Manage Sick Days

Ok, it might be time to dust off the sick day rules. This is the main reason people with diabetes ring their nurse! That’s part of the management plan but there are quite a few things you can do first. Maybe ask the doctor next time you have an appointment to put blood ketone sticks and an Optium Neo meter on the prescription if you don’t already have one.

UNWELL? START HERE…

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WHAT ARE KETONES?

Ketones are acids that are produced when the body ‘burns’ fat for energy. The body normally uses glucose to create energy. This process requires insulin, which allows glucose to pass from the bloodstream to body cells where it is ‘burned’ for energy. When there is not enough insulin, glucose accumulates in the blood causing high blood glucose levels (hyperglycaemia). The body is unable to use this glucose without insulin and will switch to ‘burning’ fat as an alternative fuel for energy.

In people with Type 1 diabetes, ketones can build up in the bloodstream and cause an emergency condition called Diabetic KetoAcidosis (DKA) also known as diabetic coma.

DKA is a major life threatening condition for people with Type 1 diabetes (and rarely in Type 2 diabetes)

WHEN ARE KETONES MOST LIKELY TO OCCUR?

during episodes of illness or infection – even if blood glucose levels are relatively normal
when blood glucose levels are high (the level can vary from person to person and episode to episode but generally at 17 mmol/L or higher)
when insulin has been forgotten or omitted for some reason

A small amount of ketones (usually less than 0.5mmol/L on blood test) may be seen in people who fast (don’t eat) for several hours, after vigorous exercise or in children overnight when fat is commonly used as an energy source. These do not require treatment.

WHEN SHOULD I TEST FOR KETONES?

When you have an infection or feel unwell, especially if you have vomiting and diarrhoea, even if your blood glucose levels are relatively normal (from 4-15mmol/L)
If your blood glucose is 17 mmol/L or higher, particularly if you feel unwell or your blood glucose level remains elevated twice or more in one day
If you have symptoms of hyperglycaemia or DKA – eg. greatly increased thirst or volume of urine, feel unusually drowsy, feel nauseated, have rapid laboured breathing, abdominal pain or a fruity/acetone smell on your breath

HOW DO I TEST FOR KETONES?

Ketones can be tested in the blood in the same way that you test blood glucose
Blood ketone testing is more accurate than urine ketone testing
Blood ketone testing can only be done on the Optium Xceed meters (which all Type 1s can get on prescription)
Optium Ketone Test Strips are available on prescription

WHAT DO THE RESULTS MEAN AND WHAT SHOULD I DO IF I HAVE KETONES?

Blood ketone level

Action

0.5mmol/L

or less

Normal level

Continue to take insulin (rapid acting and long acting) as usual even if you are not eating
If you are too unwell to eat contact your diabetes health professional for advice
Treat a high blood glucose level appropriately and re-test blood glucose in 2-3 hours
If 17 mmol/L or higher or your feel unwell, repeat ketone test

0.6-1.5mmol/L

Contact a health professional as ketoacidosis could be developing

You may require extra insulin and fluids
In general inject the dose of rapid acting insulin that you would normally take to treat a high blood glucose level*
Drink at least 250-500mls (1-2 cups) of sugar-free fluids every 30 mins
Re-check blood glucose and ketone level every 2-3 hours until your ketones are less 0.5 mmol/L (negative – trace)
Repeat rapid acting insulin injection if ketones are 1.0 mmol/L or higher (small – moderate) after 3 hours
Don’t forget to take your long acting insulin as usual

1.5mmol/L

or higher

Contact a health professional urgently as ketoacidosis could be developing

You will need additional rapid-acting insulin and fluids
In general inject 1.5 times the dose of rapid-acting insulin you would normally take to correct a high blood glucose level*
Drink at least 500mls (2 cups) of sugar-free fluids every 30 mins
Re-check blood glucose and ketone level every 2-3 hours until your ketones are less than 0.5 mmol/L (negative – trace)
Repeat rapid acting insulin injection if ketones are 1.0 mmol/L or higher (small – moderate) after 3 hours
Don’t forget to take your long acting insulin as usual
If after 3-4 hours you are unable to reduce your ketone level or keep fluids down go to the nearest After Hours Medical Centre or Hospital Emergency Department

3.0 mmol/l

or higher

CONTACT A HEALTH PROFESSIONAL You are at risk of DKA. The ketone level must be reduced urgently

You urgently need additional insulin and fluids
Inject 1.5 times the dose of rapid-acting insulin you would normally take to correct a high blood glucose level*
Drink at least 500 mls (2 cups) of sugar-free fluid every 30 mins
Re-test your ketone and blood glucose level every 1-2 hours until your ketones are less than 0.5mmol/L (negative – trace)
Repeat rapid acting insulin injection every 2 hours if ketones are 1.0 mmolL or higher (small – moderate)
Don’t forget to take your long acting insulin as usual
if after 3-4 hours you are unable to reduce your ketone level or keep fluids down go to the nearest After Hours Medical Centre or Hospital Emergency Department

* refer to “correction insulin dose calculation guidelines” or ask your Diabetes Nurse about this

HOW TO USE OPTIUM KETONE ELECTRODES

open the foil packet by tearing at the notch
with the contact bars (3 black stripes) facing up, insert the contact bars into the meter
push the electrode in until it stops
prick your finger to obtain a drop of blood
touch the drop of blood to the purple target area while the “apply blood” message is displayed

until the meter begins a 10 second countdown

your result will be displayed after the 10 second countdown is complete

BLOOD KETONE READING INDICATIONS

Above 1.5 mmol/l
Readings above 1.5 mmol/l in the presence of hyperglycemia indicate that you may be at risk for developing diabetic ketoacidosis (DKA). Contact your healthcare provider immediately for advice.

0.6 to 1.5 mmol/l
Readings between 0.6 and 1.5 mmol/l may indicate the development of a problem that may require medical assistance. Follow your healthcare provider’s instructions.

Below 0.6 mmol/l
Readings below 0.6 mmol/l are in the normal range.