Alexandra you are in the higher category of the Severe protocol, so you need to do this:
T1 Sick day rules
Severe
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.
Ouch. Your GP surgery is due for a bollocking from your hospital team. They have to ensure you have backup basal insulin as well as backup quick acting insulin, and a means of delivering both of course. Do you have no Lantus left at all?Thanks, exactly what I needed!
I'm using pens to bolus at the moment and manually adding the data to my pump handset so everything is logged. Unfortunately I can't do my basal through pen because I don't have any lantus - seems my doctors surgery didn't take note of the letter from hospital to keep them on my prescription.
Ouch. Your GP surgery is due for a bollocking from your hospital team. They have to ensure you have backup basal insulin as well as backup quick acting insulin, and a means of delivering both of course. Do you have no Lantus left at all?
Only 6 units left in a pen will go off quickly. So if you can't scrape together enough reliable Lantus for even 12 hours that means you have no choice but to stay on the pump really. :-(I know - they put a full block on my medication at the start of April!
I have 6 units left in a pen I've just found so not a full dose (I was on 24 split)
i have optium neo............it takes both bm and keytones strips
Are you ok now Alexandra?Thanks, exactly what I needed!
I'm using pens to bolus at the moment and manually adding the data to my pump handset so everything is logged. Unfortunately I can't do my basal through pen because I don't have any lantus - seems my doctors surgery didn't take note of the letter from hospital to keep them on my prescription.
Have you got any insulin pens doctor told me to have an injection of 5 units and increase basel rate by 20%. The check bloods every hour to see if its coming down, if you start to vomit best to get to hospital asapCan 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
You must be feeling awful. :-(Feeling a bit better but had to go in this morning as was still at 30. Have come down to 19.2 just feel shattered
:-(Feel pretty awful to be honest - ketones aren't coming down and bg is back up to 26
:-(
Are you doing 20% of Total Daily Dose every 2 hours while ketones remain moderate or higher?
In summary these BDEC/DEN guidelines are to inject (not pump) a doubled correction dose every 1-2 hours until ketones are no longer present. Plus taking fluids of course. So quite different to the DAFNE Sick Day rules. Though personally I think it's easier to remember to do a double correction dose, than to remember the DAFNE rules.This booklet produced by Joan Everrett( BDEC) and Dr Helen Lockett (consultant with interest in pump education) has a good section with a simple flow chart on what to do with high levels/ketones when on a pump.
http://www.diabetes-education.net/pdf/resources/insulin_pump_workbook.pdf
I agree. The DAFNE rules in effect use a wild guess, a fixed quantity every two hours. It's like a DIY version of the hospital sliding scale. Having said that, it does work, and relatively quickly.They are certainly very similar to the protocol I have from here although mine says every 2 hours, not 1-2 hours. Certainly they are insistent on using pens and not the pump in this situation. I've not been there though so, I've fortunately never had to try it out for real.
I think though it's very important to check the correction dose to use. (ie not a wild guess)
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