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Diabetes Sick Day Management
Aka: Diabetes Sick Day Management, Sick Day Management in Diabetes
- See Also
- Diabetes Mellitus
- Type I Diabetes Mellitus
- Type II Diabetes Mellitus
- Insulin Resistance Syndrome
- Glucose Metabolism
- Diabetes Mellitus Education
- Diabetic Ketoacidosis
- Hyperosmolar Hyperglycemic State
- Diabetes Mellitus Control in Hospital
- Diabetes Mellitus Glucose Management
- Diabetes Sick Day Management
- Hypertension in Diabetes Mellitus
- Hyperlipidemia in Diabetes Mellitus
- Diabetic Retinopathy
- Diabetic Nephropathy
- Diabetic Neuropathy
- Coronary Artery Disease Prevention in Diabetes
- Tobacco Cessation
- Obesity Management
- Management: General
- Diabetic action plan based on Blood Glucose Monitoring
- Early contact with medical provider when Glucose control acutely changes (see red flags listed below)
- Management: Medications
- Metformin
- Stop when dehydrated (e.g. Vomiting, Diarrhea) and restart when resolves
- Insulin Secretagogues (Sulfonylureas, Repaglinide, Nateglinide)
- Hold for decreased intake and risk of Hypoglycemia
- Bolus Insulin (e.g. Regular, Lispro)
- Increase Bolus Insulin by 5-20% for consistent Blood Glucose >250 mg/dl
- Hold or decrease Bolus Insulin for inability to take carbohydrates and risk of Hypoglycemia
- Consider smaller, more frequent Bolus Insulin doses (every 2-4 hours)
- Basal Insulin (e.g. Lantus, Detemir)
- Continue basal dosing despite illness
- Consider decreased basal Insulin Dosing if inability to eat carbohydrates
- Insulin Pump
- Make a back-up plan for Insulin Pump failure
- Management: Labs
- Glucose
- Seek medical attention (or call) for Blood Glucose consistently >300 mg/dl on at least 2 consecutive checks
- Increase monitor while ill
- No Insulin: 2-4 times daily
- Insulin: every 2-4 hours
- Ketones or Beta Hydroxybutyrate (in Type I Diabetes Mellitus)
- Home Ketone monitoring while ill (especially with Blood Glucose >240 mg/dl)
- Precautions: Red flags warranting repeat examination
- Prolonged Vomiting
- Inability to hold down fluids
- Presistent or Recurrent Hypoglcemia or Hyperglycemia
- Prevention: Emergency Supplies
- Extra Insulin
- Glucagon
- Glucometer and test strips
- Ketone testing (urine or blood)
- Fast acting Glucose (e.g. juice, Glucose tablets)
- Syringes and needles (also in case of Insulin Pump failure)
- References
- (2012) Presc Lett 20(3): 13-14
- Smith (2018) Am Fam Physician 98(3): 154-62 [PubMed]
- Westerberg (2013) Am Fam Physician 87(5): 337-46 [PubMed]