Table 8.

Sick-Day Protocol

1. Begin a log sheet
— Test blood glucose every hour and urine every void for ketones and glucose content
— Record results of blood and urine tests, temperature, number of voids, and other losses from vomiting, diarrhea, etc.
— Assess intake of liquids and food (liquids are most important)
2. Phone numbers
— Have phone numbers of endocrinologist, primary care physician, and emergency health-care personnel
— Call physician:
• If vomiting persists more than 4 h
• If patient has more than five diarrheal stools
• If there is an adverse change in mental status
• If patient has a temperature higher than 38.4°C (101°F)
• If blood glucose levels are >350 mg/dL on two separate readings
• If large ketones are present
• If there is evidence of bacterial infection
• If there is evidence of dehydration
• If the patient has trouble breathing
3. Prevent hypoglycemia
— Reduce the dose of insulin for vomiting and poor intake
— Use low dose of short- or rapid-acting insulin every 4 hours
4. Prevent diabetic ketoacidosis
— If blood glucose is elevated, give extra short- or rapid-acting insulin every 4 hours
5. Maintain hydration
— Give electrolyte- and substrate-containing solution
— Attempt to exceed fluid output with intake