9. Sick Days

What to do when your child is sick

Children and young people with diabetes generally don't get sick more often than other children if their diabetes is well managed. However, illness can have a significant impact on diabetes. The stress hormones produced during illness can cause changes to blood glucose levels. Levels can go high or low depending on the type of illness. Infections that cause fever and pain often cause high blood glucose levels. Gastroenteritis (vomiting and diarrhoea) can cause low blood glucose levels. Vomiting can also be a sign of not enough insulin.

If your child is sick:

• Always give insulin, but call the diabetes doctor for advice on changes to the usual amount

• Take your child to your GP for assessment and treatment of the underlying illness

• Test blood glucose levels 2 hourly

• Check blood or urine ketones 2 hourly

• Encourage your child to drink plenty of fluids

• If your child is unable to eat:

  • If blood glucose levels are under 10, give fluids with sugar (such as diluted juice, jelly or ice-blocks - not sugar-free)

  • If blood glucose levels are 10 or higher, give water or sugar-free fluids

• If your child has been vomiting or has diarrhoea, Pedialyte™ may be recommended by the diabetes doctor or your GP (this can be purchased from the pharmacy)

• Relieve the symptoms of pain and fever with Paracetamol or Ibuprofen

• Even teenagers who usually manage their diabetes independently need to be looked after when they are sick

When to call for advice

• Your child has ketones

  • Blood ketone test result is 0.6 or above

  • Or urine ketone testing strips turn a dark pink or purple

• Blood glucose levels remain low (under 4) despite repeated treatment for hypos

• Your child keeps vomiting or complains of abdominal pain

• Your child is very drowsy, confused or breathing heavily

• You are worried about your child for any reason

When calling the diabetes doctor they will want to know

• Your child's age

• Symptoms of the illness such as vomiting or fever

• Any medication or treatment you have used such as paracetamol

• What the blood glucose and ketone levels are

• Is your child eating and or drinking?

• Your child's usual insulin doses

Mini-Dose Glucagon

If the blood glucose levels cannot be maintained above 4, the diabetes doctor may advise the use of mini-dose glucagon. This is when a small dose (or doses) of glucagon are given using an insulin syringe. It can be used for the following situations:

• When your child's blood glucose remains less than 4 despite repeated treatment with glucose or sweet drinks

• Your child has gastroenteritis

• Your child is unable to eat or refusing food

You can view a transcript of this video here.

Mini-dose glucagon must only be used on the advice of a doctor. Sometimes children need to be admitted to hospital if the blood glucose levels cannot be maintained above 4.

Effects of other medications

If your family doctor prescribes medication for your child, remember to ask your doctor whether this will affect the blood glucose levels (oral or injected steroids are the medications most likely to affect blood sugars). If these types of medication are necessary, please call the diabetes doctor for advice on changing the dose of insulin for your child.

Ketones

• Ketones are produced by the liver when the body breaks down fat as an alternative form of energy. Ketones occur when there is not enough insulin in the body OR can also be produced due to starvation during illness.

• Ketones can occur during illness OR when the blood glucose levels are continuously high because insulin doses are too low or injections are missed.

• Ketones can occur during illness even when levels are in target range or when the levels are low, especially during vomiting.

• Ketones can be measured by blood or urine testing. If Ketones are not treated and continue to build up, your child can become very sick with ketoacidosis

Ketoacidosis

Ketones can cause the blood to become acidic and high levels of ketones can cause your child to become very unwell with severe dehydration. This is called ketoacidosis and is a very serious illness. The symptoms include:

• Nausea

• Vomiting

• Tummy pain

• Heavy or laboured breathing

• Ketones can make the breath smell "fruity" or like nail polish remover

• Confusion or drowsiness

• Unconscious

If your child has these symptoms take them directly to Starship Children's Emergency Department for urgent assessment. If out of the Auckland area, take your child to the nearest Hospital Emergency Department.

When to test for ketones

• During illness test ketones (blood or urine) 2 hourly

• If your child is well, but their blood glucose levels are 15 or higher for two tests in a row over a space of a few hours

You can read a transcript of this video here.

Surgery

If your child needs surgery or any procedure which requires fasting, they still need insulin. It is important that the diabetes team is involved in the planning of any surgery. Ideally, it is easiest to manage insulin when surgery is scheduled early in the morning. It is often advised that surgery is done at a hospital experienced in dealing with children with diabetes such as Starship. Preferably, children with diabetes should be first on the list.

Sick day management kit

When you get home from hospital put together a sick day management kit and check it every 6 months to make sure items are not expired and you have these things available:

• Contact details for your diabetes team

• Rapid acting insulin (NovoRapid, Humalog or Apidra)

• Insulin syringes or pens

• Blood glucose monitor, strips and finger-pricker

• Blood ketone meter and strips OR urine ketone strips

• Food and fluids for sick days, for example Pedialyte™, sweetened drinks, ice blocks, unsweetened fluids, soup, Glucagon kit and additional insulin syringe

• Pain relief (e.g. Paracetamol or ibuprofen)

• Thermometer

• If travelling you may need to take medication for nausea, vomiting and diarrhoea

Let's go over the main points. Think you've got it sorted now? Read our one page summary.

Think you've got it sorted now?

If you have read through the information above and watched the videos, and you feel confident that you understand this topic, print off and fill in the evaluation form below (you might need to ask someone to print this off for you) and return to the nurse on your ward. If you have any questions, note them down on this form and your diabetes nurse specialist will discuss them with you.

Sick Days Advice for Newly Diagnosed Families: Evaluation

After reading this teaching module and watching the videos:

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