Surviving Sick Days

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To take care of your child's diabetes along with her current illness, follow these general principles.

Continue Insulin Treatment
Your intuition might tell you to reduce or stop your child's insulin, especially if she is not eating very much. Younger or newly diagnosed children could need reduced insulin depending on their blood glucose level, but other children need just the opposite-extra insulin. Ask your doctor for guidelines for insulin treatment on sick days and call the doctor anytime you're not sure how much insulin to give.

Stay Close to the Meal Plan
You may want to substitute soup and other comfort foods for the usual fare. Be sure to maintain about the same meal times and number of carbohydrates at each meal and snack as you would on a normal day. If your child has an upset stomach and can't eat, give her clear liquids that contain carbohydrates (sports drinks, juices, gelatin, broth, frozen fruit bars).

Give Plenty of Liquids
Encourage your child to drink as much water and other non-caffeinated beverages as she can.

Choose Medications Wisely
Many over-the-counter medications contain sugar and/or alcohol. Although there might not be too much glucose in one dose of cough syrup, it can add up if your child takes it every four hours. If you can't find a glucose-free version or if it's more expensive, just account for the medicine's carbohydrates in the meal plan. Medicines that contain alcohol can lower blood glucose levels. If you choose a medicine that contains alcohol, have your child eat something when she takes it in order to prevent hypoglycemia. You may wish to choose alcohol-free medicines.

In addition, certain medications can affect your child's diabetes. Many decongestants can raise blood glucose levels. And ibuprofen is not safe for anyone with kidney problems. Ask the doctor what over-the-counter medications he or she recommends for your child.

Check Blood Glucose and Ketone Levels Frequently
Diabetic ketoacidosis (DKA) is a danger whenever your child is sick. DKA occurs when a person with diabetes has too little insulin in their system. If left untreated, DKA can lead to coma. To prevent DKA or catch it early, check your child's blood glucose levels often (every few hours) while she's sick. Also, check her urine for ketones several times a day. If she is vomiting or has diarrhea, check ketones even more frequently (maybe even every time she urinates, depending on the severity of the illness).

Foods for Sick Days

When your child is not feeling too well, she may not feel like eating a lot of the foods she normally loves. For example, if her belly is doing somersaults, she's probably not craving a big, spicy plate of nachos. But it's important for her to eat in order to keep her body from burning fats for fuel (and making ketones) and to keep her body energized so it can get better fast. Here are a few flu-friendly food ideas for when a bug has your child down.

Handy Sick-Day Snacks*

These foods contain between 10 and 15 grams of carbohydrates.

Fluids

• 1 double-stick popsicle
• 1 cup Gatorade
• 1 cup milk
• 1 cup soup
• 1/2 cup fruit juice
• 1/2 cup regular
• soft drink (not diet)

Foods

• 6 saltines
• 5 vanilla wafers
• 4 Lifesavers
• 3 graham crackers
• 1 slice dry toast (not light bread)
• 1/2 cup cooked cereal
• 1/3 cup frozen yogurt
• 1/2 cup regular ice cream
• 1/2 cup sugar-free pudding
• 1/2 cup regular (not sugar-free) Jell-O
• 1/2 cup custard
• 1/2 cup mashed potatoes
• 1/4 cup sherbet
• 1/4 cup regular pudding

* From Diabetes Care When You're Sick by Rachel Gifford, RN, MSN, CDE, and Belinda P. Childs, ARNP, MN, BC-ADM, CDE

Diabetes Forecast, February 2005, pp. 44–50