Diabetic Sick-day Form

Diabetes and illness: Sick-day self-care plan To better manage your blood sugar and prevent dangerous diabetes complications, discuss your sick-day routine with your diabetes care team before you get sick. Medications

Contacting your health care team

I'll continue to take my insulin — by injection or pump — or my oral diabetes medications unless:

I'll contact someone on my diabetes care team — doctor, nurse or diabetes educator — if : 

My blood sugar is higher than ____________



My urine ketone levels are _______________ for more than __________ hours



I don't urinate for more than __________ hours



I'm uncertain about my blood sugar levels or what to do



Other

I'll adjust my insulin dosage by:

I won't take pramlintide (Symlin) or exenatide (Byetta) by injection if :

Contact information Doctor ___________________________________________ Daytime telephone _____________________________ Evening or weekend ____________________________

I'll check my urine for ketones when my blood sugar is higher than ________________________ and if I continue to have vomiting and diarrhea for more than __________ hours.

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Diabetes educator _________________________________ Daytime telephone ______________________________ Evening or weekend _____________________________