Hyperglycaemia and sick day management for adults with type 1 diabetes

Hyperglycaemia and sick day management for adults with type 1 diabetes

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Having a sick day management plan is essential for managing blood glucose levels and preventing serious complications like diabetic ketoacidosis (DKA) and hypoglycaemia. When you're unwell or have an infection, your blood glucose levels can rise unexpectedly, requiring prompt action.

This guide has been developed for adults with type 1 diabetes using multiple daily injections (MDI), not insulin pump therapy. It should be used in consultation with your healthcare team to ensure safe and effective diabetes management during illness.

What you will learn in this fact sheet

This fact sheet provides critical information for managing type 1 diabetes during illness.

  • When to activate your sick day management plan.
  • Step-by-step guidance for monitoring and adjusting insulin.
  • How to calculate extra insulin doses based on blood glucose and ketone levels.
  • Nutrition and hydration strategies during illness.

When to action your sick day management plan

Activate your sick day plan when:

  • You are unwell or have an infection, even if your blood glucose level is normal.
  • Blood glucose levels are higher than 15mmol/L for 6 hours or more, even if you feel OK.
  • You have ketones in your blood or urine.
  • Based on previous experience (e.g. if you have an infection or are taking steroid medication).

Key steps to take

  1. Test your blood glucose level and adjust insulin
    Monitor blood glucose regularly and adjust insulin according to the guidelines in this fact sheet.
  2. Test your blood or urine ketone levels
    Check ketones as per sick day recommendations and adjust insulin accordingly.
  3. Continue to take your insulin
    Never stop taking insulin. Extra insulin may be required depending on your blood glucose and ketone levels.
  4. Try to continue to eat and drink
    Maintain hydration and nutrition if possible. Aim for 125–250ml of fluid per hour.
  5. Seek urgent medical attention
    Go to your nearest emergency department if you remain unwell or are unable to manage your diabetes.

Insulin adjustment guidelines

Your insulin adjustments depend on both your blood glucose levels and ketone levels. The following guidelines provide specific actions for different scenarios.

If blood glucose is less than 4.0mmol/L:

  • Blood ketones less than 1.0mmol/L
    Treat hypoglycaemia as usual, recheck in 15 minutes. Recheck blood glucose in 1 hour and ketones in 2 hours.
  • Blood ketones 1.0–1.4mmol/L
    Treat hypoglycaemia as usual, recheck in 15 minutes. If unable to eat or drink, phone 000 and give intramuscular glucagon. Recheck blood glucose in 1 hour and ketones in 2 hours.
  • Blood ketones more than 1.5mmol/L
    Treat hypoglycaemia as usual. Recheck blood glucose and ketones hourly until normalised.
  • Blood ketones more than 3.0mmol/L
    Seek urgent medical attention at your nearest emergency department.

If blood glucose is 4.1–8.0mmol/L:

  • Blood ketones less than 1.0mmol/L
    Continue usual insulin doses, drink fluids containing 15–20 grams carbohydrate. Recheck in 2 hours.
  • Blood ketones 1.0–1.4mmol/L
    Continue usual insulin doses, drink fluids containing 15–20 grams carbohydrate. Recheck blood glucose and ketones in 2 hours.
  • Blood ketones more than 1.5mmol/L
    Take 5% extra insulin, drink fluids containing 15–20 grams carbohydrate. Recheck blood glucose and ketones in 2 hours.
  • Blood ketones more than 3.0mmol/L
    Seek urgent medical attention.

If blood glucose is 8.1–15.0mmol/L:

  • Blood ketones less than 1.0mmol/L
    If ketones elevated for more than 2 hours, consider 5% extra insulin. Drink fluids containing 15–20 grams carbohydrate and administer usual insulin for carbohydrates. Recheck in 2 hours.
  • Blood ketones 1.0–1.4mmol/L
    If ketones elevated for more than 2 hours, consider 5–10% extra insulin. Drink fluids containing 15–20 grams carbohydrate and administer usual insulin for carbohydrates. Recheck in 2 hours.
  • Blood ketones more than 1.5mmol/L
    If ketones elevated for more than 2 hours, consider 10% extra insulin. Drink fluids containing 15–20 grams carbohydrate and administer usual insulin for carbohydrates. Recheck in 2 hours.
  • Blood ketones more than 3.0mmol/L
    Seek urgent medical attention.

If blood glucose is more than 15mmol/L:

  • Blood ketones less than 1.0mmol/L
    Take 5–10% extra insulin. Drink carbohydrate-free fluids OR drink fluids containing carbohydrate and administer insulin for carbohydrate. Recheck in 2 hours.
  • Blood ketones 1.0–1.4mmol/L
    Take 10–15% extra insulin. Drink carbohydrate-free fluids OR drink fluids containing carbohydrate and administer insulin for carbohydrate. Recheck in 2 hours.
  • Blood ketones more than 1.5mmol/L
    Take 15–20% extra insulin. Drink carbohydrate-free fluids OR drink fluids containing carbohydrate and administer insulin for carbohydrate. Recheck in 1 hour.
  • Blood ketones more than 3.0mmol/L
    Seek urgent medical attention.

IMPORTANT: Seek urgent medical attention if blood glucose levels or ketones continue to increase after two extra doses of insulin, or if you're unable to decrease blood glucose levels after two extra doses of insulin.

Supporting vital diabetes research

This evidence-based fact sheet was developed by the Baker Heart and Diabetes Institute, where our team provides specialist diabetes education and support.

Help us continue providing free, expert health resources. Your support enables us to develop more comprehensive fact sheets for diabetes management, conduct research that improves outcomes for people with type 1 diabetes, and make evidence-based health information freely accessible to all Australians.

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Calculating extra insulin

Your total daily dose (TDD) is the sum of your long-acting and rapid-acting insulin doses across the day. Extra rapid-acting insulin doses are based on a percentage of your TDD.

Work with your healthcare team to calculate:

  • 5% of your TDD
  • 10% of your TDD
  • 15% of your TDD
  • 20% of your TDD.

Keep these calculations readily available for quick reference during illness.

Nutrition and hydration tips

To avoid dehydration, keep drinking and eating if possible. Aim for 125–250ml of fluid per hour.

  • If blood glucose levels are less than 15mmol/L
    Have fluids containing carbohydrate (15–20 grams per hour) such as fruit juice, soft drink, milk or sports drinks.
  • If blood glucose levels are more than 15mmol/L
    Have fluids which don't contain carbohydrates (125–250ml per hour) such as water, diet soft drink, Powerade Zero, diet cordial, diet jelly or broth.

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Need personalised advice?

For individual guidance on sick day management tailored to your diabetes needs, contact the Baker Institute's diabetes education team.

Disclaimer
While reasonable efforts have been made to ensure the accuracy of this material, the information is provided on the basis that persons undertake responsibility for assessing the relevance and accuracy of its content. In particular, readers should seek independent professional medical advice from their general practitioner or specialist in relation to their own individual circumstance or condition before making any decisions based on this information. The material also includes summarised guidelines or recommendations based on information provided by third parties. The Baker Heart and Diabetes Institute disclaims to the extent permitted by law, all liability including negligence for claims of losses, expenses, damages and costs that the reader may incur (or suffer) from acting on or refraining from action as a result of all information in these materials.