General Principles
General Principles of Sickness Management in Diabetes Patients
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Ensure appropriate fluid intake (greater than 3L/24h)
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Ensure patient is able to glucose monitor (if not a regular tester generally consider a one off prescription of ‘tru-one’ glucose strips (which have a very simple disposable meter embedded into the lid of the 50 strip carton) and knows an appropriate monitoring schedule during illness
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Ensure patient knows an appropriate target range for self-managed glucose control during illness
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ideal range = 4-10mmol/L
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acceptable range = 4-14mmol
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Ensure patient knows how to adjust therapy if blodd glucose levels rise above targets (or when and how to contact their primary care-giver)
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Ensure resources are available to make adjustments (eg access to insulin)
Given that many of these plans will have been discussed some time before an illness, patients who are at risk of an illness (any who have had one in the last year) should have an individualised illness management planner – see attached link (MY ILLNESS PLAN) for a proforma.
Usual Insulin Requirements
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Basal Insulin Requirement
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about 50% of daily total insulin given 2/3rds in day, 1/3rd at night
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Carbohydrate (ie meals) -related insulin requirement
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Total Daily Dose(TDD)/50 units per 10g carbohydrate. (TDD is calculated by adding together usual short acting insulin and longer acting insulin for each 24 hr period. If this is not known, a reasonable rule of thumb is give one unit of insulin per 10g of carbohydrate)
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Correction Dose Insulin
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Individualised Correction targets & Rules (type 1 patients aware)
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Insulin Requirements during illness
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Basal Insulin
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Increase (2-4X) – physical stress / steroids (60-65%)
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Reduce – Chronic Renal Failure / extreme age
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Carbohydrate related Insulin
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Intake may be zero, may be low but nearly continuous, may be poorly absorbed
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Basic Principles still apply! (How much carbohydrate in the meal?)
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Correction-doses of insulin
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Are the rule not the exception as baseline is changing
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Need to be incorporated into next 24 hrs requirement
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