Type 1 Diabetes — Sick-Day Management

Intro

Illness (fever, vomiting, infections) raises stress hormones that push glucose up and increase ketone risk. Never stop insulin on sick days—dose adjustments, more frequent checks, and fluids keep you safe.

Key Points

Keep taking basal insulin (pump or long-acting) even if not eating.
Check glucose and ketones more often (see schedule below).
Fluids every hour; add salts if vomiting/diarrhoea.
Seek urgent care with high ketones, vomiting, or signs of DKA.

Sick-Day Testing Schedule

Glucose: every 2–4 h (hourly if rising fast).
Ketones (blood preferred):
- If glucose >13.9 mmol/L (250 mg/dL) or you feel unwell → check now.
- Re-check every 1–2 h until normal.

Ketone Actions (general framework — follow your clinic plan)

Blood ketones	What to do
0.6–1.4 mmol/L	Extra fluids; correction insulin per plan; recheck in 1–2 h.
1.5–2.9 mmol/L	Fluids, extra insulin (often 10–20% of total daily dose or ~0.1 u/kg); recheck hourly*.
≥3.0 mmol/L or any vomiting/abdominal pain/drowsiness	Emergency department now. Start fluids and follow correction advice en route.

*Use your personalized sick-day rules; doses vary by clinic and individual.

Insulin Adjustments

Pumps: check for site/tubing failure first; change set if in doubt. Consider temporary higher basal if persistently high without ketones (per plan).
MDI: continue long-acting; use correction rapid-acting according to your sensitivity factor. If not eating, you still need basal and may need small correction boluses.

Hydration & Food

Aim for 250–500 ml fluids hourly. Use electrolyte solutions if vomiting/diarrhoea.
If unable to eat solids, try carb liquids (juice, oral rehydration) in small sips to match insulin needs.
If you cannot keep fluids down → urgent care.

When to Seek Urgent Care

Ketones ≥3.0 mmol/L, or moderate/large urine ketones.
Persistent vomiting, severe abdominal pain, deep/fast breathing, confusion, or extreme drowsiness.
Child, pregnancy, or significant co-illness → lower threshold for ED.

Medications & Extras

Avoid NSAIDs if dehydrated unless advised.
Some cold meds contain sugar/stimulants—check labels.
Keep backup pens/syringes even if you use a pump.

FAQ

Should I stop insulin if I’m not eating?
No. Keep basal going and use small corrections as needed.

Can I exercise to bring glucose down?
Not with positive ketones—exercise can worsen DKA risk.

What if ketone strips aren’t available?
Treat as higher risk: hydrate, give correction insulin per plan, and seek medical advice sooner.