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Pediatric Endocrinology

Resources for Managing Diabetes - When You are Sick (Illness Management)

What will happen to my blood sugar when I am sick?

Illness usually makes the blood sugar increase even when you do not feel like eating. This is because your body requires extra energy to fight the illness. Your body tries to use sugar stored in the body for energy. SInce there is not any extra insulin available to help your body use the sugar, the sugar builds up in your blood and causes high blood sugar.

Occasionally, the blood sugar may be low when you are ill. This is especially true when you are vomiting or have diarrhea and are unable to eat or absorb food and sugar normally.

What should I do when I am sick?

• Check your blood sugar more often (every 2-4 hours). Your insulin dose may need to be adjusted and these adjustments should be based on your blood sugar levels. Call the clinic for advice.
  
• Test your urine for ketones. Ketones are produced when your body does not have enough insulin available to use sugar for energy or when you are not eating. Your body will use fat stores for energy instead, and when it does, ketones form in the blood and spill into the urine. Ketones indicate that medical attention is needed. Call your doctor or nurse if a moderate or large amount of ketones are present.

What if my blood sugar is high?

If your blood sugar is high (>200), you should drink lots of sugar-free liquids such as sugar-free Kool-Aid, pop or water, because your body loses more fluid through urine when sugars are high. Remember also to check your urine for ketones. Frequently during illness you will require more insulin. This may be given with your usual shot or occasionally as an extra injection.

You should call your doctor or nurse if:

• You are not able to drink fluids and are becoming dehydrated.
• Your blood sugar is 300 or greater.
• You have a moderate to large amount of ketones in your urine.
• You experience a change in breathing pattern.
• Vomiting or abdominal pain occurs.

What if my blood sugar is low?

If your blood sugar is low, your insulin may need to be reduced. Call BEFORE giving an insulin injection whenever you are vomiting or unable to eat normally. If you are not eating, and your blood sugar is less than 200, you will need to drink sugar-containing liquids to maintain your blood sugar. The amount of carbohydrate in these fluids can be calculated so that the liquid diet resembles your normal exchange diet, or is about 15 grams of CHO/hour.

Here are some examples of liquids or foods that can be used when you are sick and unable to eat normally:

• To replace 1 bread or 1 fruit exchange (15 grams CHO):
  • 1/2 - 3/4 ac. regular soda
  • 1/2 c. orange, apple, pineapple juice, or 1/3 c. cranberry or grape juice
  • 8 oz. Gatorade
  • 1/2 single popsicle
  • 1 Tbsp. granulated or brown sugar
  • 1 Tbsp. honey
  • 1/2 c. regular Kool-Aid or juice drink
  • 1/2 c. Italian ice
  • 1/2 c. Jello
    
• Soft foods = 1 bread or 1 fruit (15 grams CHO):
  • 1/2 c. mashed potato
  • 1 slice toast
  • 6 saltines
  • 3 graham crackers
  • 6 vanilla wafers
  • 1/2 c. pasta
  • 1/2 c. hot cereal
  • 1/2 c. applesauce
    
• To replace 1 milk (12 grams CHO):
  • 1/3 c. fruited yogurt *
  • 4 oz. vanilla yogurt *
  • 6-8 oz. Nutrasweet yogurt *
  • 1 c. milk
  • 1 pkg. Instant Breakfast (dry) - regular or no sugar added
  • 1/2 c. homemade custard
  • 1/4 c. regular pudding
  • 1/4 c. sherbet
  • 1/2 c. ice cream
  • 1 c. cream soup

  * check the label for specific carbohydrate amount for yogurts

• To replace 1 oz. meat:
  • 1/4 c. cottage cheese
  • 1 egg
  • 1/4 c. egg substitute
  • 1 Tbsp. peanut butter
  • 1 oz. cheese

   

Are there any medications I can't take?

Many over-the-counter medications (i.e., cold medicine, Tylenol, etc.) contain sugar flavoring. The amount of sugar in these preparations is small and is not enough to raise blood sugar readings significantly, despite the fact that many of the labels on these medications will recommend avoiding them if you have diabetes. Most cold medications have warnings for diabetics even if they don't contain sugar. This concerns the decongestant ingredient and does not generally apply to children. These medications can be taken unless you have been told to avoid them for some other reason.

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