Sick Day Help

[Becca's Mom]

How do you adjust the insulin amount when children are sick and can't eat (stomach bug)?

[JDRF-Team-gg]

Hi Becca's Mom!
I am a volunteer with Medhelp and a Mom of a 16 year old who was diagnosed at the age of 21 months.  I am not a medical professional, so any advice that I pass on to you should be verified with Becca's healthcare team.  I do remember the sick days very well and especially with flu season starting, this is probably a good time to go over a few basics.  As far as dosing when they cannot keep food in their stomachs, this is best left to the professionals.  You need to contact Becca's endocrinologist and leave this up to him or her.  It is important that they receive their insulin, despite the fact that they can't eat.  It is also important that you always have sick day food in the house, as you cannot predict when this type of flu or stomach problem may occur.  We always have gatorade, jello (regular, along with sugar free too)and one of my favorite little tricks, Cola Syrup.  This can be used to both keep the bg up and to settle the stomach.  Ask your pharmacist for it.  It is poured over crushed ice and has saved us from taking some trips into the ER.  Always check in with Becca's healthcare team so that they are aware of her status.  Dehydration is something that you need to be looking out for also.  I know this sounds a little weird, but if their skin tastes salty, they may be dehydrated.  This can happen pretty quickly, so you need to be on your toes.  Checking for Ketones is also something that you need to be doing, even if their bg is within a normal range.  Ketones are a red flag and you should be contacting your endo immediately if they show up.  Plenty of fluids, rest and a close eye on things should have her feeling better in no time.  Best of luck!

[JDRF-Team-LRS]

Hi Becca's mom,
First, put a call in to her endo to work out the finer points.  I'm not a physician, so you'll need to review my personal suggestions with her doc who knows her well and is licensed to practice medicine ;-)  While s/he might not be in teh office today, s/he will undoubtedly have a doctor on call for just this type of situation.  I'm a long-time diabetic and I'll share my experience with you.  

Even when we don't eat, our bodies need insulin, so sick day rules always include insulin even when we don't eat.  Sometimes we require even more insulin than when we're healthy.  It's important to test often.  Rules vary by individual and by the impact of the illness itself on BGs.  When I've been sick, I need to take all my long-acting (or basal) insulin and sometimes more.  My short-acting (or bolus) is adjusted based on my BG readings and presence of ketones.

Test for ketones (urine strips are available w/o Rx) and be prepared to get to an ER if ketones are high and BG is high and will not respond to insulin.  

The usual sick day rules are helpful -- try to take on clear fluids and do test often - noting patterns.  

Good luck Becca's mom.  I hope Becca feels better soon.  I'm sure you'll feel better as soon as she does ;-)