Diabetes Sick Day Management

Aka: Diabetes Sick Day Management, Sick Day Management in Diabetes

1. See Also
   1. Diabetes Mellitus
   2. Type I Diabetes Mellitus
   3. Type II Diabetes Mellitus
   4. Insulin Resistance Syndrome
   5. Glucose Metabolism
   6. Diabetes Mellitus Education
   7. Diabetic Ketoacidosis
   8. Hyperosmolar Hyperglycemic State
   9. Diabetes Mellitus Control in Hospital
   10. Diabetes Mellitus Glucose Management
   11. Diabetes Sick Day Management
   12. Hypertension in Diabetes Mellitus
   13. Hyperlipidemia in Diabetes Mellitus
   14. Diabetic Retinopathy
   15. Diabetic Nephropathy
   16. Diabetic Neuropathy
   17. Coronary Artery Disease Prevention in Diabetes
   18. Tobacco Cessation
   19. Obesity Management
2. Management: General
   1. Diabetic action plan based on Blood Glucose Monitoring
   2. Early contact with medical provider when Glucose control acutely changes (see red flags listed below)
3. Management: Medications
   1. Metformin
      1. Stop when dehydrated (e.g. Vomiting, Diarrhea) and restart when resolves
   2. Insulin Secretagogues (Sulfonylureas, Repaglinide, Nateglinide)
      1. Hold for decreased intake and risk of Hypoglycemia
   3. Bolus Insulin (e.g. Regular, Lispro)
      1. Increase Bolus Insulin by 5-20% for consistent Blood Glucose >250 mg/dl
      2. Hold or decrease Bolus Insulin for inability to take carbohydrates and risk of Hypoglycemia
      3. Consider smaller, more frequent Bolus Insulin doses (every 2-4 hours)
   4. Basal Insulin (e.g. Lantus, Detemir)
      1. Continue basal dosing despite illness
      2. Consider decreased basal Insulin Dosing if inability to eat carbohydrates
   5. Insulin Pump
      1. Make a back-up plan for Insulin Pump failure
4. Management: Labs
   1. Glucose
      1. Seek medical attention (or call) for Blood Glucose consistently >300 mg/dl on at least 2 consecutive checks
      2. Increase monitor while ill
         1. No Insulin: 2-4 times daily
         2. Insulin: every 2-4 hours
   2. Ketones or Beta Hydroxybutyrate (in Type I Diabetes Mellitus)
      1. Home Ketone monitoring while ill (especially with Blood Glucose >240 mg/dl)
5. Precautions: Red flags warranting repeat examination
   1. Prolonged Vomiting
   2. Inability to hold down fluids
   3. Presistent or Recurrent Hypoglcemia or Hyperglycemia
6. Prevention: Emergency Supplies
   1. Extra Insulin
   2. Glucagon
   3. Glucometer and test strips
   4. Ketone testing (urine or blood)
   5. Fast acting Glucose (e.g. juice, Glucose tablets)
   6. Syringes and needles (also in case of Insulin Pump failure)
7. References
   1. (2012) Presc Lett 20(3): 13-14
   2. Smith (2018) Am Fam Physician 98(3): 154-62 [PubMed]
   3. Westerberg (2013) Am Fam Physician 87(5): 337-46 [PubMed]