DAFNE Sick day rules
During illness, never stop taking your insulin. Your body is likely to become more insulin resistant during illness, so you need to monitor bg closely and may need more insulin.
Dafne uses two categories of illness: minor, where blood glucose levels are not too elevated and ketones don’t appear as more than a trace, and severe, where bg levels are over 13 or ketones are present.
For both types of illness, Dafne stresses the importance of testing bg and ketones.
Minor
If bg is less than 8mmol/l and ketones are negative
Maintain usual ratios of bolus insulin.
Maintain usual basal doses
Monitor 4-6 hourly.
(If you are not eating, you may only need the basal insulin.)
If bg is more than 8mmol/l and ketones are negative or trace
Maintain usual ratios of bolus insulin.
Add corrective doses of bolus.
Increase basal doses by 1-2 units (20 per cent)
Monitor 4-6 hourly.
(If you are not eating, you may still need corrective bolus insulin.)
If bg is more than 13mmol/l and ketones are more than tracefollow the “severe illness” rules.
Severe
If bg is 10-13mmol/l and ketones are “small” or “moderate”
Calculate the total insulin (basal and bolus) in the previous 24 hours, calculate 10 per cent of that.
Bolus: take take equivalent of 10 per cent of that daily total every 2 hours
Plus normal bolus ratio for anything you eat.
Maintain usual basal doses
Monitor bg and ketones 2 hourly.
Have 100ml of sugar-free liquids per hour.
When bg drops below 10mmol/l AND ketones are negative or trace:
Eat/drink 10-20g carb
Use normal bolus ratios
Use normal basal dose.
Monitor bg and ketones 2-4 hourly.
If bg is over 13mmol/l and ketones are “moderate” or “large”
Calculate the total insulin (basal and bolus) in the previous 24 hours, calculate 20 per cent of that.
Bolus: take equivalent of 20 per cent of that daily total every 2 hours
Plus normal bolus ratio for anything you eat.
Maintain usual basal doses
Monitor bg and ketones 2 hourly.
Have 100ml of sugar-free liquids per hour.
When bg drops below 10mmol/l AND ketones are negative or trace:
Eat/drink 10-20g carb
Use normal bolus ratios
Use normal basal dose.
Monitor bg and ketones 2-4 hourly.
General notes:
During illness, if you are vomiting you don’t need to eat until you feel well enough to do so, but try to keep sipping fluids.
If you continue to vomit, cannot keep fluids down and/or cannot reduce your blood glucose or ketone levels (or if you are unsure what to do) call your GP, diabetes team or hospital as an emergency.
There are at least two meters, the Glucomen LX and one of the Optiums, that can accept a ketone strip for blood ketone testing. These give a number as a result instead of a colour result like a urine ketone strip.
Can anyone help me out on the percentage of extra insulin you're supposed to take when you have ketones? NHS direct are pretty useless and I've ( completely unexplained) shot up to bg of 33.7 so checked for ketones and showing 4.3feeling pretty lousy atm and really don't fancy another hospital admission for DKA so need to try and get on top of it in the next few hours
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