Sick Days 1, 2, 3, 4 & 5


While maintaining good blood glucose levels is key to successful diabetes management, it is also important to keep your ketone levels low, if you have type 1 diabetes. High ketone levels can cause toxic acid build up when energy-starved muscles start to “burn” fat in the absence of insulin.

Preventing high blood ketone levels

Very high ketone levels may require emergency medical treatment. Whilst any insulin user is at risk of developing high ketone levels, it is most likely to occur if you have type 1 diabetes and are sick – as insufficient insulin is being taken to balance rising glucose levels. The first signs of increased ketone levels are increased urination and thirst. Later symptoms can include nausea and vomiting, leading to dehydration. To help keep ketone levels at bay when you are ill, it is recommended that you monitor both blood glucose and ketone levels regularly. Following are some tips on how you can better manage your diabetes during times of illness.

Keep Taking Your Insulin

  • Insulin must be taken even when you’re ill and eating less.
  • Infection promotes insulin resistance, so you may need increased or supplemental doses of insulin to manage hyperglycemia and high ketones as advised by your healthcare team.
  • Test your levels regularly to help determine the appropriate dose of supplemental insulin you may need to take as advised by your healthcare team.

Prevent Dehydration and Hypoglycaemia

  • Drink plenty of fluids.
  • Your blood glucose level will determine if you should consume fluids with or without sugar.
  • If you are feeling nauseous or vomiting, take small quantities of fluid frequently instead of lots of fluid at once.
  • If vomiting persists, contact your healthcare professional immediately.

Monitor Blood Sugar Frequently

  • Test your blood glucose every 2-4 hours.
  • If your level is low, more frequent monitoring is recommended.
  • Maintain a careful record of your illness to track progress and detect early signs of rising ketone levels well in advance.

Monitor for Ketones

  • Home blood ketone monitoring allows for early detection of rising ketone levels, which may help guide insulin therapy at home.
  • Urine ketones provide information about what your levels were two to four hours before you tested and is dependent on the person being able to pass urine. Ketones are detected in the blood far earlier.5
  • Ketone testing is recommended when you are unwell and have type 1 diabetes. The following table will help you decide what you should do with your test results.

Blodd Keytone

Keep Rapid Acting Supplemental Insulin in Stock

  • If you are experiencing hyperglycemia and high ketone levels, supplemental doses of fast acting (regular) or rapidly acting insulin should be administered in addition to your usual insulin dosages. Ask your Health Care professional for advice.

Treat Underlying Triggers

  • Viral infections not requiring specific prescriptive therapy may still elevate blood glucose and produce ketones, making it necessary for you to continue monitoring your blood glucose and ketone levels.
  • Patients with a history of rising blood ketones, known eating disorders, psychosocial problems, or poor glycemic control are at risk for decompensation.
  • Such patients should call their healthcare professionals at the first sign of illness or decompensation.
  • Persistent ketones for more than 12 hours
  • Signs of dehydration, including dry mouth, weight loss or sunken eyes
  • Symptoms including nausea, abdominal or chest pain, ketotic breath, hyperventilation or altered consciousness

Look Out for Warning Signs

Get your family members to help you look out for these warning signs that require you to seek immediate medical attention:

  • Continued vomiting for more than 2-4 hours.
  • Blood glucose level exceeds 16.7 mmol/L.
  • Persistently high ketone level for over 12 hours
  • Signs of dehydration, including dry mouth, weight loss or sunken eyes.
  • Symptoms including nausea, abdominal or chest pain, ketotic breath, hyperventilation or altered consciousness.

For more information on “Diabetes &  Ketones” click HERE

References:1 Lori Laffel, MD, MPH Endocrinology and Metabolism Clinics of North America. 2000;29 (4):707-723. 2 Joslin’s Diabetes Mellitus, 14th Edition 2005, New York Ovid Technologies. 3 National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health Bethesda, Mol. NIDOK. 4 Kronenberg: Williams Textbook of Endocrinology 11th Edition 2008. 5 Guerci et al; Accuracy of an Electrochemical Sensor for measuring capillary Blood Ketones by fingerstick samples during metabolic deterioration after continuous subcutaneous insulin interruption in Type 1 Diabetic Patients. Diabetic Care, Volume 26, Number 4, April 2003.

People diagnosed with diabetes with elevated blood ketone levels should seek medical advice. Please consult your healthcare professional before making any changes.