Diabetes and sick day management

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Being sick can impact your child's blood sugar levels. Find tips on how to manage diabetes on sick days.

Key points

  • Your child should continue to take insulin even if they are sick and not eating.
  • Monitor blood sugar levels carefully while your child is sick as blood sugar levels may go up or down, depending on the illness.
  • If your child vomits twice or more within 12 hours, call your diabetes team​ for advice.
  • If you are worried about the sugar in medications, ask your pharmacist to suggest preparations that are sugar-free.

In ​a person with diabetes, illnesses — even common ones such as a cold, a sore throat, or the flu — can trigger imbalance in blood glucose (sugar) levels​. At first, blood sugar levels usually go up with an illness. However, because appetites tend to fall with illness, the blood sugar levels may fall too.

If your child is not able to eat solid foods, make sure they have drinks that contain carbohydrates​. This will help them to:

  • stay hydrated
  • have enough energy to fight the infection
  • keep blood sugar in a safe range.

Your child should still keep taking insulin even if they are sick and not eating; however, the dose may need to be adjusted.

Diabetes and sick days

Children with diabetes do not experience more illnesses than their friends without diabetes. An otherwise healthy person with well-controlled diabetes has normal resistance to infection and normal healing of injuries. Although your child is not more likely to fall ill and their illnesses might not be any more difficult to treat than those of their friends, there is one difference: Children with diabetes must be aware that some illnesses may upset the blood sugar balance.

When children with diabetes get sick, their blood sugar level often (but not always) goes up and ketones may appear in the urine. This is because illness is a stress to the body and stress creates a demand for more energy. Energy comes primarily from sugar. As result, more insulin may be needed. People without diabetes automatically make more insulin at such times, but children with diabetes do not. Therefore, on a sick day the usual amount of insulin may not be enough.

Not all illnesses make blood sugar levels go up. In fact, illnesses like diarrhea may be accompanied by low blood sugar levels. Therefore, when a child with diabetes is sick, careful monitoring of blood sugar levels and urinary ketones will help determine the effect of the illness and the best plan of action. If blood sugar level is high and ketones are present during the duration of the illness, you may need to increase the insulin dose, even though the child’s appetite is poor, to prevent diabetic ketoacidosis (DKA).

Monitoring blood sugars

When your child is sick, you should monitor blood sugar levels carefully and ensure that diabetes management stays on track while eating and drinking patterns fluctuate.

  • Check blood sugar and urinary ketone levels when the illness first appears. You do not need to do extra checks for a mild case of the sniffles, but you should for more significant illness symptoms. Continue to check every four hours around the clock until the illness has improved and blood sugars are normal.
  • Continue giving insulin during the illness. Even though your child may not be eating well, the physical stress of the illness will probably raise the blood sugar levels and cause ketones to form. Never stop giving insulin to your child. They may need less insulin but never no insulin at all. Remember that insulin prevents ketones from forming, and is therefore always required.
  • If your child does not want to eat, give small, frequent amounts of clear fluids containing carbohydrates (for example, fruit juice).
  • Teens who normally manage their diabetes on their own will likely need help or supervision throughout their illness.
  • Make sure you are treating the illness that is disrupting your child’s diabetes blood sugar control. Acetaminophen or ibuprofen​ in the usual doses for fever or pain is safe, unless the doctor says otherwise.

Call your diabetes doctor or nurse immediately if illness is accompanied by:

  • vomiting and/or poor eating or drinking
  • urinary ketones in small, moderate, or large amounts and you are unsure of how to adjust your child’s insulin dose.

If your child vomits twice or more within 12 hours, call your diabe​tes team​ for advice. Your child may need to be taken to the closest emergency room for management, especially if they have a blood sugar level higher than 14 mmol/L and have ketones in the urine.

Food and drink guidelines for sick days

When your child is sick, they may be unable to eat the usual amounts of food in their meal plan. It is important to replace the uneaten food with fluids that have enough sugar to balance the insulin administered.

If your child’s carbohydrate intake is consistent

  • If possible, keep following the meal plan. Your child still needs carbohydrates to prevent a “low blood sugar” (hypoglycemia).
  • If your child has a hard time eating solid foods, you can give them fluids that contain carbohydrates, such as fruit juice, frozen ice treats, sugar-containing fruit-flavoured gelatin, or soft drinks. This will replace the amount of carbohydrates that your child would normally have during that day.
  • If your child cannot tolerate large volumes of fluid all at once, give them small, frequent amounts of carbohydrates throughout the day.

For example, if your child has 42 grams of carbohydrates for breakfast and 15 grams for morning snack, the total for the morning is 57 grams of carbohydrates. While your child is sick, they can have the 57 grams all at once or have 10 to 15 grams every hour for the morning hours.

If your child’s carbohydrate intake fluctuates

When your child is sick, they should have 10 grams of carbohydrates every hour. Examples of food/drinks that contain 10 grams of carbohydrates are:

  • half a cup of juice
  • 1 cup of soup
  • a third of a can of regular pop
  • a quarter cup of regular Jell-O.

If your child vomits twice or more within 12 hours, call the diabetes team or take your child to the hospital immediately. Continued vomiting may lead to DKA or severe hypoglycemia.

Medication and sick days

Some parents wonder what to do if their child has a minor illness, such as a cough, that they would normally treat without a visit to the doctor.

Health Canada does not recommend giving oral cough or cold medications to children younger than 6 years of age. If your child is older than 6 years and there is a cough syrup that you find effective for your child, then use it as directed. The sugar content of the prescribed dose is probably minimal. If you are worried about the sugar in medications, ask your pharmacist to suggest preparations that are sugar-free.

Children with diabetes usually take the same medications as other children. However, take note of the following:

  • If your doctor prescribes a course of antibiotics, your child must finish the prescription, even if blood sugar levels begin to rise. Many parents think the antibiotics are the cause of the blood sugar increase. In fact, the illness is probably causing stress on the body, leading to higher sugar levels.
  • Oral medications containing steroids can lead to high blood sugar readings. One example is prednisone, which is sometimes prescribed for children with asthma. These drugs can create a need for more insulin. Be prepared to increase the insulin dose, which your diabetes team can help you do.
  • If your child is on oral diabetes pills and is tolerating them well, these medications should be continued during the course of the illness.
  • If your child is dehydrated, and cannot drink enough fluid to stay hydrated, or if your child has extreme vomiting and diarrhea, contact your diabetes team, particularly if your child is taking the following medications:
    • blood pressure pills
    • water pills
    • metformin
    • diabetes pills​
    • pain medications
    • non-steroidal anti-inflammatory drugs (found in ibuprofen and cold medications)

    These medications might need to be stopped or their dosages adjusted. Do not do this without the support of your health-care provider.

    If you are unsure about any drugs your child is taking, check with your diabetes team to confirm.

Last updated: October 17th 2016