Seek advice if:

i. Unable to eat or drink
ii. Loss of fluids due to repeated vomiting or diarrhea
iii. Very high blood sugar levels (higher than 25 mmol/l) despite taking more insulin
Persistent keytones or large keytones
v. Blood glucose levels are low
vi. You become drowsy or confused
vii. You are worried

Call your health care provider right away if:

i. Your blood glucose has been above 240 for longer than a day
ii. You have ketones
iii. You feel sleepier than usual
iv. You have trouble breathing
v. You cant think clearly
You throw up more than once
vii. You have had diarrhea for more than 3 hours

Important points to keep in mind:

* Always take your usual daily dose of insulin or diabetes medication. Never omit your medicines, even if you are unable to eat. Illness may even be a time when you need additional insulin or to change to a different schedule.

* Test your blood sugar every four hours or as directed by your physician. If your blood sugar is 240mg/ml or greater, you should also check your urine for ketones and notify your physician if ketones are present in your urine. Keep a record of your results to report to your physician.

* Weigh yourself frequently during an illness. This can help your physician estimate any fluid loss you may be experiencing.

* Drink four to eight ounces of fluid (e.g., beverages containing sugar, water, broth, teas) every two hours. Keep a record of total fluid intake that you can report to your physician.

* If you are unable to eat regular meals, try to consume liquid or soft foods that equal 15 grams of carbohydrate every hour or 50 grams every three to four hours. See sample diet at bottom of page.

* Rest and stay warm. Do not exercise. Have someone available to help you take care of yourself.

* If you should be alone during an illness, contact a neighbor, friend, or relative who will check on you several times a day.

* Check with your doctor to determine at what blood sugar level he/she wants to be notified. Usually a blood sugar greater than 320 or 2+ ketones. KEEP NAME AND TELEPHONE NUMBER OF PHYSICIAN HANDY.

* In any illness preventing you from eating anything at all (Nausea/Vomiting) for more than six hours, you should check your blood sugar every four to six hours and adjust with sliding scale of regular insulin and cut down long-acting insulin to half the daily insulin dose, per physician recommendation.

* Call your doctor if:
a) Fever persists
b) Vomiting and/or diarrhea is severe
c) Illness persists beyond one to two days

* Once the illness has passed, gradually return to your regular diabetic meal plan