Jennifer F. Wilson
Infection (for example, pneumonia, urinary tract infection, sepsis)
Medications (such as corticosteroids)
Acute gastrointestinal disease (for example, pancreatitis, obstruction, mesenteric thrombosis)
Feeling sick or have had a fever for a couple of days and not getting better
Vomiting or having diarrhea for more than 6 hours
Check blood sugars at least every 4 hours, but, when changing quickly, check more often
Check urine or blood ketones
Modify usual insulin regimen according to a plan developed by the diabetes physician or team
Maintain adequate food and fluid intake. If poor appetite: aim for 50 g of carbohydrate every 3–4 hours. If you are nauseated, consume high-carbohydrate liquids, such as regular (not diet) soft drinks, juice, frozen juice bars, sherbet, pudding, creamed soups, and fruit-flavored yogurt. Broth is also a good alternative.
If glucose levels are >13.3 mmol/L (>240 mg/dL) despite taking extra insulin according to a sick-day plan
If you take diabetes pills and blood sugar is still >13.3 mmol/L (>240 mg/dL) before meals and remains there for more than 24 hours
If symptoms develop that might signal DKA or dehydration, such as dizziness, trouble breathing, fruity breath, or dry and cracked lips or tongue
* From American Diabetes Association. Living with diabetes. Accessed at www.diabetes.org/living-with-diabetes/treatment-and-care/my-healthcare-team/when-youre-sick.html on 16 November 2009.
Wilson JF. Diabetic Ketoacidosis. Ann Intern Med. ;152:ITC1–1. doi: 10.7326/0003-4819-152-1-201001050-01001
Download citation file:
Published: Ann Intern Med. 2010;152(1):ITC1-1.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
Results provided by:
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use