Managing Illness with T1DM

Managing Illness with T1DM

Why is it important to always take my insulin?

When you are ill your body becomes more resistant to the insulin that you take by your injections. This means that your blood glucose levels can rise. You therefore need to monitor your blood glucose and ketone levels and decide if you need more insulin. It is likely that you will need to increase your insulin dose. Failure to do so could result in serious harm or death.

******REMEMBER TO NEVER STOP TAKING YOUR INSULIN – even if you are ill and cannot eat******

What are the symptoms of High Blood glucose levels?

• Increased thirst
• Passing more urine
• Feeling sick or vomiting
• Feeling tired
• Dryness in mouth and lips
• Drowsiness
• Breathing fast
• Abdominal pain

What else do I need to consider?

• Drink plenty of water and sugar-free drinks – at least 3-4 litres (5-7 pints) a day.
• If you are unable to eat, try sipping a glass of Lucozade, fruit juice, sugared fizzy drinks, ice cream/lollies.
• Take adequate rest – do not exercise if you are unwell and your blood glucose is above 13 mmol/l.
• Continue monitoring your blood glucose more frequently (see advice overleaf) and continue to monitor throughout the night until you regain control of your ketones and blood glucose.
• Never stop taking your insulin
• Always have a way to test ketones – use urine test strips or blood test monitor. If you do not have these or are unsure how to use them, please contact us on the numbers given overleaf, your GP or NHS 111.
• Always carry quick acting insulin
• If you continue to vomit, are unable to keep fluids down, or unable to control ketone and blood glucose levels you must contact the hospital as an emergency.

What insulin will I need to take if I become unwell with ketones?

Total daily dose: Your previous days quick acting insulin + Background insulin
Example calculation:

• Lantus 26 units + Levermir 24 units = 50 units………….10% of 50 units = 5 units.
• Novorapid 26 units + Levermir 24 units = 50 units………..20% of 50 units = 10 units.

Quick Acting 10% total daily dose	Quick Acting 20% total daily dose

What are the symptoms of low blood glucose levels?

Hypoglycaemia occurs when your blood glucose level is TOO LOW (Below 4 mmol/l).

WARNING SIGNS:

• Sweaty
• Change in mood
• Dizzy
• Feeling weak
• Trembling

ACTION: 15–20g RAPID ACTING CARBOHYDRATE such as: 3-5 Jelly Babies or 200ml pure Orange Juice or 5-7 Glucose tablets (Dextrose energy tablets) or 4-5 Glucotabs.

Retest after 10-15 minutes and if your blood glucose is still below 4mmol/l repeat as above.

Once your blood glucose is above 4mmol/l have your meal if it is due or have a snack of about 10g of longer acting carbohydrate such as: biscuits/glass of milk/piece of fruit.

ALWAYS CARRY RAPID ACTING CARBOHYDRATE WITH YOU

What do I do if my blood glucose level is above 13mmols and I am unwell?

Urine Ketones: Negative Blood Ketones: Less than 1.5 mmol/l Continue testing blood glucose and ketones every 4 – 6 hours and give correction dose as discussed opposite if still negative to ketones.	Take a normal correction of quick acting insulin (Novo Rapid, Humalog, Apidra) as well as your normal insulin. One extra unit of quick acting insulin will reduce your blood glucose by 2-3mmol/l. You must continue to take your background insulin and consider increasing by 10 – 20% if you remain unwell (longer than 24 hours). If you take Novomix 30, Humalog mix 25, Insumen twice daily then give a correction of 4 – 6 units.
Urine Ketones: + or ++ Blood Ketones: 1.5-3 mmol/l Continue testing ketones and blood glucose every two hours and give correction of Quick Acting insulin of 10% if ketones remain as above.	Take a correction dose of quick acting insulin of 10% of your total daily dose (see calculation overleaf), as well as normal insulin. You must continue to take your background insulin and consider increasing by 10 – 20% if you remain unwell (longer than 24 hours). If you take Novomix 30, Humalog Mix 25, Insumen 25 seek further advice from health care professional.
Urine Ketones: +++ or ++++ Blood Ketones: More than 3 mmol/l Continue testing ketones and blood glucose every two hours and give correction of Quick Acting insulin of 20% if ketones remain as above. If ketone levels reduce to: urine ketones + to ++ Blood Ketones 1.5 – 3 mmol/l follow advice as for Small to Moderate ketones above.	Take a correction dose of quick acting insulin of 20% of your total daily dose (see calculation overleaf), as well as normal insulin. You must continue to take your background insulin and consider increasing by 10 – 20% if you remain unwell (longer than 24 hours). If you take Novomix 30, Humalog Mix 25, Insumen 25 seek further advice from health care professional

If you do not improve or get worse attend the hospital urgently

Contact Numbers:

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: [email protected]
Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.
If you are unable to understand this leaflet, please communicate with a member of staff.

For additional medical advice, if your symptoms or condition worsens:
Contact your GP
NHS 111: Telephone 111
Get help with your symptoms, NHS111: https://111.nhs.uk/
Information to help you manage your health: www.nhs.uk
In an emergency telephone 999

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