During a sick day for type 1 diabetes when meals cannot be tolerated, what is the recommended insulin approach?

During a sick day for type 1 diabetes when meals cannot be tolerated, what is the recommended insulin approach?

• A. Stop basal insulin
• B. Increase prandial insulin to cover meal
• C. Only monitor glucose and ketones
• D. Continue basal insulin; reduce prandial insulin; check glucose and ketones frequently; stay hydrated; adjust per clinician

Answer: (D)

When illness raises stress hormones, glucose goes up and ketosis risk increases, while not eating reduces carbohydrate intake. The best approach is to keep basal insulin flowing to prevent ketone production, but lower prandial insulin since there isn’t a meal to cover. Check glucose and ketone levels frequently, stay hydrated, and adjust the plan with your clinician as the illness evolves. This approach helps prevent both high glucose and diabetic ketoacidosis. Stopping basal insulin would allow ketosis to develop; increasing prandial insulin without meals can cause lows; simply monitoring without insulin adjustments isn’t enough.

When illness raises stress hormones, glucose goes up and ketosis risk increases, while not eating reduces carbohydrate intake. The best approach is to keep basal insulin flowing to prevent ketone production, but lower prandial insulin since there isn’t a meal to cover. Check glucose and ketone levels frequently, stay hydrated, and adjust the plan with your clinician as the illness evolves. This approach helps prevent both high glucose and diabetic ketoacidosis. Stopping basal insulin would allow ketosis to develop; increasing prandial insulin without meals can cause lows; simply monitoring without insulin adjustments isn’t enough.