• Illness persists without improvement for 24-48 hours.
  
• Temperature rises above 100 degrees Fahrenheit.
  
• Vomiting or diarrhea continues longer than 4 hours.
  
• There are moderate to large amount of ketones in the urine.
  
• Blood sugar levels continue to run less than 3.5 mmol/L (60 mg/dl),
  or above 13 mmol/L (240 mg/dl ), (above 130 mg/dl during pregnancy)
  after taking extra bolus doses as prearranged with your doctor.
  
• You have signs of ketoacidosis, dehydration or other serious problems such as:
  
  • increased drowsiness
  • abdominal or chest pain
  • difficulty breathing
    fruity odor to the breath
  • dry cracked lips, mouth, or tongue
    
• You have any uncertainty as to what to do to take care of yourself.
  

Medication

• Never omit your insulin!
  
• If you are ill and cannot eat, your need for insulin continues and may also increase.
  
• Continue your usual basal dose of insulin along with your
  sensitivity insulin or supplemental insulin scale as prearranged
  with your doctor or healthcare professional.
  
• You may need to temporarily increase or decrease your basal rate by using the temporary basal feature as prearranged with your doctor or healthcare professional.
  

Blood and Urine Testing

• Check your blood sugar before your usual mealtime and every 2-4 hours if indicated.
  
• Test your urine for ketones at least 4 times a day, or according to instructions from your healthcare professional.
  

Fluids and Diet

Always follow your physician/healthcare professional's sick day guidelines. Fluid intake is essential with any illness. You may need to drink 4 to 8 ounces of liquid every 30 to 60 minutes, and consume 10-15 grams of carbohydrate every 1 to 2 hours. If blood glucose is greater than 13.5 mmol/L (240 mg/dl), drink water, tea without sugar, instant broth, diet drinks, OR eat ice chips, sugar-free icicle pops, sugar-free gelatin, etc. If vomiting, start fluids 1 to 2 hours after and sip slowly.