SICK DAY PLANS FOR ALL CHILDREN WITH DIABETES

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1 SICK DAY PLANS FOR ALL CHILDREN WITH DIABETES High blood sugar Any child with diabetes may at times have high blood sugars; it may be for a single blood test or for several tests. High blood sugar can be from: too much food too little insulin little or no exercise pump failure bad pump site too much stress For any sugar over 240, check for urine ketones. (See ketones below) A high sugar is not an emergency. To treat a high blood sugar: have your child drink sugar free drinks such as Water Sugar free Kool-Aid Diet soda If ketones are negative, you can have your child exercise. Extra Humalog/Novolog can be given based on your child s correction factor. (Ex: /50= ) Use the correction factor only before meals unless told to give at other times by the diabetes team. If the blood sugar is high at the same time of the day, every day, the insulin dose may need to be raised. As your child grows, he/she will outgrow the insulin dose. High blood sugar does not mean that you are doing anything wrong. How to handle illness? Illness can be a hard time for the child with diabetes. This is a plan to help you with your child s diabetes during illness. For non-diabetic related illnesses, please call you regular doctor (pediatrician, family doctor or clinic). Call the diabetes office during office hours (Monday-Friday 8:00-4:30) for help on how to deal with the diabetes during the illness. The diabetes office number is *** ***

2 SICK DAY RULES 1. Give insulin as usual Do not skip insulin when your child is ill: most of the time, a child will need larger amounts of insulin when ill. Even if they are not eating well. 2. Check urine for ketones every 3-4 hours while the child is ill. Check ketones no matter what the blood sugar is.( see ketones section below) 3. Check blood sugar often. Blood sugar should be checked every 2-3 hours. 4. Push fluids during illness. Drinks such as water or diet drinks will help to rinse out ketones. The child needs to drink at least 8 ounces every hour. 5. Call the diabetes office for vomiting or ketones that continue past 4 hours 6. Use these carbohydrate guidelines: use sick day drinks if the child cannot eat as usual. 4 ounces regular soda =15 grams carbohydrate 1/2 cup regular jell-o= 15 grams carbohydrate 1 regular Popsicle=15 grams carbohydrate Sick day hints: Have a sick day shelf in your pantry stocked with these items regular Jell-o regular soda broth and other easy to digest foods and liquids. Keep urine ketone strips. Check the expiration date and replace when out of date. Testing for ketones is very important during an illness (discard 6 months after opening bottle and get a new bottle) store strips in a tightly sealed bottle. Be careful when using over the counter medicines. Cold and allergy medicines may hide the signs of a low sugar. Many liquid antibiotics are in sugar based syrup. If your regular doctor feels the medicine is needed to help your child, then it is okay. The tiny amount of sugar in a teaspoon of antibiotic is minor. Acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) may be used for aches, pains and fever. Follow the dosage directions on the package.

3 URINE KETONES What are urine ketones? Ketones are the result of your body using fat and muscle for energy. If the body cannot use sugar, the body breaks down fat and muscle to be used as energy. For the child with diabetes, ketones mean that the child is not getting enough insulin. Ketones can be an emergency. When do I test for urine ketones? Test for ketones when the blood sugar is over 240mg/dl or higher and during any illness or infection. Remember to check for ketones when your child is vomiting. You should go to the emergency room if your child has: large urine ketones that are not going down in 4 hours continued vomiting lasting more than 4 hours stomach pain fruity smell to breath hard time catching their breath. How do I test for urine ketones? Gather the equipment Urine in a cup Urine ketone test strip Timer or watch with a second hand 1. Remove the strip from the bottle. Replace the cap at once. Store urine ketone strips in a tightly sealed bottle. 2. Do not touch the test pad on the strip. 3. Dip the test pad end of the strip into urine and remove it right away. You can pass the test pad end through a stream of urine. 4. At the exact time stated on the bottle, match the test pad area to the ketones color chart. ( pink to purple) Ignore any color change after the stated time. (Note: If the ketone strip you have has two test pads: one for sugar and one for ketones. Ignore the test pad for sugar it will be green or brown) 5. Write down result and time

4 Extra insulin during a sick day The following is a plan for extra insulin during an illness when the child is able to eat and drink. Use rapid acting insulin (Humalog/Novolog) when extra insulin is needed. Do not give extra insulin more often than every 2-3 hours. Small to moderate ketones and blood sugar over 240. Give normal dose base on correction formula that you normally use. (Example: blood sugar minus 150 divided by /50 =1.8 round up and give 2 units) Large ketones and blood sugar over 240. Give normal correction dose based on correction formula you normally use Plus extra 2 units for children 9 and under. For children 10 and over you would give the normal correction plus 4 extra units. Extra Humalog/Novolog may be given every 2-3 hours as long as ketones are present. Try to follow the shot of insulin with a small snack of 15 grams of carbohydrate. Remember to use foods that are easy to digest such as Broth Jell-o Popsicle pudding Check blood sugar and urine for ketones every 3-4 hours until the ketones are gone. Have the child drink at least 8 ounces of sugar free beverages every hour. If your child is not better in 4 hours, go to the emergency room. ketones going down feeling less sick to stomach able to drink better

5 Pump guidelines during illness If your child wears an insulin pump, and the site is working, you will follow the same sick day rules. drink extra sugar free fluids o Water o Sugar free Kool-Aid o Sugar free popsicles check blood sugar every 2-3 hours check ketones every 3-4 hours Some things to remember when on a pump are that the vomiting and/or ketones are often due to a site that is kinked. Any time your child has ketones give a correction on the pump using the formula that you normally use. (Example: blood sugar minus 150 divided by 50). Remember not to give a correction any sooner than every 2-3 hours. After a correction, check the blood sugar in 2 hours; if the sugar has not come down by 100 mg/dl give a correction shot using a pen or syringe. Remove the pump site and move it to another area and have the child drink at least 8 ounces of sugar free fluid every hour. Recheck the blood sugar and urine for ketones in 2 hours. (A good way to remember what to do is; shot,site,fluids ( SSF) If your child has moderate or large ketones you need to set a temporary basal rate of 20% increase for 4 hours. Check your pump book for instructions on how to set the temporary basal. This will be different for each pump. If you think a pump has stopped working, you should call the pump company. The phone number is located on the back of the pump. NOTE: you should always keep Lantus to be used as a backup in case the pump stops working. The Lantus dose will be the same dose as your child s 24 hour basal total. The total 24 hour basal insulin is listed in your basal menu of the pump. If you cannot find this, you can check the pump book or call the pump company and they can help you find the dose. You should always keep the pump settings written down in case the pump stops working.

6 Diarrhea What effect can Diarrhea have on diabetes control? Diarrhea may cause high or low blood sugar. To treat diarrhea with blood sugar less than 150, drink beverages with sugar regular 7 up regular sprite regular Kool-aid Use sugar free drinks if the blood sugar is over 150. Avoid drinks that have caffeine (soda and tea). Pepto-Bismol should not be used. If diarrhea is severe (3-4 large liquid stools) contact your regular doctor for help. For mild diarrhea, the best action is no action. Caution: Some non sugar sweeteners which are found in sugar free candies and cookies can cause diarrhea if eaten in large amounts. Vomiting How do I treat diabetes when my child is vomiting? Nausea and vomiting are hard to manage in the child with diabetes. Read this plan but remember: Vomiting can be an emergency. How do I avoid low blood sugar when my child is vomiting? Give nothing to eat or drink for 1 hour after vomiting. After 1 hour begin with sips of flat or weak (½ and ½ with water) fizzy beverages, ice chips or Popsicle. If there is no vomiting after 2 hours, try more liquid using the plan below. o If the blood sugar is more than 150, use sugar free drinks only. o If the blood sugar is less than 150, use sugared drinks. Try to drink enough to keep the blood sugar over 150. If vomiting continues during this, call the office during office hours at*** *** or go to the emergency room if after hours.

7 How to dose insulin when child is vomiting and ketones are negative The child with diabetes must have insulin to prevent ketones. If the child is not eating, a smaller dose of insulin may be needed. Remember to check urine for ketones when vomiting. Check the blood sugar and urine for ketones every 3 to 4 hours during illness. Use the plan under the sick day section to give extra insulin if needed. NOTE: give Humalog/Novolog every 2-3 hours as needed. If the blood sugar is greater the 240 but ketones are negative give all the usual dose of Humalog/Novolog. If the blood sugar is less than 240 and ketones are negative give half the usual dose of Humalog/Novolog. If blood sugar is less than 100 give no Humalog/Novolog until the blood sugar is above 200. Give the Usual dose of Lantus. Give the normal insulin dose when vomiting has stopped and the child is able to eat/drink.