10 Safety Rules: managing diabetes when your child is sick
Managing diabetes can be challenging when your child is sick. An illness (such as an infection or flu) often causes high blood glucose and ketones, even if your child is not eating. Or sometimes loss of appetite, vomiting or diarrhea can result in low blood glucose. These symptoms and high blood glucose (along with frequent urination that accompanies highs) can lead to dehydration. The following safety rules will help you manage your child’s diabetes during an illness.
1. It is wise to check blood glucose every 2-4 hours, around the clock.
2. If blood glucose is 14.0 mmol/L or higher, it’s important to check urine or blood for ketones every 4 hours around the clock.
DO NOT ASSUME that nausea and vomiting are related to your child’s current illness. These symptoms could be a result of a build-up of ketones. If you do not check for ketones when the blood glucose is high and act upon them quickly by giving additional fast-acting insulin, dangerous diabetic ketoacidosis (DKA) can develop.
If your child is on an insulin pump, remember that high blood glucose and ketones can also happen because of a pump or infusion set problem, so it’s especially important during illness to make sure that all parts of the pump are functioning properly.
More on Ketones & Testing for Ketones:
3. Continue to give insulin when your child is ill.
Even when blood glucose is on the low side, even when your child is not eating and/or is vomiting, there needs to be some insulin (especially basal, or background insulin) in the blood for the body to be able to use glucose for basic energy needs. If no insulin is present, the body will default to burning fat, and ketones will develop.
Whether or not you give more, less, or the usual amount of insulin depends on your child’s symptoms and blood glucose readings:
- Give the usual dose of insulin if your child is eating and does not have ketones.
- If the blood glucose is above 14.0 mmol/L and ketones are present, give additional fast-acting insulin.
- If the blood glucose is below 10.0 mmol/L and your child is not eating the usual amount, give less insulin.
For details, see Insulin Adjustment for Illness – Injections or Insulin Adjustment for Illness - Insulin Pump, or contact your child’s diabetes health care provider.
4. If your child is able to eat:
- Follow the usual meal plan and offer foods that are easy to tolerate (such as crackers, dry toast, plain pasta).
- Don't worry about your child eating protein- and fat-containing foods until he is feeling better.
Food/Drink Suggestions:
5. If your child is not able to eat, make sure she is at least consuming fluids (as outlined in #6, next).
- Follow the usual meal plan and offer foods that are easy to tolerate (such as crackers, dry toast, plain pasta).
- Do not worry about giving protein- and fat-containing foods until your child is feeling better.
6. Give sips of fluid to prevent dehydration.
Your child needs at least ½ to 1 cup (125-250 mL) of fluids each hour to keep hydrated. Sugar-free fluids are suggested if blood glucose is high. Sugar-free Powerade® will also help restore potassium levels. Canned broths, Gatorade®, and Pedialyte® will also help replace electrolytes. Specifically:
For children on a Conventional Insulin Program (N/NPH):
- If blood glucose is below 14.0 mmol/L, fluids containing sugar are best (for example, apple juice, regular pop, regular Kool-Aid®, regular popsicles). Carb content of this fluid should reflect the amount of extra carbs needed at this time to match the insulin peak.
(If you are unsure of the amount of carbs to deliver, contact your child’s health care provider.) - If blood glucose is above 14.0 mmol/L, sugar-free fluids are best (for example, water, consommé soup, diet pop, diet Kool-Aid®, sugar-free Powerade®)
For children on a Basal/Bolus Program (Lantus/Levemir):
- If blood glucose is below 10.0 mmol/L, fluids containing sugar are best (for example, apple juice, regular pop, regular Kool-Aid®, regular popsicles). A good rule of thumb is to try and keep your child’s BG between 8 and 10 mmol/L by using a small amount of carbs (5-10g).
- If blood glucose is above 10.0 mmol/L, sugar-free fluids are best (for example, water, consommé soup, diet pop, diet Kool-Aid®, sugar-free Powerade®)
For children on an Insulin Pump Program:
- If blood glucose is below 10.0 mmol/L, fluids containing sugar are best (for example, apple juice, regular pop, regular Kool-Aid®, regular popsicles). A good rule of thumb is to try and keep your child’s BG between 8 and 10 mmol/L by using a small amount of carbs (5-10g).
- If blood glucose is above 10.0 mmol/L, sugar-free fluids are best (for example, water, consommé soup, diet pop, diet Kool-Aid®, sugar-free Powerade®)
7. Make sure your child rests.
If blood glucose is high with ketones, increased activity may cause the blood glucose to rise even further.
8. If you have concerns about your child’s illness...
see your family doctor or call your local health information service.
- in Alberta, call Health Link at 8-1-1
9. Medication
- You may use acetaminophen (Tylenol®) or ibuprofen (Motrin®, Advil®) for fever and pain.
(Be aware that acetaminophen may cause Continuous Glucose Monitor results to be inaccurate – if your child uses a CGM, opt for finger pokes for blood glucose monitoring, as needed.) - If you choose to use products for coughs and colds, you may opt for sugar-free versions.
- Prescription drugs such as antibiotics may be used as directed by your doctor.
10. Contact your child’s doctor/diabetes nurse, or go to the Emergency Department, if:
- You are unable to keep blood glucose above 4.0 mmol/L.
- Your child vomits more than 2 times in 4 hours.
- Ketones do not go away after 2 corrections (extra doses of fast-acting insulin).
- Blood ketones are greater than 3.0 mmol/L. (Your child may have diabetic ketoacidosis.)
- Your child has signs of dehydration: dry mouth or tongue, cracked lips, sunken eyes, dry flushed skin, not peeing much.
- Your child has signs of diabetic ketoacidosis: high blood glucose and ketones with nausea, stomach pain, vomiting, fast-breathing, fruity-smelling breath and drowsiness. DKA is a medical emergency that requires immediate treatment with intravenous insulin and fluid, as well as electrolyte replacement.
References:
The above information was adapted with permission from The Alberta Children’s Hospital Diabetes Clinic information handouts.
The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.
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