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Sick day guidelines for a child with diabetes

If you suspect your child may be unwell

Make sure you always have a good supply of the following:

  • Blood ketone test strips  for use with a  blood ketone meter(check ketone strips have not expired)
  • Blood glucose test strips
  • Sweet foods and drinks (see list below)
  • Rapid acting insulin eg novorapid


Diabetes and Illness

The body’s response to illness is to release stress hormones (blood glucose raising hormones). This will most likely increase your child’s blood glucose levels, you will therefore need more insulin than normal when your child is ill.  However it is also usual to eat less when you are feeling unwell. These two factors must be considered and managed throughout the days your child is unwell.

During illness even if the child is not eating, blood sugar levels tend to rise so more insulin is generally needed. The blood glucose levels may become too low (hypo) if your child has a sickness and diarrhoea illness. Seek advice from diabetes team

Actions for Parents to take and when

Test your child’s blood glucose levels more frequently. (2 -4 hourly) depending on severity of illness.

Check your child’s blood Ketone levels if blood  glucose is repeatedly over 14mmol/l.

Contact diabetes team/ward if your child has ketones present and they are increasing.

Encourage your child to drink plenty of water or unsweetened fluids. When the blood glucose levels are high your child is likely to pass more urine and therefore more likely to become dehydrated. If your child is unable to eat as they normally would, replace their meals/snacks with something sweet.

  • Flat soft drinks (full sugar) e.g. coke, Lucozade
  • Ribena, squash (full sugar)
  • Milk
  • Soup
  • Toast
  • Jelly and ice cream
  • Milk pudding, porridge
  • Biscuits
  • Yoghurts

Insulin dose adjustments

Depending on the illness the blood sugar levels may increase and more rapid acting insulin may be needed e.g. Novorapid needs to be given.

As a general rule you will need to give your child an extra bolus dose of fast acting insulin as a correction dose if their blood glucose levels are above 10mmols.

If the blood glucose levels are consistently low you may need to give less fast acting insulin. This usually occurs with diarrhoea and vomiting.

Call for advice if your child is unable to keep fluids down/vomiting.


What are Ketones?

Ketones are made when the body breaks down fat to use as energy when it cannot use carbohydrates -usually due to lack of insulin. You can check if your child has ketones by testing their blood using a blood Ketone meter .

Symptoms of Ketones

Nausea and vomiting
Abdominal pain
Deep rapid breathing
Breath smelling of pear drops

Ketones and low blood glucose:

These Ketones have been produced because the body is hungry. If your child’s blood glucose is very low and Ketones are positive then your child’s body is hungry for food. Respond by offering sweet drinks/food or whatever can be tolerated.

If your child is unable to tolerate fluids and you are having difficulty keeping blood glucose levels above 4mmol/l bring your child to A&E.

Ketones and high blood glucose:

These Ketones are produced because the body does not have enough insulin. If your child’s blood glucose is high encourage them to drink plenty of unsweetened fluids.

Depending on the amount of Ketones your child may require extra rapid acting insulin. Please call the diabetes team for advice.

Refer to management of high blood sugars guidance.

What to do if blood Ketones are rising and  your child is deteriorating

Ketones are an acid which can quickly make you feel very unwell and can make you vomit.

The build up of Ketones can lead to DKA – diabetic ketoacidosis.

This requires urgent medical treatment at the hospital. If blood ketones are rising despite extra insulin or/and your child is vomiting bring into PDU PROMPTLY

Signs and symptoms of DKA:

Remember to:

  • Treat the symptoms of the illness as well e.g. paracetamol (sugar free calpol) for a temperature.
  • Check glucose levels and Ketones regularly and call for advice if needed. This may require urgent medical treatment at the hospital.