Help with sickday rules

Hi, can anyone give me some advice please. I have a sickness bug that started early this morning and is still ongoing I've eaten nothing at all today. My BG was 10.8 first thing so I had my usual 1 unit of humlin i and 1 unit of humalog to correct. I've monitored my BG's all day and they have stayed stable and within range. I've just taken my BG and its 6.5 but I have ++ keytones. My TTD is only 9 units (its very little I know!). I can't take any QA as advised by dafne as I run the risk of a hypo. What do I do if my keytone levels are worse in 2 hours time but my BG is normal? and do I still take my BI of 4 units of humulin i before bed? I'm abit worried so any help or advice would be appreciated.

ketones are the same as glucose in that they need insulin to be processed..............


so as your not eating, you should be testing every 2 hours and giving the advised amount od QA as well, which is 20% I think.........so for you 2 units every 2 hours......you cant keep ketone levels down without insulin.........

what do you mean when you say you have been advised to not take any QA, surely you need insulin................even if your are very sensitive to it.............

you must always take your BI insulin whether your eating or not.................

have a look at the online handbook to get a better picture of what you need to do..............the rules work..............

Hi Julia

Just to add to James's advice - the flowchart does say you have QA's so long as keytones are present. The statement re high BG just says usually it would be above 13 mmol/l so the flowchart applies even if your BG is only 6.5.

For keytones of ++ the amount is 10% of the TDD which would be 1 unit every two hours whilst the keytones are at the ++ level. This would be in addition to the Background insulin and any QAs for CPs.

http://www.dafneonline.co.uk/hbook_topics/188

Hi James & Simon
Thanks for your replies. I ended up going to my OOH clinic in the early hours as my keytones had risen to +++ and I was still being sick. The doctor gave me some anti sickness tablets which then meant I was able to eat and take some QA which gradually brought the keytones down during the night.
Feeling alot better this morning
Thanks again.

But remember that the sick day rules exist to process ketones, so you don't need to eat anything to take QA..........

When I had the flu 2 Christmases ago I couldn't eat anything, so every 2 hours I tested my blood, they were on target, but I had ketones, so I still had to inject 7-10 units every 2 hours, the ketones were brought under control and my BG levels remained steady.......

So you didn't really need to go out to the clinic, but confidence in using these rules will come with time.....

Glad your feeling better today.........

JuliaW said:
The doctor gave me some anti sickness tablets which then meant I was able to eat and take some QA which gradually brought the keytones down during the night.
Thanks again.