Diabetes and illness

Sick day management

• Although children whose diabetes is under good metabolic control should not experience more illness or infections than children without diabetes, those with poor metabolic control may have decreased immunity to a variety of different infections
• Illness associated with fever tends to raise BG because of higher levels of stress hormones, gluconeogenesis and insulin resistance
• Illness associated with vomiting and diarrhea (e.g. gastroenteritis) may lower BG, with the possibility of hypoglycemia

The diabetes care team should provide clear guidance on managing diabetes during intercurrent illnesses to avoid the complications of Dehydration Ketoacidosis Hypoglycemia

Guidance should include advice on the following

• Never stop insulin

• But advice should be available on alterations of insulin dose

• More frequent monitoring

• Frequent BG testing facilitates optimal management during illness
• Urinary ketone tests will guide management
• Adequate supplies of BG and ketone test strips should be available to avoid complications during intercurrent illness

• Loss of appetite

• Replacing meals with easily digestible food and sugar-containing fluids

• Maintaining hydration

• Hyperglycemia, fever and excessive glycosuria increase fluid losses

• Specific medical advice

• Treating fever, malaise and headache with antipyretics such as paracetamol
• Vomiting may be caused by
      (a) the illness itself when the BG may be low
  or (b) lack of insulin when the BG will be high and ketones may develop
  Consider treatment of vomiting with a single injection of an anti-emetic to help oral intake of carbohydrate
  
• Sugar-free medicines for young children are advisable but not essential