Patient Education
Sick Day Management for the Child with Diabetes

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Food & Beverage Ideas

* These numbers are approximate. Please refer to food labels of individual products.

Management

Goal: To prevent ketoacidosis resulting from dehydration and lack of insulin.
Remember: Insulin requirements INCREASE with illness.

Target: blood glucose range during illness is 100-200 mg/dl.

Keep Humalog or Novolog insulin, syringes, Ketostix, glucagon, blood glucose monitoring strips available. Keep sugar free and regular fluids on hand for sick day care.

1. Never omit insulin without speaking with the Diabetes Health Care Team.
   
   
2. If unable to eat, give a correction factor every 3-4 hours for blood glucose over 250 with moderate to large ketones. Increase correction factor as follows:
   
   - Add 1 unit for moderate ketones.
   - Add 2 units for large ketones.
   
   For insulin pumps: if blood glucose is over 400 for 3-4 hours give correction factor by syringe in the muscle.
   
   THERE MUST BE 3 HOURS BETWEEN HUMALOG/NOVOLOG INSULIN DOSES TO PREVENT TOO MUCH INSULIN AND LOW BLOOD GLUCOSE.
   
   
3. Call the Diabetes Health Care Team for Assistance if:
   
   - YOU HAVE CORRECTED FOR ELEVATED BLOOD GLUCOSE (> 250) TWICE
   - HAD 2 READINGS < 80 AFTER CORRECTING
   AND/OR
   - YOU HAVE MODERATE TO LARGE URINE KETONES
   
   
4. Give carbohydrates according to usual requirements using suggested sick day fluids and foods.
   
   
5. Prevent dehydration by drinking fluids constantly, even through the night. Examples: water, decaf diet soda, soup broth. The approximate amount needed depends on your child's weight:
   
   

   Approximate Weight	Ounces/Hour
   20 lbs	1
   35	2
   50	2 ½
   100	3
   150	5

   
   
6. Continue same Lantus dose.
   
   
7. Monitor blood glucose and urine ketones at least every 2 to 3 hours (DAY AND NIGHT) during all illnesses associated with fever, decreased food intake, vomiting, or diarrhea.
   
   
8. Test for ketones with every urination even if blood sugar is normal or low.
   
   
9. Treat your underlying infection or illness.

Go to Emergency Room if:

• persistent vomiting and/or diarrhea and unable to keep fluids down
• blood glucose is less than 80 with moderate to large ketones
• you have persistent large ketones for more than 6-8 hours

Inform the Diabetes Health Care Team of your need to go to the Emergency Room.

Diabetes Health Care Team

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