Part 2: Sick days
Sana has type 1 diabetes and a stomach bug. It's midnight, her meter says 310, and she is about to make the most common mistake there is.
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Midnight. Sana has been sick twice since dinner. Her meter reads 310 mg/dL.
“I can't keep anything down. I haven't eaten, so I'll skip my long-acting insulin tonight.”
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“Sana? I heard you. Are you all right?”
Should Sana skip her long-acting insulin tonight?
Tap an answer to see what happens.
AYes: no food, no insulin.
What happens instead
Basal insulin is never simply stopped during illness, even without food. Stopping it is a common route into ketoacidosis.
BNo: keep it going, follow her sick-day plan, and call her team about the dose.
✓ The right step
If you take insulin, don't stop it, even if you can't eat. The doses may need to change, and your team should give you a written plan for exactly this.
CTake a double dose to bring the 310 down.
What happens instead
Any correction for high readings has to come from your own diabetes team. Never guess a dose.
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If you have type 1 diabetes or take an SGLT2 inhibitor, check ketones too — especially if your glucose is above 200 mg/dL or you are vomiting.
Sana pricks her finger again, this time for the ketone strip: 1.8 mmol/L.
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“1.8. That means: contact my team now.”
- Below 0.6 mmol/L: normal.
- 0.6 to 1.5 mmol/L: slightly high — follow your sick-day plan and check again in 2 hours.
- 1.6 to 3.0 mmol/L: at risk of ketoacidosis — contact your diabetes team now.
- Above 3.0 mmol/L: you may have ketoacidosis — go to hospital.
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“I'm right here. Tell them everything: the vomiting, the 310, the 1.8.”
Drink plenty of unsweetened fluids, such as water and thin soup, a little at a time and often.
Two hours later she checks again: ketones 3.4 mmol/L. She is breathing fast, and her stomach hurts.
Above 3.0 mmol/L: you may have ketoacidosis — go to hospital.
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“I'll get the car keys—”
“No, Chachi. We call 1122.”
Call Rescue 1122 rather than driving yourself.
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At the hospital, the team takes over.
“You did three things right: you kept your insulin going, you checked ketones, and you came in as soon as they passed 3.0.”
What to remember
- If you take insulin, don't stop it, even if you can't eat.
- Check your glucose at least every four hours while you are ill.
- If you have type 1 diabetes or take an SGLT2 inhibitor, check ketones too — especially if your glucose is above 200 mg/dL or you are vomiting.
- 1.6 to 3.0 mmol/L: at risk of ketoacidosis — contact your diabetes team now.
- Above 3.0 mmol/L: you may have ketoacidosis — go to hospital.
- Call Rescue 1122 rather than driving yourself.