Kids with diabetes get sick once in a while, just like other kids. However, because the effects of illness on the body can raise or lower blood sugar levels in people with diabetes, parents need to know about a few extra precautions for keeping blood sugar levels under control on those days. With proper planning and some advice from your child's doctor, you'll be prepared to handle sick days with confidence.

How Illness Affects Blood Sugar Levels

When your child gets sick - whether it's a minor illness like a sore throat or cold or a bigger problem like dehydration or surgery - the body perceives the illness as stress. To relieve the stress, the body fights the illness. This process requires more energy than the body normally uses.

On one hand, this is good because it helps supply the extra fuel the body needs. On the other hand, in a person with diabetes, this can lead to high blood sugar levels. But although stress tends to make blood sugar rise in people with diabetes, some illnesses cause loss of appetite, nausea, or vomiting. The poor intake of food in such cases can result in low blood sugar levels in a person who is taking his or her usual doses of insulin.

In a nutshell: Blood sugar levels can be very unpredictable on sick days. Because you can't be sure exactly how the illness will affect your child's diabetes control, it is important to check your child's blood sugar levels often on sick days and adjust insulin doses as needed.

Advance Preparation

Your child's diabetes health care team will include sick-day instructions in the diabetes management plan. These sick-day guidelines might include:

• how to monitor both blood sugar levels and ketones when your child is sick
• which over-the-counter and prescription medicines are OK to give your child
• what adjustments you should make to your child's food and drink and to your child's medications
• when to call your child's doctor or another member of the diabetes health care team

In addition, kids with diabetes should get the pneumococcal conjugate vaccine (PCV), which protects against some serious infections, such as certain types of pneumonia, blood infections, and bacterial meningitis. Kids with diabetes should also get a flu shot every year. These vaccines may help cut down on sick days.

When Your Child Is Sick

Your child's doctor will give you specific advice about what to do when your child is sick. Here are some general guidelines:

• Stay on track. Unless your child's doctor tells you to make changes, be sure your child keeps taking the same diabetes medications. It's important for your child to keep taking insulin during illness, even though your child's food intake may be reduced. The liver produces glucose and releases stored glucose into the blood, so even if your child is not eating very much, the body still needs insulin to process the glucose. In fact, some people need more insulin than usual on sick days - and some people with type 2 diabetes who don't take insulin may even need some. Without insulin, the body starts to burn fat, ketones build up in the blood, and diabetic ketoacidosis can occur.
• Keep a close eye on blood sugar and ketone levels. Blood sugar levels should be checked frequently - your child's doctor will give you advice about how often. Urine tests for ketones are often positive during illness (even in kids without diabetes) when a child's intake is poor and the body has shifted to using stored fat for energy. But for children with diabetes, testing ketones can provide an early warning sign that ketone levels in the blood may be building up to levels that can cause diabetic ketoacidosis. Your child's diabetes treatment plan should guide you as to when and how often to check ketones.
• Pay special attention to nausea and vomiting. Children with diabetes occasionally catch a bug that causes nausea, vomiting, or abdominal pain. However, because these can also be symptoms of ketoacidosis in a child with diabetes, it's important to closely monitor blood glucose and ketone levels and seek medical help according to the guidelines in your child's diabetes treatment plan.
• Prevent dehydration. Have your child drink plenty of fluids. You might offer beverages that your child likes and that don't worsen symptoms like nausea. Your child's doctor can advise you about the types of fluids that would be best to give your child in a given situation to help manage the illness and maintain control of your child's diabetes.
• Use medications wisely. Although doctors' opinions vary as to whether they are really helpful, over-the-counter medications are often given to kids to control symptoms for illnesses such as the cold or flu. These medications may contain ingredients that raise or lower blood sugar or that imitate symptoms of high or low blood sugar levels. You should follow the advice of your child's doctor before giving an over-the-counter medication to a child with diabetes. Guidelines for using common medications are often included in the diabetes management plan, including things you need to check on the medications' labels. If over-the-counter medications are given at the right dose for your child, they generally don't have any significant effect on diabetes control. On the other hand, prescription drugs such as glucocorticoids (like those given for a severe asthma flare) can significantly raise blood sugar. Make sure you are aware of the possible effects on your child's diabetes of any drugs prescribed for him or her. Contact your child's doctor if you think any adjustments to the diabetes treatment plan might be necessary.
• Take notes. When you talk to your child's doctor, certain information will be helpful and should be kept handy. Through your child's illness, keep a record of your child's symptoms, medications and doses your child has taken, what food and drink was consumed, and whether your child kept the food down. Also, note any weight loss or fever and record blood sugar and ketone level test results.
• Help your child rest. Of course, people need rest when they're sick. If your child or teen usually manages diabetes on his or her own, you may need to take over for a day or 2. Encourage your child to sleep or rest as much as possible.

When to Call Your Child's Doctor

Your child's diabetes management plan will include specific guidelines to help you recognize when your child may need medical help. It will tell you what actions to take and whom to call. Here are some general reasons for calling the doctor if your child is sick:

• all the same reasons you normally would call about diabetes management, as well as for any questions you have about the illness
• if your child has a lack of appetite or inability to eat or drink
• if your child has persistent vomiting or diarrhea
• if your child's blood sugar is low because of poor food intake - but remember to take steps at home to bring your child's blood sugar back up, such as injecting glucagon, if necessary, before calling the doctor or rushing off to the emergency department
• if your child has blood sugar levels that are high for several checks or don't decrease with extra insulin
• if your child has moderate or large amounts of ketones in the urine
• if you think your child may be having symptoms of diabetic ketoacidosis
• if your child's food or fluids will be restricted for things like diagnostic tests, surgery, or a dental procedure

Any time you have questions or concerns, feel free to call your child's doctor. Together, you can make sure that your child is feeling well again soon.

Reviewed by: Steven Dowshen, MD, and Elana Pearl Ben-Joseph, MD
Date reviewed: June 2005