Illness affects diabetes care, and during illness the need for insulin often increases. Test the urine/blood frequently, take amounts of juice, fruit of diary products at regular intervals, and test the blood sugar every 2 to 3 hours.

The effects of illness on blood sugar can be unpredictable. The need for insulin often increases during illness, especially if you have a high fever. In fact, the need for insulin during illness can increase so much that problems with high blood sugar and ketones occur rapidly.

Blood sugar testing

Test the blood sugar every 2 to 3 hours. If blood sugar levels exceed 15 mmol/l, contact your Diabetes Team or use your sick day regime.

Urine/blood testing for ketones

Test the urine/blood frequently for ketones when you have a high temperature. Ketones caused by high blood sugar levels and high fever are dangerous. They must be treated quickly by giving small doses of extra short-acting insulin every two to four hours. This extra insulin treatment should continue until there are no ketones in the urine/blood. Ketones can cause symptoms such as abdominal pain, nausea and vomiting. If ketones build up to high levels, they can cause a dangerous condition called ketoacidosis. Ketoacidosis can lead to unconsciousness and death.

Sometimes low blood sugar levels cause ketones to form. These “starvation-ketones” may form when you are vomiting or simply have a poor appetite and can’t eat. In this case the ketones are not likely to lead to ketoacidosis. The treatment of “starvation-ketones” is sugar or food, not extra insulin.

Insulin

Never fail to take your  insulin. You may have to adjust the type or dose of insulin. If you have a high temperature, you may need to give more insulin.  In any case, remember that your child always needs insulin.

Food and beverages

The effect of illness on blood sugar can be unpredictable. Sometimes, even if your appetite is poor during illness, blood sugar levels remain normal or are too high. Take small amounts of juice, fruit or dairy products at regular intervals, and test the blood sugar every 2 to 3 hours. Blood sugar levels should be kept between 5 and 10 mmol/l.

If extra short-acting insulin is given to treat ketones, blood sugar level should still be maintained with small amounts of food or drink, such as juice.

If you vomit, it is important to take small mouthfuls of juice, regular lemonade or soft drinks. A small amount of sweets may be taken if that is preferred. If you continue to vomit, consult your doctor/diabetes care team. In some cases, admission to the hospital may be required.

Special problems

When your blood sugar levels are high, the risk of infection in wounds or cuts increases and the healing process will be slow.

A final word

Always feel free to contact your diabetes care team for advice, especially when very small children are ill, when vomiting causes any child’s blood sugar to be too low, or if ketones are present. Examination by a doctor will determine whether the child needs special treatment.

Remember that diabetes treatment is only part of caring for an illness. Illness may require medication, such as antibiotics, or other medical care. Pay attention to your  overall condition and symptoms. Never hesitate to contact your doctor or nurse for help!