What Should You Do If Your Child With Diabetes Is Sick?

From colds to flu to strep throat — getting sick is a common experience for children. This can already be a stressful experience for both parents and children, but when your child has diabetes, you have more things to consider to keep your child healthy.

Some illnesses may impact your child’s blood sugar or ketone levels. You may also have questions about what medications they can take and what they should eat. And you’ll need to make sure your child stays hydrated throughout all of this.

There are some simple ways to make sure your child stays safe while they’re sick:

• Test their blood sugar more often
• Test their ketones more often
• Give insulin as scheduled or according to their physician’s recommendations
• Increase fluid intake
• Don’t give medicines to control nausea or vomiting (unless instructed to by the Diabetes Team)

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Here are some ways to manage your child’s diabetes while they are fighting off an illness.

How Can An Illness Affect My Child’s Diabetes?

When your child’s body is trying to fight off an illness, blood sugar and ketone levels may change. It’s important to know what’s normal — and when to call your child’s medical team.

Low Blood Sugars

Low blood sugars can happen when your child is vomiting because their body is losing sugar. However, insulin is still needed for the body to make energy and should still be given with help from the Diabetes Team at Children’s.

High Blood Sugars

Even if your child does eat very well, their body’s response to an illness can raise their blood sugars. This rise in blood sugar is due to stress hormones being released to help the body fight the infection. These hormones cause the liver to release sugar into the bloodstream that can be used for energy with the help of insulin.

Ketones

Ketones can develop easily regardless of the blood sugar level while your child is sick. This is because the body is using extra energy to fight off their illness and may have to turn to fat for energy.

Call the Diabetes Team at Children’s at 402-955-3871 if:

• Your child is vomiting
• Moderate or large ketones are present
• Signs of dehydration are present — dry mouth, sunken eyes, little tearing, poor urine output
• Signs of ketoacidosis are present — deep rapid breathing, vomiting

Caring For Your Child While They’re Sick

If your child is sick, you’ll want to do everything you can to help them feel better. However, if your child has diabetes, some of these treatments may impact their health and be unsafe.

Medications

Over the counter cough and cold medications are okay to use, but prescribed medications may affect your child’s blood sugar — especially steroids. Contact the Diabetes Team whenever your child is starting an oral steroid (such as Prednisone) or an injected steroid (such as Solu- Medrol for severe asthma attack).

Fluids

Fluids are another important key to managing your child’s illness. A good goal is for your child to drink one ounce per hour for every year of age. For example, a 6-year-old should drink 6 ounces per hour. If your child is not vomiting, give them sugar-free fluids.

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How Much Fluid Should I Give My Child Who Is Vomiting?

In addition to calling the Diabetes Team, follow the 200 rule:

• If blood sugar is less than 200 mg/dL, drink/give clear sugar fluids.
• If blood sugar is greater than 200 mg/dL, drink/give clear sugar-free fluids.

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Sick Day Diet For Children With Diabetes

When your child is sick, they may not be able to eat the foods they usually eat, but they still need calories and carbohydrates to have energy.

15 grams liquid carbohydrates:

• 1/2 cup fruit juice
• 1/2 cup regular soda
• 1 cup Gatorade
• 1/2 cup regular gelatin (Jell-O)
• 1 tablespoon jelly
• 1 tablespoon honey
• 1 single Popsicle
• 1/2 cup ice cream or ice milk
• 1/4 cup sherbet
• 1 cup canned soup made with water

15 grams solid carbohydrates:

• 1/4 cup regular pudding
• 6 saltines
• 1 slice of toast
• 1/2 cup cooked cereal
• 1/2 banana
• 1/3 cup cooked pasta
• 1/3 cup cooked rice
• 1/2 cup mashed potatoes
• 1/2 cup unsweetened applesauce

Keep a sick day box in your kitchen with some of these items, including sugar-free items for when blood sugar is over 200.

Sick Day Scenarios

What you do on a sick day will vary with the type of illness and symptoms that your child has. There are 3 common scenarios your child may experience:

1. They are able to eat as usual (usually with colds, sore throats, ear infections, and wound infections).
2. They are able to eat the sick day diet (usually with flu, chicken pox, and diarrhea).
3. They are vomiting.

Able To Eat As Usual	Able To Eat Sick Day Diet	Vomiting
Check your child’s blood sugar and ketones every 4 hours	Check your child’s blood sugar and ketones every 4 hours	Check your child’s blood sugar and ketones every 4 hours
Follow a normal meal plan	Try to resume the normal meal plan using sick day diet	Check ketones each time your child uses the bathroom
Drink fluids	Drink fluids	Drink sips of fluids, follow the 200 rule
↓	↓	If under 200 = drink sugary fluids
YES, THERE ARE KETONES	YES, THERE ARE KETONES	↓
↓	↓	Call the Diabetes Team BEFORE giving ANY insulin
Call the Diabetes Team before giving your child insulin	Call the Diabetes Team before giving your child insulin	Communicate with the Diabetes Team every 1-2 hours
Communicate with the Diabetes Team every 1-2 hours	Communicate with the Diabetes Team every 1-2 hours
OR	OR
NO, THERE ARE NO KETONES	NO, THERE ARE NO KETONES
Resume normal insulin plan	Figure the meal insulin dose based on the insulin:carb ratio
Communicate with the Diabetes Team in several days if blood sugars remain high	Call the Diabetes Team before giving Lantus/Levemir dose
	Communicate with the Diabetes Team every 1-2 hours

Do you still have questions about managing your child’s diabetes while they’re sick? Contact the diabetes team at Children’s Diabetes Center, Children’s Nebraska at 402-955-3871 for more information about keeping your child safe while they recover from their illness.