Skip to main content Skip to navigation Skip to navigation
  • 844-4CHILDRENS (844-424-4537) 844-424-4537
  • Patient Login (MyChart) Visit our MyChart Guide to learn more about how to create and use your MyChart account.
  • Employee and Provider Login
  • Pay My Bill
  • Careers
  • Donate Now
Visit the home page

No disponible en español

  • Home
  • Treatment
  • Patient Families
  • Visitors
  • Provider Resources
  • Research and Innovation
  • Health and Community Resources
  • Donate or Volunteer
Visit the home page
Call children's health Access medical records by logging in to MyChart Find Bill Pay options here Find Children's Health Locations Find Children's Health Doctors
  • Home
  • Treatment
    • Treatment Home
    • Departments and Programs
    • Conditions and Treatments
    • Preventative Care and Immunizations
    • Primary Care
      • Primary Care
      • Primary Care Home
      • When to See a Primary Care Physician
      • New Patient Information
      • Preparing for Your Appointment
    • Urgent Care
    • Emergency and Trauma Care
    • Outpatient Pharmacies
    • Remote Patient Monitoring
    • Rehabilitation and Therapy Services
      • Rehabilitation and Therapy Services
      • Rehabilitation and Therapy Services Home
      • Our Childrens House
    • Virtual Care
      • Virtual Care
      • Virtual Care Home
      • School-Based Programs
      • Virtual Visit
    • Find a Doctor or Provider
    • Find a Location
    • Request an Appointment
    • US News and World Report 2020 - 2021 Ranking

      Ranked in all 10 pediatric specialties thanks to our caregivers.

  • Patient Families
    • Patient Families Home
    • Resources for Your Child
      • Resources for Your Child
      • Resources for Your Child Home
      • School Services
      • Transition to Adult Care
      • Activities for Kids
      • Child life
    • Parent Resources
      • Parent Resources
      • Parent Resources Home
      • Language and Interpreter Services
      • Hospital Guide
      • Social Work
      • Family Resource Library
      • Medical Records Request
      • MyChart Guide
      • Preparing for Your Visit or Stay at Children's
      • Pastoral and Spiritual Care
      • Family Advisory Network
      • Mobile App
    • Travel and Lodging
      • Travel and Lodging
      • Travel and Lodging Home
      • Patient Family Lodging
      • Public Transportation
    • Diversity and Inclusion
    • Billing and Insurance
      • Billing and Insurance
      • Billing and Insurance Home
      • Pay My Bill
      • Family Guide to Billing
      • Billing Dictionary
      • Financial Assistance and Support
      • Common Billing Questions
    • Write a Review
  • Visitors
    • Visitors Home
    • Policies and Procedures
      • Policies and Procedures
      • Policies and Procedures Home
      • Contacting a Patient
      • Visiting Hours and Policies
    • Hospital Guide
      • Hospital Guide
      • Hospital Guide Home
      • ATM Locations
      • Dining and Food Services
      • Gift Shops and Retail
      • Wheelchair and Disability Accessibility
      • Parking
      • WiFi and Internet Access
      • Frequently Asked Questions
      • Guest Relations
      • Amazon Hub Lockers
    • Amazon Lockers Logo with Lockers

      Children’s Health is proud to become the first pediatric health system in the country to offer Amazon Lockers, self-service kiosks that allow you to pick up your Amazon packages when and where you need them most – 24 hours a day, seven days a week. Learn more about Amazon Lockers.

  • Provider Resources
    • Provider Resources Home
    • Refer a Patient
      • Refer a Patient
      • Refer a Patient Home
      • Direct Admit
      • Request Transportation
      • Contact my Provider Liaison
      • Email Sign up Provider Newsletter
      • Login to Provider Portal
      • Provider Tools
      • Infusion Therapy Referrals
    • Education & Training
      • Education & Training
      • Education & Training Home
      • Fellowship and Subspecialty Training Programs
      • Pediatric Residency
      • Vizient/AACN Nurse Residency
      • Continuing Education
      • Pharmacy Residency
      • Clinical Pastoral Education
      • Child Life and Music Therapy Training Opportunities
      • Pediatric Emergency Services Network
      • Student Affiliations
      • Student Internships
      • Pediatric Advanced Life Support (PALS)
      • Scholarships
      • Andrews Physical Therapy Residency
      • Community Partner
    • Services and Centers
      • Services and Centers
      • Services and Centers Home
    • Business Solutions
      • Business Solutions
      • Business Solutions Home
      • Pediatric Partners
    • Medical Staff Services
    • Nursing Services
      • Nursing Services
      • Nursing Services Home
      • Our Nurses
      • Our Nursing Model
      • Nursing Stories
  • Research and Innovation
    • Research and Innovation Home
    • Clinical Trials
      • Clinical Trials
      • Clinical Trials Home
      • Why is Research Important?
      • Research FAQs
      • Research Glossary
    • Research Focus Areas
      • Research Focus Areas
      • Research Focus Areas Home
      • Cardiology Research
      • Endocrinology Research
      • Food Allergy Research
      • Gastroenterology Research
      • Hematology and Oncology Research
      • Neonatal-Perinatal Research
      • Nephrology Research
      • Neurology Research
      • Otolaryngology Research
      • Urology Research
    • Publications
    • Research Library
    • Center for Pediatric Population Health
    • Innovation
      • Innovation
      • Innovation Home
      • Telemedicine
      • Center for Clinical Simulation
  • Health and Community Resources
    • Health and Community Resources Home
    • Health & Wellness Library
    • Community Resources
      • Community Resources
      • Community Resources Home
      • Family Education
      • School-Based Partnerships and Programs
      • Children’s Health Care Network
    • DFW Children's Health Assessment
    • Podcasts
    • When to keep children home sick

      When to keep children home sick

  • Donate or Volunteer
    • Donate or Volunteer Home
    • Volunteer
      • Volunteer
      • Volunteer Home
      • Adult Volunteer Program
      • Student Volunteer Program
      • Volunteer Dogs
      • Group Service Projects and Events
    • Donate
      • Donate
      • Donate Home
      • Donate Items
      • Make a Financial Gift
      • Handcrafted Items
{}
Pediatric Type 1 Diabetes Sick-Day Guidelines
  • Treatments
  • Departments and Programs
  • Pediatric Endocrinology
  • Pediatric Endocrinology Programs and Services
  • Pediatric Diabetes Program
  • Pediatric Type 1 Diabetes Sick-Day Guidelines

Pediatric Type 1 Diabetes Sick-Day Guidelines

Everyone gets sick, but when your child with type 1 diabetes gets sick, you have special considerations to think about. Illness may cause glucose levels to be unpredictable and hard to manage. Children’s Health℠ has created some general guidelines for you to follow the next time your child with type 1 diabetes feels under the weather.

The below guidelines apply to both insulin injection and insulin pump patients unless otherwise noted.


What should I do when my child is sick?

Stay on track.

Keep your child’s usual routine, including mealtime insulin to carbohydrate ratio (ICR), to prevent ketones from being made. In fact, your child may need extra insulin when sick. If your child lacks an appetite, let them eat and drink as much as they can and give insulin immediately after mealtime. See our sick-day food and drink guide for more tolerable choices on sick days.

Test urine or blood for ketones every 2 to 3 hours.

Ketones may appear with normal, low or high glucose levels when your child is sick.

  • If tests show your child has ketones, they’ll need extra insulin to clear their ketones and minimize their risk of diabetic ketoacidosis (DKA). Follow the insulin dosing guidelines.
  • Pump users should have a low threshold for changing pump sites anytime a child has ketones.

Keep a close eye on glucose levels.

With the body’s increased need for insulin during illness, check your child’s glucose every 2 to 3 hours.

Stay extra hydrated.

Beverages, such as water or other sugar-free fluids, will help prevent dehydration and flush out the ketones. Avoid drinks with caffeine. Follow the fluid intake guidelines.

Pay attention to nausea and vomiting.

If your child is vomiting, even small amounts of fluids can help. Start by giving 1 tablespoon of fluid every 5 to 10 minutes (about 3 ounces per hour).

  • Emetrol is an over-the-counter medication that can settle the stomach.
  • A prescription medication, such as Zofran (ondansetron), is a helpful treatment for nausea and vomiting. This medication can be prescribed by your child’s doctor.

Check resources.

  • Use the sick-day dosing guidance on fluids and insulin and monitoring glucose and ketones.
  • You can also text “diabetes” to 77444 to download the Diabetes Advisor iOS app by Children’s Health for 24/7 help with dosing decisions. (An Android version is in development.)
    • Register for the ketone manager feature using your one-time access code provided by your care team or email diabetesapp@childrens.com to receive a code. Ketone manager access codes are unavailable after clinic hours.

When should I call the diabetes emergency line?

Call the diabetes team at Children’s Health if:

  • Your child is showing the following signs of diabetic ketoacidosis (DKA):
    • Moderate or large ketones
    • Deep, rapid respirations
    • Unable to drink or tolerate fluids
    • Vomiting many times or if vomiting doesn’t stop
  • Ketones don’t clear after 2 correction doses
  • You are concerned at any time

We offer round-the-clock care with our diabetes emergency lines open 24/7.

  • Dallas: 214-456-5959

When you call us we will ask for the following information first to help us understand your child’s diabetes needs.

  • Your child’s name and age
  • How long your child has had diabetes
  • Your child’s daily insulin regimen

Why does my child need extra fluids and insulin?

Extra fluids help eliminate the ketones that have already been made.

  • When your child has positive ketones, aim to drink 1 ounce per year of age, every hour until ketones are negative.
    • The maximum fluid intake is 16 ounces per hour for children 16 years old or older.
  • Fluids should be water or other sugar-free drinks, unless your child is experiencing low blood sugar readings.

Extra rapid-acting insulin stops ketones from being made. This dose can be calculated as a percentage of your child’s total daily dose (TDD) of insulin.

  • If ketones occur at a mealtime, and your child wants to eat, add the calculated units from the sick-day dosing table to the meal dose. Do NOT add the usual correction scale insulin.

Remember, always wait at least 2 hours between doses of rapid-acting insulin.

How do I calculate my child's TDD?

Insulin Injections

Add all of the insulin your child takes in 1 day of both long-acting and rapid-acting insulin.

Example TDD calculation:

  • Breakfast: 5 units Humalog (H)
  • Lunch: 5 units Humalog (H)
  • Dinner: 5 units Humalog (H)
  • Bedtime: 15 units Lantus (G)
  • TDD = 30 units Humalog (H)

Example % TDD calculation:

  • 5% of 30 units = 1.5 units Humalog
  • 10% of 30 units = 3 units Humalog
  • 15% of 30 unites = 4.5 Humalog
  • 20% of 30 units = 6 units of Humalog

 

My current insulin doses are:

  • Breakfast dose: __________  
  • Lunch dose: ___________
  • Dinner dose: __________ 
  • Bedtime dose: __________ 
  • My child's TDD =: __________

My estimated % TDD calculations:

  • 5% of TDD =  __________  units
  • 10% of TDD = __________ units
  • 15% of TDD = __________ units
  • 20% of TDD = __________ units

 

Insulin Pump

You can look up your child's TDD on their pump's dosing history. On a sick day, use the average TDD of the last 3 to 7 days.

Example % TDD calculation:

  • 5% of 30 units = 1.5 units Humalog
  • 10% of 30 units = 3 units Humalog
  • 15% of 30 unites = 4.5 Humalog
  • 20% of 30 units = 6 units of Humalog

My child's average TDD =: __________

My estimated % TDD calculation:

  • 5% of TDD = ___________ units
  • 10% of TDD = __________ units
  • 15% of TDD = __________ units
  • 20% of TDD = __________ units

What should I keep in mind when using the sick-day dosing guidelines?

  • If your child’s ketone levels are 0.1-0.5 mmol/L (trace on urine testing), it is OK to give the correction bolus through the pump.
  • Test your child’s glucose and ketones 2 hours after treating using the pump to see if values are improving. If you don’t see improvement, give the next correction bolus through a pen or syringe and consider a pump site change.
  • If ketone levels are 0.6 mmol/L or higher, give sick-day bolus through a pen or syringe using the sick-day dosing guidelines, and change your pump site.
  • For glucose readings greater than 200 mg/dL with moderate to large ketones (1.0 mmol/L or greater on blood testing) you may set a temporary basal rate of 120% of the normal rate (increase of 20%) for 2 hours in addition to the advised sick-day bolus.

Resources

  • Sick-day insulin and fluid guidelines
  • Sick-day food and drinks

 

 

 

Share:
Twitter Facebook Linked In Email
dfdbd6ca-b122-41d5-8e30-d4e8860c447f

Diabetes

214-456-5959


Learn about our Diabetes Advisor App or text "diabetes" to 77444 to download
  • What to Expect at your Pediatric Diabetes Appointment
  • Diabetes Classes
  • Diabetes Glucose Logs
  • Diabetic Sick-Day Guidelines
    • Sick-Day Insulin and Fluid Guidelines
    • Sick-Day Food and Drinks
  • Diabetes Advisor App
  • Diabetes sick day bag
  • Transitioning to Adult Diabetes Care
​
Follow Children's Health on social media
Facebook Twitter Instagram YouTube Linked In
Subscribe to our email newsletter
1935 Medical District Drive Dallas, Texas 75235 844-4CHILDRENS 844-424-4537
  • Why Children's Health
  • About Us
  • Diversity and Inclusion
  • Our Difference
  • Our People
  • Working at Children's Health
  • Careers
  • Employee Resources
  • Billing and Insurance
  • Price Estimator Tool
  • Policies and Procedures
  • Patient Rights and Responsibilities
  • Notice of Privacy Practices
  • Terms of Use
  • Quality and Safety
  • Complaint Resolution
  • International Patient Services
  • CHNA Report
  • Supplier Portal
  • Media Toolkit
  • Newsroom
  • Gain template information in the Brand Center
  • Shop Children's Health
  • Contact Us
  • Sitemap
  • Accessibility
Badge: Institutional member - Children's Hospital Association

© 2021 Children's Health. All rights reserved.