Type 1 Diabetes — Sick-Day Management

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

🚑 Bottom Line

Keep taking basal insulin (pump or long-acting), even if not eating.
Check glucose + ketones frequently (every 2–4 hours; hourly if unwell or glucose rising).
Seek urgent care with ketones ≥3.0 mmol/L, vomiting, abdominal pain, drowsiness, or rapid breathing.

Sick-Day Testing Schedule

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

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

Insulin Adjustments

Pump users: check for site/tubing failure first; change set if in doubt. Consider a temporary higher basal rate if persistently high without ketones.
MDI (multiple daily injections): continue long-acting; give correction rapid-acting as needed. Even if not eating, you must take basal and small corrections.

Hydration & Food

Aim for 250–500 ml fluids hourly.
Use electrolyte drinks if vomiting/diarrhoea.
If unable to eat solids: take carb-containing liquids (juice, ORS, broth) in small sips to match insulin.
If you cannot keep fluids down → ⚠️ urgent medical care required.

When to Seek Urgent Care

Ketones ≥3.0 mmol/L, or moderate/large urine ketones.
Persistent vomiting, severe abdominal pain.
Rapid breathing, fruity-smelling breath, confusion, extreme drowsiness.
Children, pregnancy, or other co-illness → lower threshold for ED.

Medications & Extras

Avoid NSAIDs if dehydrated unless prescribed.
Check cold/flu meds — some contain sugar or stimulants.
Keep backup pens/syringes in case of pump failure.

FAQ

Should I stop insulin if I’m not eating?
No. Always continue basal insulin; use corrections as needed.

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

What if ketone strips aren’t available?
Act cautiously: hydrate, give correction insulin per plan, and seek medical advice sooner.