Sick Day Management. Flashcards
How often should a type 1 test for ketone bodies when sick?
What do they do if ketosis is detected?
Every 2 to 4 hours.
If ketosis present, important to stay hydrated and use supplemental insulin doses. If they do not clear ketones in 12 hours they need to contact diabetes team.
What are the typical insulin supplemental doses given to a patient when ill?
Depends on BG and ketones and whether tolerating food/fluids.
Usually rapid acting 10% of TDD
When should an ill patient seek medical assessment?
Vomitting continuing more than 2-4 hours
BG > 16.6
Presence of ketones for more than 12 hours.
Signs of dehydration.
Signs of DKA developing. (N/V abdominal pain, acetone breath, hyperventilation, altered consciousness.
Why do you never stop insulin when a patient is sick and not eating?
Many illnesses especially those with fever cause an increase in stress hormones which increases gluconeogenesis and insulin resistance.
Many patients will actually require supplemental or increases in insulin when ill due to insulin resistance brought on by infection.
Insulin omission can lead to ketone body production.
Insulin should never to stopped and patients should be encouraged to maintain CHO intake with fluids or glucose tablets.
There are times when insulin should be reduced if patient is losing fluids through vomitting and diarrhea. Hence the importance of frequent BG monitoring when ill. At least every 3-4 hours.
SADMANS protocol is recommended only for diabetics with CKD. true or false?
False. While clinical judgement is important, level of illness and dehydration play a role so even people with normal kfxn may need to stop meds
What two physiological responses does the body have to illness that increases glucose?
Stress increases Counter regulatory hormones whic leads to increase in
Glucose FFA and ketosis.
Illness may be accompanied by dehydration which causes volume depletion and insulin resistance and may inhibit renal clearance of glucose
If BG is greater than 20, but urine ketone is negative or small, and sick patient is drinking CHO containing beverages and not vomitting what is the course of action?
From figure 11 chapter 2:
Give 15% of TDD supp dose and recheck every 4 hours. Keep giving doses depending on BG and urine ketones every 4 hours. Ie:
BG 4-16 give supp as per ISFactor
BG >16. Give 10% if negative to small urine ketones.
BG > 20. Give 15% if neg to small it one ketones.
BG >16 AND mod/large urine ketone, 20% supp dose and contact health care team.
If a sick patient tests BG and blood ketones and is not vomitting and able to drink CHO fluids, what is course of action for following test results:
BG 4-16 with BLood K 0.6
BG > 16 with BK 0.6-1.4
BG > 16 but BK 1.5-3
BG 4-16 with B K 0.6= 10% dose
BG > 16 with BK 0.6-1.4 = 15% dose
BG > 16 but BK 1.5-3 =20% dose and contact team!
**in all cases retest every 4 hours and keep treating as above!
