Recent Posts in General Discussion

Apr 12, 2012

JuliaW 2 posts

Topic: General Discussion / 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 Sad

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.

Apr 12, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / Help with sickday rules

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.............. Wink

Apr 12, 2012

SA2010 69 posts

Topic: General Discussion / Help with sickday rules

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

Apr 13, 2012

JuliaW 2 posts

Topic: General Discussion / Help with sickday rules

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 Smile

Thanks again.

Apr 13, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / Help with sickday rules

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.........

Apr 16, 2012

Carolin 83 posts

Topic: General Discussion / Help with sickday rules

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.

Glad you got sorted Julia, sorry I didn't see your message until today.

It's a learning point for everyone really, that you can get 'starvation ketones' when you're not eating, so if you have ketones but your BG is OK you simply need to try to get some CPs down with usual ratio of QA. That's why once you started eating the ketones began to clear.

Take care,

Carolin

Apr 12, 2012 JuliaW 2 posts	Topic: General Discussion / 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.

Apr 12, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / Help with sickday rules 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..............

Apr 12, 2012 SA2010 69 posts	Topic: General Discussion / Help with sickday rules 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

Apr 13, 2012 JuliaW 2 posts	Topic: General Discussion / Help with sickday rules 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.

Apr 13, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / Help with sickday rules 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.........

Apr 16, 2012 Carolin 83 posts	Topic: General Discussion / Help with sickday rules 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. Glad you got sorted Julia, sorry I didn't see your message until today. It's a learning point for everyone really, that you can get 'starvation ketones' when you're not eating, so if you have ketones but your BG is OK you simply need to try to get some CPs down with usual ratio of QA. That's why once you started eating the ketones began to clear. Take care, Carolin