What are the sick day rules for a person with type 1 diabetes using an insulin pump when they have significant ketones (blood ketones 1.5–3.0 mmol/L) and blood glucose above target?

Do not stop or suspend the pump. Give 10% of the total daily dose (TDD) as a bolus every 2 hours, adding the usual insulin-to-carbohydrate ratio if eating, and increase basal insulin by 30% using a temporary basal rate. Sip sugar-free fluids and check blood glucose and ketones regularly, and go to hospital as an emergency if you vomit, cannot keep fluids down, or cannot control glucose or ketones.

The pump DAFNE sick day rules state that you must never suspend or stop the insulin pump. Sip sugar-free fluids at least 100 ml per hour, and calculate your typical total daily dose (TDD). Give 10% of TDD as a bolus every 2 hours, and include your usual insulin-to-carbohydrate ratio if you are eating. Increase basal insulin by 30% using a temporary basal rate, overriding the bolus calculator. If blood glucose remains above target, use a corrective bolus even if you are not eating; you may need larger doses, so override the bolus calculator if necessary. If glucose is persistently above target, consider a further 10 to 20% basal increase using an increased temporary basal rate. Check blood glucose and ketones every 2 hours. If blood glucose remains unchanged or rises further, take a corrective dose of rapid-acting insulin using a pen, change the cannula, infusion set and insulin reservoir, and recheck in 2 hours. Seek emergency medical care if you vomit, are unable to keep fluids down, or cannot control your blood glucose or ketones.