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08 Apr 2008 - Sick Day Survival

Put a call into your endo or CDE as soon as your child shows signs of fever, vomitting or other 'major' illness. This way you are 'on record' if you need to call back for advice. Have the following information ready when you call: fever, last 5- 10 blood sugar readings, ketone test results, how many times your child has vomitted, your TDD (total daily dosage of insulin)

Sick Day Guidelines


Monitor blood sugar levels more frequently
When you are under stress from illness or injury, your body releases hormones, which can cause blood sugar levels to skyrocket.  Loss of appetite, nausea, and vomiting, on the other hand, may result in extremely low blood sugar levels.  Since you can't be sure how an illness will affect blood sugar levels, it is important to check them often.  How often depends on the individual and the seriousness of the illness, but a general target is at least every two to three hours.

Don't stop taking insulin
People with type 1 diabetes should never completely stop taking their insulin, even when they're not eating anything.  Insulin is necessary to maintain normal metabolism, and without it, the body starts to burn fat, which can lead to diabetic ketoacidosis (DKA).  Therefore, even if you or your child is vomiting or unable to eat, you will still need to take insulin. To determine the proper dosage, use blood sugar numbers to guide you, or call your doctor for help.   

Check urine (or blood) for ketones
This is very important for people with type 1 diabetes.  The presence of ketones in the urine or the blood, regardless of blood sugar level, shows that the body is in serious need of insulin.  This could become a life-threatening situation if not corrected.  If you find ketones in the urine, give additional insulin and lots of fluids.  If the ketones don't clear up in a few hours, call your doctor. 

Be careful with over-the-counter medicines
Over-the-counter remedies for colds, allergies, upset stomachs, etc., may contain ingredients that raise or lower blood sugars, or that imitate the symptoms of high or low blood sugar.  Be sure to read the labels before you buy any over-the-counter medication.  Some products recommend that people with diabetes check with their doctors before using the product.

Have a game plan and don't hesitate to ask for help
Ideally, you and your doctor should come up with a strategy for managing sick days before you or your child ever gets sick.  Discuss the possibility of using smaller, more frequent doses of short-acting insulin to better avoid high blood sugars.  For low blood sugars brought on by vomiting or loss of appetite, you'll need to replace carbs--perhaps with liquids or soft foods.

Call your doctor if you notice the following: fever or illness that lasts longer than two days, or vomiting or diarrhea that lasts more than eight hours; blood sugar levels that are higher than about 250-300 mg/dl that you can't seem to bring down; ketones in the urine or blood that don't go away within a few hours; inability to keep any food or liquid down; or any time that you just feel uncomfortable or confused about what to do. In order to communicate effectively with the doctor, be sure to keep accurate records of blood glucose readings, ketones, medication, fever, and all symptoms.

Over the Counter Medications:

Many medications have a warning lable stating that a person with diabetes should not use the medicine. This is because the medication may cause a rise in blood sugar. It is ok to take these medications, but keep an eye on your blood sugar reading. You may need to take some extra insulin to combat those highs.

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