Diabetes & Sick Days

The human body will produce more insulin when being sick as a reaction to defend against sickness, as the body needs more energy to fight the disease. So, blood sugar level is expected to raise to higher level.

This increase in the fasting blood sugar may occure for any one, however, it may cause a problem to patients with type 1 diabetes as they may develop Diabetic Ketoacidosis.

It is a trial including :

High blood sugar level.
Acidosis.
Detection of Ketoacidotic bodies as acetones in the blood/urine.

Ketoacidotic bodies in the blood or urine is an indicator of acute deficiency of insulin and its unability to deal with high blood sugar level. In such case, the body will try to get its needs of energy by destroying fats, with consequent production of ketoacidotic bodies and blood acidosis.

tachypnea (rapid breathing)
abdominal pain, diarrhea
acetone smell of the breathing
redness of face
skin dryness
nausea & vomiting

Because if it is not managed properly by insulin and fluids the patient will get severe complications such as electrolyte imbalance, and subsequent imbalance, and subsequent effects of the body organs.

Recommendations for prevention of DKA and maintaining blood sugar level in cases os sickness.

If you suffers from symptoms of sickness such as runing nose, cough, high tempreture, or symptoms of inflamation you must do the following :

Check your blood sugar level and ketones (acetone) in the blood / urine every 4 hours.If the blood sugar level increases or acetone bodies are detected you must take additional dose of insulinas will be explained.
Take your main meals as usual, if it is difficult, try to take about 15 grams of carbohydrates every two hours (See the table below)
Drink a lot of fluids (unsweetened) to avoid dryness, at least you must drink 100 ml (about one cup) of water every two hours. (In the first hour take 15 grams of carbohydrates and take 100 ml of water on the succeeding hour)
Take all your doses of insulin as scheduled, and never skip any of them even if you did not eat.
Contact your doctor or go to emergency department at the hospital immediately when you.
a. are vomiting repeatedly.
b. are having frequent diarrhea.
c. can not keep food down.
d. ketone continue to appear, despite taking extra doses of insulin.
e. Do not know what to do.

Insulin extra doses (every 4 hours)
When ketones are absent and the blood glucose level is more than 8 Take an extra dose of insulin of 10% of the total units of insulin per day (ie if you take 100 units a day, take 10 extra units).

When ketones appear, Do the following

The 10% extra dose	When the ketones level is (+1)
Take an extra dose of insulin of 20% of the total units of insulin per day	When the ketones level is (+2)or (+3)
Seek medical advice immediately	If ketones continue to appear in blood or urine despite taking extra insulin doses:

Examples of foods containing 10 grams of carbohydrates:

One cup of milk	A small cup of unsweetened fruit juice
one scope of ice cream	Two tablespoons of jelly
A small packet of yogurt	½ small packet of fruit yogurt
One cup of soup	150 ml Pepsi or Coca-Cola (regular, not diet)

Examples at 100 ml of non-sweetened fluids :

Water	Diet Peps
Coca-Cola Diet	Seven Up Diet

How do you determine your extra dose of insulin

Add the numbers of all units of all types of insulin you take a day to determine the total insulin units: for example: If you take 10 units Actrapid before breakfast, , 10 units Actrapid before lunch, 10 units Actrapid before dinner and 30 units Lantos at bed time: -> the total insulin dose is: 60 units per day.

Your Extra insulin doses

10% of the total insulin units = 6 units.

20% of the total insulin units = 12 units.

Here is a table that helps you determine your 10% extra dose:

The 10% extra dose	The total insulin units per day
4 units	40 units
5 units	50 units
6 units	60 units
7 units	70 units
8 units	80 units
9 units	90 units
10 units	100 units

And here is a table that helps you determine your 20% extra dose:

The 20% extra dose	The total insulin units per day
8 units	40 units
10 units	50 units
12 units	60 units
14 units	70 units
16 units	80 units
18 units	90 units
20 units	100 units