Diabetes – sick day plan

Ensure access to a working glucose meter and sufficient test strips for at least 7 days (12 tests/day if needed).
Confirm test strips are within expiry date.
Maintain an adequate supply of all prescribed diabetes medications, including insulin if applicable.
Have rapid-acting carbohydrates (e.g., glucose tablets, juice) available.

Initiate your sick day plan if any of the following occur:

Treat with 15g of rapid-acting carbohydrate (e.g., ½ cup juice or 5–6 large jelly beans).
Retest in 15 minutes:
- If still <4 mmol/L, repeat 15g carbohydrate.
- If still <4 mmol/L after second dose: seek urgent medical help.
Once BGL is >4 mmol/L and next meal is >20 minutes away, consume a slow-acting carbohydrate (e.g., slice of bread, glass of milk).
Do not drive until BGL is consistently ≥5 mmol/L.

Record BGL and any symptoms (e.g., fatigue, abdominal pain).
Continue hydration.
Monitor for ketones, particularly if:
- You take insulin or SGLT2 inhibitors.
- BGL remains >15 mmol/L for more than 4–6 hours.
Seek medical advice or go to ED if:
- BGL >15 mmol/L persists >24 hours.
- You develop symptoms like drowsiness, nausea, confusion, or laboured breathing.

Check blood ketones (preferably over urine) if:
- BGL >15 mmol/L for >4 hours.
- You are taking SGLT2 inhibitors or insulin.
- Symptoms suggest possible ketosis.
Notify your GP or diabetes team if blood ketones >1.5 mmol/L.

🔄 Management Based on Medication Use

Continue medications unless advised otherwise.
Temporarily withhold the following during vomiting, diarrhoea, or poor oral intake:
- Metformin – to avoid risk of lactic acidosis
- SGLT2 inhibitors – risk of dehydration, euglycaemic DKA
- Sulfonylureas – risk of hypoglycaemia with poor intake
- GLP-1 receptor agonists – risk of worsening nausea/vomiting
Restart these medications once eating and drinking normally, after medical review.

Never stop insulin, including basal insulin, unless specifically advised by a healthcare provider.
Monitor BGL every 2 hours during illness.
For basal insulin, if BGL >15 mmol/L persistently:
- Consider a temporary 10% dose increase.
- Monitor response over the next 4–6 hours.
- If no improvement: check ketones and consider correction with rapid-acting insulin (if prescribed and trained to use).
Contact your GP or diabetes team for guidance on:
- Correction doses
- Ketone management
- Adjusting insulin for missed meals

Aim for at least 250 mL of fluids every hour:
- Sugar-free fluids (e.g., water, electrolyte drinks) if BGL >15 mmol/L.
- Carbohydrate-containing fluids (e.g., juice, lemonade) if BGL <15 mmol/L or unable to eat.
Eat easy-to-digest carbohydrate-containing foods (e.g., soup with noodles, crackers, toast).
Try to maintain regular carbohydrate intake even if appetite is reduced.

Once stable (BGL between 4–15 mmol/L, eating and drinking normally):
- Resume paused medications if cleared by your GP.
- Review with your diabetes care team to adjust treatment as needed.

Contact your GP or go to hospital if: