Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-76

12-76 I CHAPTER 12

Figure 10:Sick-day management for CSII

MOUNT SINAl HOSPITAL l"-, Joseph and WollLebovic HealthComplex ,... Leadership Sinai Centre for Diabetes

Insulin Pump: Sick Day Management Unanticipated or repeatedly high blood glucose values of mo re than 14 mmol /L,or feeling unwell such as flu, nausea, vomiting,or fever. Being unwell can make your blood glucose high. High blood glucose levels can lead toDiabetic Ketoacidosis (DKA). DKA can occur when you do not have enoughinsulin and are unable touse glucose for energy. Your body thenburns fat for energy. Burning fat makes ketones which at high levels are toxic toyour body and can cause weakness, fatigue,stomachpani , feeilngunwell,rapid breathing,nausea & vomiting,andin severe stages lead to coma and death. It is important to test your blood glucose & blood ketone levels i f you feelunwell. High blood glucose and/or ketones mean you need more insulin. The amount of insulindepends on your blood glucose leveland the amount of ketones. Insulindeficiency leads to ketone build-upin the blood, which can be life threatening. DKA is a life threatening condition, which if left untreated can lead to death! It is important to check for ketones when you feel sick even if your blood glucose levels seem normal. Who isat Risk of Developing DKA? • If you are unwell,have a fever,flu,diarrhea,vomitingor infectoi n • If your insulin delivery has been interrupted/stopped or decreased • If you have high glucose and/or ketone levels.Do not exercise.It will make your body produce more ketones.

How to Prevent DKA? • Continue to take your insulin even if you are not eating normal mealsl • Drink plenty of sugar-free fluids,at least 8 to10cups of fluids each day. • Test your blood glucose and your ketones every 2-4 hours if feelngunwell.

Go to the Emergency Department if ANY of the following occurs:

• Vomitingor diarrhea and unable to eat for 12hrs • Have nausea,abdominalpain,shortness of breath, weakness,confusion,increased thirst, and urination You have blood ketones greater than 3 mmoi/L and/or your blood glucose remains elevated even with correction by syringe. These are signs of SEVERE DKAl

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Sick Day Management (Pump)

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