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Sick Day Management for the Child with Diabetes

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Food and Beverage Ideas

Food or Beverage

 Serving Size Carbohydrate Grams*
FREE FLUIDS    
    
Broth
1 cup 0-1
Diet Ginger-Ale or 7-Up
1 cup (8 oz) 0
Jello (sugar-free)
 ½ cup 0
Popsicle (sugar-free) 1-2 pops 0-5
CARB CONTAINING        
Apple Juice 1 cup (8 oz) 30
Applesauce
½ cup 20 (15 if unsweetened)
Cereal, dry ½ cup 15
Chicken noodle soup 1 cup 10-15
Ginger-Ale or 7-Up 1 cup (8 oz) 25
Graham Crackers 3- 2 ½ " squares 15
Jello
½ cup 15
Popsicle 1-2 pops 10-20
Potatoes, mashed ½ cup 15 g
Pudding ½ cup 25-30
Saltine Cracker 6 Crackers 15
Rice 1/3 cup 1
Toast 1 slice 15 g

* These numbers are approximate. Please refer to food labels of individual products. 

Management

Goal: To prevent ketoacidosis resulting from dehydration and lack of insulin.
Remember: Insulin requirements INCREASE with illness. 

Target: Blood glucose range during illness is 100-200 mg/dl.

Keep Humalog or Novolog insulin, syringes, Ketostix, glucagon, blood glucose monitoring strips available. Keep sugar free and regular fluids on hand for sick day care. 

1. Never omit insulin without speaking with the Diabetes Health Care Team.

2. If unable to eat, give a correction factor every three to four hours for blood glucose over 250 with moderate to large ketones. Increase correction factor as follows:

  • Add 1 unit for moderate ketones.
  • Add 2 units for large ketones.

For insulin pumps: If blood glucose is over 400 for three to four hours give correction factor by syringe in the muscle.

THERE MUST BE THREE HOURS BETWEEN HUMALOG/NOVOLOG INSULIN DOSES TO PREVENT TOO MUCH INSULIN AND LOW BLOOD GLUCOS

3. Call the Diabetes Health Care Team for Assistance if:

  • YOU HAVE CORRECTED FOR ELEVATED BLOOD GLUCOSE (> 250) TWICE
  • HAD TWO READINGS < 80 AFTER CORRECTING
    AND/OR
  • YOU HAVE MODERATE TO LARGE URINE KETONES 

4. Give carbohydrates according to usual requirements using suggested sick day fluids and foods.

5. Prevent dehydration by drinking fluids constantly, even through the night. Examples: water, decaf diet soda, soup broth. The approximate amount needed depends on your child's weight:

Approximate Weight (lbs) Ounces/Hour

20		 1
35 2
50 2.5
100 3
150 5


6. Continue same Lantus dose.

7. Monitor blood glucose and urine ketones at least every 2 to 3 hours (DAY AND NIGHT) during all illnesses associated with fever, decreased food intake, vomiting, or diarrhea. 

8. Test for ketones with every urination even if blood sugar is normal or low.

9. Treat your underlying infection or illness. 

Go to the Emergency Room if your child:

  • Persistently vomits and/or has diarrhea and is unable to keep fluids down 
  • Registers blood glucose levels less than 80 with moderate to large ketones 
  • Has persistent large ketones for more than six to eight hours 

 Inform the Diabetes Health Care Team of any emergency room visits.