When Your Child With Type 1 Diabetes Gets Sick

It's difficult to be a parent, especially when you have a sick kid.  Kids with the flu, or an ear infection, or some other illness, are a parent's nightmare.  Not because their kids are harder to deal with when sick, or because of the extra work involved in child care when the child is ill, but because of the extra layer of worry and fear that gets added when your child gets sick.

I think this is doubly true when your child also has type 1 diabetes.  You still have to manage the illness itself, with the fevers and the vomiting and the dehydration and the lack of eating that can all come with being sick.  On top of this, though, is a whole bunch of extra concerns.

The symptoms of an illness are never alone when they happen to a diabetic child.  Instead, they all have possible double meanings and occasional conflicting ways to manage them.  For example:

• Is he vomiting because he has the flu, or does he have ketones?
• If he has ketones, are they because of the vomiting (or the underlying illness), or vice versa?
• His blood sugar is low because he's not eating (or not keeping anything down), but his ketones are high from lack of insulin.  What do I do now?
• Eating makes him vomit, but his blood sugar is low.  How do I get it to come back up?
• His blood sugar is high, he's drinking a lot of water, but he's still dehydrated.  I can't get his blood sugar down.  What can I do?

There are two things your child needs when his ketones are high: fluids and insulin. So you need to get your child to drink as much as possible, or you'll have to take him to the hospital to get IV fluids. The insulin can be trickier, but it's manageable.

In order to give your child insulin, you need to get carbs into him. If he'll eat, great. Problem solved. If not, try sugared drinks, like juice or Gatorade (this helps with the fluid intake as well). If those don't work, resort to non-diet soda. It's not great when trying to avoid dehydration, but it's better than nothing. Then give insulin according to his treatment plan.

If his ketones don't come down with insulin, or you can't get enough carbs into him to give him insulin, contact his doctor or take him to the hospital as there is a risk of diabetic ketoacidosis (DKA).

Often, sick children either can't or won't eat. This can be a serious problem for a diabetic child with low blood sugar, even more so if the child has ketones. There are a couple of things to try.

If your child will eat, but only a few bites, aim for high carb foods. This is the time to break out the cookies, candy, and other sweets, or the starchy foods your child enjoys. Let your child eat what he likes when he's sick and low blood sugar is a problem; getting any carbs you can into him is the goal. As previously mentioned, if your child won't eat, the next best thing is a sugary drink. Juice, Gatorade, Pedialyte, or soda will all work.

If neither of these helps, then you're probably going to need your Glucagon pen (the emergency low blood sugar treatment). You mix it per the instructions, then get an insulin syringe and dose him with one unit per year of age. This will raise his blood sugar and allow you to give insulin if needed. You can repeat this as necessary. The mixed Glucagon is good for 24 hours. Additionally, in this situation, you should get in contact with his doctor for more instructions.

If you're having trouble getting or keeping his blood sugar up, take him to the hospital where he can get IV glucose.

When sick, your diabetic child may have unusually high blood sugars. You can, and should, give extra insulin. He will also need extra fluids to avoid dehydration, because high blood sugar will make him urinate more.

If the extra insulin isn't bringing his blood sugar down, contact his doctor for instructions as to how much more insulin you need to give. High blood sugar alone while sick isn't serious enough to warrant hospitalization unless your doctor recommends it. However, if your child is getting dehydrated and/or has ketones that you can't get rid of, a trip to the hospital may be necessary.

The best way to manage an illness with a diabetic child is to develop a plan with your doctor BEFORE your child gets ill.  This way, you'll be less likely to panic, have a better idea how to manage the possible sick day scenarios, and be able to avoid a possible hospitalization.

You should also educate any other caregivers about your child's sick day plan.  Illnesses can come on quickly, these complications can come on quickly, and they may not have time to or be able to get ahold of you to contact you for instructions.

Being prepared will minimize confusion and anxiety, for both you and your child.