Clinical Meaning
Sick Day Diabetes Management bridges routine outpatient diabetes care and the DKA emergency.
Sick Day Diabetes Management bridges routine outpatient diabetes care and the DKA emergency. Counter-regulatory hormones released during illness (cortisol, glucagon, epinephrine, growth hormone) drive glucose up and impair insulin effectiveness — even patients who cannot eat will have rising glucose and may develop ketones. The life-threatening teaching failure: the patient stops insulin during vomiting because they are not eating. This is incorrect and dangerous in type 1 diabetes. Sick-day rules the nurse teaches: Never stop insulin. Check glucose every 4 hours. Check ketones when glucose >240–300 mg/dL. Push clear fluid intake. Call provider or seek emergency care for: inability to keep fluids down (>2 episodes vomiting), moderate-to-large ketones, glucose not responding to correction, altered mentation, or glucose >300 mg/dL not improving. Boards test the nurse's recognition that vomiting + ketones + glucose 350 in a type 1 patient = DKA trajectory requiring emergency evaluation — not outpatient management.
