blood glucose levels (e.g. in patients who are vomiting) IV fluid and insulin is indicated and patient should be admitted to hospital
• Always recheck blood glucose and ketones within two hours to assess improvement or deterioration

• 20% of total 24 hour normal insulin dose
•  e.g. if person normally takes 30 units insulin per day
• give 6 units rapid acting insulin as stat dose

• 100 divided by total daily insulin dose e.g.
• assume total daily dose is 50 units
• 100 divided by 50 = 2
• therefore 1 unit of insulin will reduce (correct) blood glucose by 2mmol/L
• assume blood glucose is 20 mmol/L, then 5 units of rapid acting insulin will correct blood glucose to 10mmol/L
• aim to correct blood glucose to 10mmol/L

•  Inability to swallow or keep fluids down
• Persistent vomiting
• Persistent diarrhoea
• Strongly positive ketonuria/ ketonaemia with or without hyperglycaemia
• When ketoacidosis is clinically obvious i.e. dehydration, abdominal pain, intractable vomiting, rapid or laboured respirations

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