Sick Day Guidelines and Ketone Testing

Transcription

1 Sick Day Guidelines Sick Day Guidelines and Ketone Testing 6 Steps for Sick Days (All Patients) 1. Prevention: Get influenza vaccination yearly and pnuemococcal vaccination if >65 years old. Eat a healthy diet, get plenty of rest, stay hydrated and don t smoke. 2. Continue Your Medications: Illness is a stress that causes over production of sugar. It is important for patients to take insulin and all other medications when ill. Sometimes patients may need extra insulin or medications even though they are eating less. 3. Monitor Blood Sugars: Test BG at least 2-4 times per day. If patient is on insulin they may need to test more often (at least 4 times and increase insulin dose) 4. Food and Fluids: When ill the body still needs food for energy. Often if a patient feels nauseous they will find it difficult to eat, encourage patients to consume easy to digest foods such as unsweetened apple sauce, toast, or a banana. If the patient is unable to tolerate solid food they should replace those foods with sugar containing fluids. They should consume 10-15g of carbohydrate every hour. 5. Stay Hydrated: Illness can cause dehydration from frequent urination and/or vomiting. Drink at least 8 cups or sugar free/caffeine free fluids and/or water per day. 6. Know When to Seek Help: If persistent hyperglycemia >14mmol/L patient should know to contact educator for assistance. If illness persists for more than 1-2 days or they cannot eat or drink, or have severe vomiting or diarrhea patient should know to go to the ER.

2 Diabetic Ketoacidosis (DKA) DKA usually occurs in people with Type 1 Diabetes if the patient has high BG and a lack of insulin (ie. They have missed an insulin dose) the body is unable to use the sugar in the blood stream for fuel. This means the body is forced to break down fat as an alternate source of fuel. Unfortunately, fat breakdown produces toxic byproducts called ketones. Excess ketones make the blood acidic and cause symptoms such as naseau, vomiting, abdominal pain, difficulty breathing, and fruity smelling breath. If untreated excess ketones in the blood known as DKA can lead to coma or even death. This is a medical emergency and should be treated in hospital. Ketones can be detected by urine ketone testing or a simple blood test with a special meter (Precision-Xtra). Urine testing is not encouraged as it is problematic. Patients should be encouraged to use blood ketone testing. Patients using MDI When sick with the flu or fever but tolerating food and/or fluids patients should test blood glucose (BG) and ketones every 4 hours all day and all night. If ketones are greater than 3mmol/L at any time patient should know to go to the Emergency Room (ER) immediately. The patient should also go to the ER if they are not able to tolerate fluids without vomiting or are having frequent low blood sugars. 2 lorem ipsum :: [Date]

3 How to Calculate Rapid Insulin When Sick Use the chart below as a guide to decide how much fast/rapid insulin to take every 4 hours, in addition to your usual insulin dose. Add up the number of units of insulin (all kinds) that your patient takes on a usual day. This is the Total Daily Dose (TDD). Patients TDD: units Calculate 10% = units, 15% units, 20% units of TDD * This is the extra dose to be taken in addition to their usual dose (the supplement dose) * If the patient is using a blood ketone meter ie. Precision Xtra, use the following table as a guide to assist them with adjusting insulin in times of sickness. BG Blood Ketone Recommended Action Extra Insulin (mmol/l) (mmol/l) *If patient able to take fluids Dose < No extra insulin required - Decrease dose of pre-meal insulin as directed - Patient to contact care team if vomiting occurs <0.6 - Use usual insulin dose (same as non sick day) >0.6 - Take a 10% of TDD as extra dose, patient to follow this scale depending on result. > 16.0 <0.6 - Take a 10% of TDD as extra dose, patient to follow this scale depending on result. >16.0 > Take a 15% of TDD as extra dose, patient to follow this scale depending on result. >16.0 > Take a 20% of TDD as extra dose, patient to follow this scale depending on result. Have patient contact healthcare team ASAP. 3 lorem ipsum :: [Date]

4 Case Study Insulin Dose Adjustments for Sick Day Caitlin calls to report that she is feeling flu-ish. She normally takes 22 units of Levemir at bedtime and NovoRapid insulin before meals (6 units before breakfast, 8 units before lunch and 10 units before dinner). Yesterday (August 27 th ), she had her usual breakfast and lunch and took her usual insulin doses. She states she vomited only once during the night. She reports the following BG and blood ketone levels. Date Break BG (mmol/l) and Ketone(K) Levels Post Lunch Post Supper Post Break Lunch Supper 27 BG=14.6 K= BG=17.3 K=1.2 Bed BG=3.9 K=0.6 Night BG=20.7 K=2.9 Basal Insulin Questions 1. Calculate insulin doses recommended for each time period listed: a. 27 th at 5:30pm (before dinner): fever present, no further vomiting Dose: Answer: Usual insulin dose b. 27 th at 9:30pm (before bed): fever gone, no appetite Dose: Answer: No correction dose, treat low BG c. 28 th at 3:30am (night): able to tolerate fluids Dose: Answer: 20% correction dose = +9 units d. 28 th at 6:30am (breakfast): able to tolerate fluids, no vomiting Dose: Answer: 15% correction dose = +6 units 4 lorem ipsum :: [Date]

5 5 lorem ipsum :: [Date]

6 6 lorem ipsum :: [Date]

7 Pellentesque habitant morbi tristique senectus et netus et malesuada fames ac turpis egestas.