| Insulin injection management during illness | 1751.00000000000 | Insulin injection management during illness | Insulin injection management during illness | I | English | Endocrinology | Child (0-12 years);Teen (13-18 years) | Pancreas | Endocrine system | Drug treatment | Adult (19+) | NA | | 2016-10-17T04:00:00Z | | | | | | 7.90000000000000 | 62.5000000000000 | 654.000000000000 | | Flat Content | Health A-Z | <p>Find out how to manage insulin injections while your child is sick.</p> | <p>When children are sick, they still need their long-acting insulin at their usual times. In fact, they may need extra injections of <a href="/Article?contentid=1729&language=English">rapid-acting insulin</a> as often as every four hours if they have <a href="/Article?contentid=1723&language=English">high blood glucose (sugar) levels</a> or if <a href="/Article?contentid=1727&language=English">ketones</a> show up in their urine.</p> | | <h2>Key points</h2><ul><li>To decide how much insulin to give, check blood sugar and urinary ketone levels every four hours.</li><li>To determine the total daily dose (TDD) of insulin, you must add all amounts of insulin from the past 24 hours including both long/intermediate and rapid-acting insulin.<br></li></ul> | <p>Because toddlers urinate at random times and not on command, it can be challenging for parents to regularly check urinary ketones. Your
<a href="https://akhpub.aboutkidshealth.ca/article?contentid=2511&language=English">diabetes team</a> may provide you with a blood ketone metre to check ketone levels in your toddler’s blood instead of the urine.</p><h2>Adjusting insulin doses according to blood sugar and ketone tests</h2><p>To decide how much insulin to give, check blood sugar and urinary ketone levels every four hours.</p><p>Consult the information below each time. The following illness scenarios offer courses of action depending on results of the blood sugar, urinary ketone, and blood ketone tests.</p><h3>Scenario one</h3><p>
<strong>Blood sugar:</strong> Less than 6 mmol/L<br><strong>Urinary ketones:</strong> Negative or positive (any amount)<br><strong>Blood ketones:</strong> 0 to 3 mmol/L<br><strong>Action: </strong></p><ul><li>If it is time to give insulin, reduce the dose of the long/intermediate-acting insulin and/or rapid-acting insulin by 10% to 20%.</li><li>Encourage your child to drink fluids that contain carbohydrates.<br></li><li>Speak to your doctor if further reductions are required, if your child refuses to drink, or if your child vomits.</li><li>If your child cannot eat or drink to treat a low blood sugar (hypoglycemia) this may be a time to give mini-dose glucagon.</li></ul><h3>Scenario two</h3>
<strong>Blood sugar:</strong> 6 to 14 mmol/L<br><strong>Urinary ketones:</strong> Negative or positive (any amount)<br><strong>Blood ketones:</strong> 0 to 3 mmol/L<br><strong>Action:</strong>
<p></p><ul><li>Give the usual insulin (long-acting and/or rapid) at the usual time. Do NOT give extra.</li><li>Recheck blood sugar and urine for ketones in 4 hours.</li></ul><h3>Scenario three</h3><p>
<strong>Blood sugar:</strong> More than 14mmol/L<br><strong>Urinary ketones:</strong> Negative or small (if your ketone strips follow the plus [+] scale, then [-] or [1+] fall under this category)<br><strong>Blood ketones:</strong> 0 to 0.6 mmol/L<br><strong>Action:</strong></p><ul><li>Give extra rapid-acting insulin now, up to 10% of the total daily dose. Give this in addition to the usual insulin (long-acting and/or rapid) at the usual time.</li><li>Recheck blood sugar and urine for ketones in 4 hours.</li></ul><h3>Scenario four</h3><p>
<strong>Blood sugar:</strong> More than 14 mmol/L<br><strong>Urinary ketones:</strong> Moderate or large (if your ketone strips follow the plus [+] scale, then [2+] or [3+] fall under this category)<br><strong>Blood ketones:</strong> 0.7 to 3 mmol/L<br><strong>Action: :</strong></p><ul><li>Give extra rapid-acting insulin NOW, at least 10% to 20% of the total daily dose. Give this in addition to the usual insulin (long-acting and/or rapid) at the usual time.</li><li>Recheck blood sugar and urine for ketones in 4 hours.</li></ul><p>To figure out how much more rapid-acting insulin to give, add up the total daily dose (TDD) of insulin.</p><h2>How to figure out the total daily dose (TDD)</h2><p>To determine the total daily dose (TDD), you must add all amounts of insulin from the past 24 hours including both long/intermediate and rapid-acting insulin.</p><p>Here is an example to help you figure out how much rapid-acting insulin to give based on the TDD.</p><p>Consider a child taking the following:</p><ul><li>20 units of intermediate-acting and 4 units of rapid-acting insulin before breakfast</li><li>4 units of rapid-acting insulin before supper</li><li>7 units of intermediate-acting insulin before bed.</li> </ul><p>This child has a total of 20+4+4+7=35 units of insulin a day. Ten percent of 35 units is 3.5 units because (35 x 10)/100=3.5. Twenty percent of 35 units is 7 units because (35 x 20)/100=7).</p><p>This child should receive 4 to 7 units. Small children tend to be sensitive, so for them, you should start with dosages at the lower end of the range.</p> | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Insulin injection management during illness | | False | | | | | | | | |
