Diabetes
Type 1 Diabetes — Sick-Day Management
2025-08-30 • Updated 2025-09-14
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.
Further Reading
- NHS — Type 1 Diabetes: Sick Day Rules
- American Diabetes Association — Sick Day Management
- ISPAD Clinical Practice Consensus Guidelines — Sick Day Management (2022)
Related Guides
- Diabetes Emergencies — Hypos, Highs, and Ketones
- DKA Quick Reference (Type 1 Diabetes)
- Recognising Highs and Lows
- Night-time Hypoglycaemia
- Diabetes in Children and Adolescents
- Type 1 Diabetes — Guide Hub
Educational only; not a substitute for professional medical advice.
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