Diabetes – sick day plan

Preparation for Sick Days:

• Ensure you have a working glucose monitor and enough test strips for a week (up to 12 tests per day). Check strip expiry dates.
• Verify that you have an adequate supply of medications, including insulin.

When to Initiate the Sick Day Plan:

• Begin the plan if:
  • You feel unwell, even with normal glucose levels.
  • Your blood glucose levels exceed 15 mmol/L twice consecutively.
  • Your blood glucose levels drop below 4 mmol/L.

Blood Glucose Monitoring:

• Start monitoring your blood glucose if you aren’t already doing so when you initiate this plan.

If You’re Unable to Access Support:

• If you can manage, continue following the plan.
• If you feel too unwell, contact your doctor or diabetes care team for assistance.

Managing Low Blood Glucose (Hypoglycaemia):

• If glucose levels are below 4 mmol/L:
  • Consume 15 grams of glucose (e.g., 5–6 large glucose jelly beans).
  • Retest after 15 minutes. If still below 4 mmol/L, take another 15 grams of glucose.
  • Retest after another 15 minutes. If levels are still low, call your GP or dial 000.
  • If levels rise above 4 mmol/L, consume a slow-acting carbohydrate (e.g., bread, dry biscuit, milk) if you cannot eat a full meal within 20 minutes.
• Continue testing every 2–4 hours while unwell. Schedule an appointment with your GP or diabetes team to review.

Important: Do not drive if blood glucose levels are below 5 mmol/L.

Managing High Blood Glucose (Hyperglycaemia):

• Record blood glucose levels over 15 mmol/L for sharing with your healthcare provider.
• If taking insulin, follow relevant instructions under “For Insulin Users.”
• Contact your doctor or call 000 if:
  • Blood glucose levels remain above 15 mmol/L for 24 hours.
  • You experience abdominal pain, drowsiness, confusion, or breathing difficulty.

Blood Ketone Monitoring:

• Start ketone monitoring if instructed by your health team, or if:
  • Blood glucose exceeds 15 mmol/L for over 4 hours.
  • You are taking SGLT2 inhibitors or insulin.
  • You have symptoms such as abdominal pain, drowsiness, or breathing issues.
• Notify your doctor if ketone levels are above 1.5 mmol/L.

If Taking Diabetes Tablets or Non-Injectable Medicines:

• Do Not Stop Medication unless advised. Your GP may advise stopping certain medications (e.g., metformin, GLP-1 RA, SGLT2 inhibitors, sulfonylureas) if you have vomiting, diarrhoea, or cannot tolerate fluids.
• Continue monitoring ketones if on SGLT2 inhibitors.

If Taking Insulin:

• Do Not Stop Insulin without advice.
• Dose adjustments may be required during illness—seek guidance from your GP or health team.
• Monitor blood glucose every 2 hours while unwell and refer to “Low Blood Glucose” or “High Blood Glucose” sections as needed.
• If glucose levels fall below 4 mmol/L, follow hypoglycaemia instructions.
• For glucose levels above 15 mmol/L while on basal insulin:
  • Temporarily increase basal insulin dose by 10%.
  • If glucose normalizes, resume usual dosage.
  • If glucose remains above 15 mmol/L after 4 hours, initiate ketone monitoring and, if necessary, administer additional rapid-acting insulin as directed.

Food and Fluids:

• Stay hydrated by drinking 250 mL of fluid hourly.
  • For glucose levels above 15 mmol/L, drink water or non-carbohydrate fluids.
  • For glucose below 15 mmol/L, any fluids, including those with sugar, are acceptable.
• Eat carbohydrates if possible, even if nauseated. Light or soft foods like soup (not just broth) are recommended.

Recovery:

• Once blood glucose is stable (below 15 mmol/L but above 4 mmol/L) and you’re eating and drinking well, resume any paused medications.
• Schedule a review with your GP or diabetes care team to discuss illness management.

When to Seek Emergency Care:

• Contact your GP if:
  • You cannot monitor glucose or keep fluids down.
  • Blood glucose exceeds 15 mmol/L for more than 24 hours.
  • Blood glucose stays above 15 mmol/L despite two extra insulin doses.
  • Blood glucose falls below 4 mmol/L and cannot be stabilized.
  • Blood ketone levels exceed 1.5 mmol/L.
  • You experience severe symptoms such as drowsiness, confusion, difficulty breathing, or persistent vomiting (more than 2–4 hours).