Sick Day Guidelines for Children with Type 1 Diabetes
Any type of illness mainly nausea, vomiting, and diarrhea or an infection with a fever can cause your child’s blood sugar to go higher. Most people think that the blood sugar will be low because your child is not able to eat or drink. But, illness is a stress that increases the body’s need for energy. During illness, stress hormones are produced in the body, which increase blood sugar. As a result, the blood sugar level will be higher when your child is ill, even if your child isn’t eating. There may be some times when the blood sugar may be low.
Symptoms of high blood sugar
- Increased thirst shows body’s need for fluid.
- Increased urination is the body’s way of getting rid of excess sugar.
- Fatigue shows low energy level because sugar is not being changed into energy due to a lack of insulin.
- Weight loss as the body is burning fat for energy.
- Dehydration as excess fluid is lost in an effort to get rid of sugar. This is more if throwing up or diarrhea is present.
If the blood sugars are not controlled during an illness and your child does not get enough insulin, ketoacidosis can occur. Your child may have ketones even if the blood sugar is normal. You should be able to prevent ketoacidosis by following special guidelines when your child is sick and not able to eat his normal meals.
When to Call Your Health Care Provider
When your child becomes ill, call your doctor right away at (608) 263-6420. After hours, the clinic number will give you the paging operator. Ask to speak to the pediatric diabetes doctor on call. Give the operator your name and phone number with the area code. The doctor will call you back. Or, go to your nearest emergency room.
When you call, have this information ready. A written record may help you recall it.
- How long your child has been sick.
- Number of times vomited in last few hours.
- Recent blood sugar levels.
- Recent urine ketone levels.
- Amount of fluid or food intake with illness.
- Temperature (take your child’s temperature).
- Amount of insulin taken and usual insulin dose.
- How long your child has had diabetes.
- Recent weight.
Guidelines for Sick Days
Checking
1. Check your child’s blood sugar every 2-4 hours.
2. Check your child’s urine for ketones every time he or she urinates, or at least every 4 hours. It is best to keep a supply of ketostix at home in case you need to test your child’s urine for ketones. If ketones are moderate to large, your child will need extra insulin.
Insulin
1. Never omit your child’s insulin. Keep giving your child his or her normal Lantus or Levemir insulin. Do not give NPH insulin. Use a sliding scale (correction insulin) of Regular, Humalog, or Novolog insulin as directed by your diabetes team.
Blood Sugar Insulin
Less than 150 No insulin, and recheck blood sugar in 1 hour
______ _______ units of Regular, Humalog, or Novolog Insulin
______ _______ units of Regular, Humalog, or Novolog Insulin
______ _______ units of Regular, Humalog, or Novolog Insulin
______ _______ units of Regular, Humalog, or Novolog Insulin
______ _______ units of Regular, Humalog, or Novolog Insulin
2. The sliding scaled (correction insulin) doses are based on your child’s weight. As your child grows, these doses will change. Please call for dosing advice.
If your child has symptoms of ketoacidosis (see last page for details) and is ill, your doctor or nurse may advise you to take your child to the nearest hospital emergency room to be checked over. Do not delay treatment. Ketoacidosis needs treatment right away. This can be a life-threatening illness.
Nutrition Guidelines
1. To prevent dehydration, your child needs to keep drinking water and other liquids. If your child also is throwing up and having diarrhea, the body is losing vital electrolytes such as potassium and sodium. These losses must be replaced. Try having your child sip small amounts of fluids every 10 – 15 minutes (8 ounces every hour). Bouillon, soups, juices, and sports drinks are good sources of sodium and potassium.
2. If your child is not able to eat normal foods, you should try to replace the carbohydrates in the normal meal plan with sugary foods or soft foods that your child can tolerate. These include: regular (non-diet) soda, Jell-O®, pudding, juices, Popsicles®, sherbet, sports drinks, etc. Sodas that are warm and flat are easier to drink than cold, carbonated sodas. You may want to stir the soda to release the bubbles. These foods must have sugar/carbohydrates (regardless of the blood sugar level) to prevent the breakdown of fat into ketones, which leads to ketoacidosis. Your child should try to eat or drink these foods often.
Ketoacidosis
Ketoacidosis is a life-threatening illness that results from not having enough insulin in the body. It can happen within a few hours with an illness. When there is not enough insulin in the body, the body burns fat for energy. Ketones come from the breakdown of fat. Ketones are an acid. If high levels of ketones build up in the blood, an illness known as ketoacidosis develops. This can occur even if the blood sugar is normal or low. Causes
|
Symptoms
If not treated, your child could go into a coma.
Note: Symptoms of ketoacidosis may mimic the stomach "flu". |
Health Care Provider’s Name and Telephone Number ________________________________________________________
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 03/14/2012
Copyright © 03/14/2012 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5647
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