If you have type 1 diabetes you will need to take insulin using pen injections or an insulin pump.

You will have your own medication plan specific to you which will be discussed between you and the diabetes team on a regular basis. You can ask them any questions or talk through any concerns you have. It may be helpful to remember to rotate injection sites; if you keep injecting into the same area small lumps can build up under the skin. They don't look or feel very nice and they make it harder for the body to absorb and use the insulin properly. So it's important that you change the spot that you use each time.

It is also important to know how to manage your diabetes and what to do if you are feeling unwell. 

Sick day rules

Your diabetes does not make you more susceptible to illness if well controlled, but illness can cause your diabetes to be difficult to manage. The body's natural response to illness results in higher blood sugar levels due to the release of stress hormones with increased resistance to the action of insulin. During illness, you will need frequent blood sugar and blood ketone monitoring and often more insulin than usual. Never stop your insulin if you are ill, even if you are not eating as much as normal. You may need more insulin if ketones are present. Speak to a member of the team if you need advice to adjust the dose.

Hyperglycaemia (BG higher than 13mmol/L) and raised blood ketones on injection or an insulin pump

This situation needs urgent action to bring blood glucose down. Hyperglycaemia can be due to illness, pump failure or problems with the infusion/giving of insufficient insulin:

• Troubleshoot your pump - you should change the cannula and infusion set if concerned insulin is not infusing correctly from the pump.
• If blood ketones are higher than 0.6mmol/L, give additional fast acting insulin using an insulin pen  to prevent you getting worse, as a set change can take some time to take effect. 
• When blood glucose levels are rising, you are unwell and needing frequent additional insulin doses, consider using higher temporary basal insulin rates. Up to double normal basal rates may be needed in some patients.
• REMEMBER to contact your diabetes team for extra advice.

 Hypoglycaemia (low blood sugar) during illness

Infections causing vomiting or diarrhoea may lead to hypoglycaemia.

• If ketones are present when the blood glucose is low, they are called 'starvation' ketones and respond to eating carbohydrates. 
• If you are unable to eat, replace the normal carbohydrate with fluid such as milk, fruit juice, lemonade, Lucozade, Coke or equivalent sweet drinks. 
• Monitor blood glucose very closely. Correction doses of insulin may be required when blood glucose starts rising. 
• Consider a temporary reduction in the basal insulin (Levemir or Lantus) dose. 

Top tips

• Blood glucose and ketones should be monitored every one to two hours.
• Encourage extra fluids - if you are unable to eat, have frequent sips of sugar-free fluids to increase fluid intake, making sure you drink every hour or more frequently. This helps avoid dehydration and flushes out ketones.
• For pain or a temperature take sugar free paracetamol (e.g Calpol) or Ibuprofen (e.g Nurofen) according to usual directions. 

When to attend hospital 

• If blood glucose and ketones are not reducing despite insulin adjustment and increased fluid intake 
• If you are vomiting and have ketones 
• If you have abdominal pain, are drowsy and/or you have breathing difficulties as this could indicate diabetic ketoacidosis.
• If you cannot tolerate oral fluids 

Remember: Always tell someone if you are unwell and if you need advice contact your diabetes team