Your sugar is extremely high , such as
over 240mg/dl twice in a row, or Your sugar is extremely high , such as
over 240mg/dl twice in a row, or
You have nausea , vomiting or are unable
to eat.
The presence of nausea and vomiting should be recognized as potentially indicating ketoacidosis or 'DKA'. If there is any question on your part that you might be in DKA, call your diabetes team immediately.
1) If you are unable to eat, do NOT omit your usual insulin doses!! This is the #1 mistake beginners make when they get sick. Just because you aren't eating, doesn't mean your body doesn't need insulin. In fact, in times of illness you may need MORE insulin, even when unable to eat.
2) Drink lots of fluids to prevent dehydration. If you are vomiting and unable to keep fluids down, you need to call us. We may either need to see you in the office or ER, or we may be able to call in medications to help control your nausea.
Good ideas for food & fluids are soup broth, bouillon , Gatorade diluted 50/50 with water, regular 7-Up, Pedialyte, etc. If all else fails, try ginger ale with the bubbles removed by warming on the stove or microwave. Try saltine crackers to settle your stomach.
3) Monitor your glucose every 3 - 4 hours while sick. ( This one is non-negotiable.)
4) If your glucose is more than 240, check urine ketones. You should always have strips on hand, but if you 'just ran out' have Mom, Dad, spouse, friend, etc, go buy Ketostix or Chemstrip uK. And if nobody can get you the strips, your local pharmacy can deliver them. When you call the doctors office to report your illness, the first words out of their mouth will likely be "What are your urine ketones ?". So be prepared, have those strips on hand and use them.
5) If you have more than a trace of urine ketones, you need to take extra fast acting insulin on top of your usual insulin dose. Ketones are a sign of insulin deficiency. We call this extra insulin dose a 'sick day dose'. To decide how much extra 'sick day dose' to take, add all of your usual insulin doses for the day. Divide this total by 6. This gives you the sick day dose.
Example: You take 5 Humalog + 10N in am, 8 Humalog at supper , 10N at bedtime. Your total daily dose is 33 units per day. 33units divided by 6 is 5.5 units. If we round this off to 6, your sick day dose is 6 units of fast acting insulin (Humulin R / Novolin R / Humalog)
Repeat your glucose every 4 hours. Every time your glucose is more than 240, and you have more than trace ketones, give another sick day dose.
6) Don't do this on your own. If you live alone, call a friend or relative to stay and help you. Notify your doctors office that you are sick as they may need to see you.
7) Call us if you aren't getting better. If you can't get your ketones less than 3+ after 2 or 3 sick day doses , or if you can't keep anything down, you need to call us. If you are having chest pain or shortness of breath, call our answering service to let us know and proceed directly to the hospital.
You should check ketones for any readings above 200. Call us immediately for more than than 2 readings with positive ketones, or for inability to keep fluids down. Also call us for repeated high readings, even without ketones.
1) In addition to the above, give your sick day doses via a regular syringe, not the pump, until we can verify the pump is working properly.
2) Change out your infusion set. You may have developed an occlusion in the set, or pinched off the plastic tubing underneath the skin where you can't see it. In our experience, pump alarms never go off fast enough, so don't rely on an alarm.
3) Call us or your pump manufacturer to troubleshoot the pump with you.
1) You doctor may not be at his/her office when you call. Be prepared to tell your usual insulin dose, and have your logbook handy to review your recent logbook readings.
2) Be ready to report your urine ketones. If you don't have strips, call and tell us you are out of strips.
3) Measure your temperature, and let the doc know if it is above normal. Report any pains, chills, sweats, rash, GI problems, or any unusual events. If you missed an insulin dose, let us know.
4) Call sooner rather than later. In general, doctors think more clearly at 8pm than at 2am. If it looks like you might need attention, call early.
Numbers for Amarillo Medical Specialists Patients:
William C. Biggs MD 358-8331
Ken M. Brantley MD PhD 354-0895
Stephen J. Usala MD PhD 358-8437
Cesar Arias MD 358-8331
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Amarillo Medical Specialists provides online information as a community service. The information contained in this site is presented as an educational resource and should not take the place of the advice and recommendations of your personal physician. If you have or suspect you have a health problem, please call or visit a health care professional.
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This page last updated: 10/23/05