Patient education for prevention

Sick Day Rules - Weathering the Storm

📌 SICK Day Mnemonic:

• Sugar: Check blood glucose frequently (q2-4h).
• Insulin: Never stop basal insulin. May need ↑ supplemental doses.
• Carbs & Fluids: Maintain hydration and carb intake. If unable to eat, drink carb-containing fluids.
• Ketones: Monitor urine/blood ketones q4h, especially if glucose is >250 mg/dL.

⭐ The most common precipitating factor for DKA is infection (e.g., UTI, pneumonia), which increases counter-regulatory hormones and insulin demand.

Monitoring - Know Your Numbers

• Blood Glucose (BG):

  • Check every 2-4 hours when sick.
  • Log readings, insulin doses, and symptoms.
  • Call your provider if BG remains > 250 mg/dL despite corrective insulin.

• Ketones:

  • Check every 4-6 hours if BG is > 250 mg/dL or you feel ill.
  • Urine: Positive result (moderate/large) is a warning sign.
  • Blood (β-hydroxybutyrate): Preferred method for accuracy.
    • Normal: < 0.6 mmol/L
    • Call provider if > 1.5 mmol/L

⭐ Blood ketone (β-hydroxybutyrate) testing is more accurate than urine testing for diagnosing and monitoring DKA. Urine acetoacetate levels can lag, remaining positive even after DKA begins to resolve.

Insulin & Meds - The Lifeline

• Never Stop Insulin: The most common cause of DKA is insulin non-adherence. Emphasize continuing basal (long-acting) insulin even when ill.
• 📌 SICK Day Rules:
  • Sugar: Check blood glucose more frequently (q 2-4h).
  • Insulin: Continue basal insulin. Use supplemental short-acting insulin for hyperglycemia.
  • Carbs: Maintain adequate fluid and carbohydrate intake.
  • Ketones: Check urine or blood for ketones if glucose is >250 mg/dL.

⭐ A patient's basal insulin requirement persists and is crucial to suppress ketogenesis, even with zero oral intake. Never advise stopping it.

Diet & Hydration - Fueling Right

• Consistent Carb Intake: Match carbohydrate intake with insulin doses. Regular meals and snacks prevent blood sugar lows that can lead to poor food choices.
• Hydration is Key: Drink plenty of water and calorie-free fluids. Dehydration can concentrate blood glucose and increase ketone production.
• Sick Day Management: Never stop insulin. Maintain hydration and carb intake with liquids if solid food isn't tolerated (e.g., juice, broth, gelatin).

⭐ Dehydration itself worsens hyperglycemia and impairs the kidney's ability to clear glucose and ketones, accelerating the progression to DKA.

High-Yield Points - ⚡ Biggest Takeaways

• Sick day management is crucial: never stop taking insulin, even with poor oral intake. Monitor glucose and ketones frequently.
• Maintain hydration, alternating between sugar-free and sugar-containing fluids depending on glucose levels.
• Emphasize strict insulin adherence as the primary prevention strategy.
• Know when to seek help: persistent vomiting, high fever, or glucose >250 mg/dL with ketones.
• Recognize and manage DKA triggers like infection, stress, and missed insulin doses.