Sick Day Golden Rules

1. Never stop taking insulin

• The doses of insulin may need to be increased (or decreased in some cases) depending on blood glucose levels.
• The increased need for insulin may persist for a few days after the illness has passed
• Insulin should be adjusted according to the sick day rules provided.

2. Frequent blood glucose monitoring

• Regular testing is essential
• Test 2-3 hourly even overnight and more often if blood glucose levels remain high
• Aim to keep blood glucose above 5mmol/l and less than 14mmol/l
• For more information, download this document

3. Ketone Testing

• Ketones must be checked at first sign of sickness (high temperature, feeling sick, abdominal pain etc)
• Ketones must be checked if blood glucose >14mmol/l

4. Give extra fast acting insulin for ketones

• If blood glucose level is above 14mmol/L and urine ketones are 1+ or greater, or if blood ketones are 0.6mmol/L, additional fast acting insulin is required.
• See flow chart/sick day dose table

5. Rest

6. Medications

• You can give over the counter or prescribed medications as directed for example paracetamol, antibiotics, sugar free cough syrup

7. Regular dietary intake

• Drink plenty of water and sugar free liquids to prevent dehydration
• Normal meal patterns should be maintained if possible
• If appetite is reduced, meals can be replaced with carbohydrate containing drinks
• If vomiting, encourage to drink small, regular amount of fluids
• See ‘Dietary intake during sickness’ for suggestions

For advice please speak to your Diabetes Team.