Pediatric Diabetic Sick Day Guidelines

Pediatric Diabetic Sick Day Guidelines



In general, kids with diabetes are healthy and rarely sick.  When illness occurs, sick day guidelines are necessary to prevent complications.

Sick day rules

Having diabetes DOES NOT weaken the immune system causing your child to become sick more often. However, controlling diabetes during an illness can be tricky. For non-diabetic illnesses, please call your primary care provider (pediatrician, family doctor or clinic) to treat the illness. For help on controlling diabetes while sick, call the diabetes team.

  1. Give insulin as scheduled, unless told otherwise by our office. Your child still needs to take insulin even when ill. Your child may need more insulin when ill, even if not eating well.
  2. Check urine for ketones every two to three hours while the child is ill. When your child is ill, he/she may have ketones with normal or high blood glucose levels (see ketone information in hyperglycemia section).
  3. Check blood glucose often. Because of the body's increased need for insulin during illness, you should check your child’s blood glucose level every two to three hours when they are ill.
  4. Give your child lots of beverages during an illness. Beverages, such as water or diet soda, will help to stop dehydration and flush out ketones. Avoid drinks with caffeine. Encourage your child to drink the following amounts:
    • Less than 20 lbs - 2 ounces
    • 20 - 40 lbs - 4 ounces
    • 40 - 80 lbs - 6 ounces
    • Over 80 lbs - 8 ounces
  5. Avoid anti-nausea medications which may cause your child to be drowsy. Try Emetrol, an over-the-counter anti-nausea medication that will not cause drowsiness.
  6. Follow your child’s usual meal plan. Use sick day liquids if your child is not able to eat the usual amount of carbohydrates (See sick day liquid exchange list in the diet handout):
    • 4 ounces regular soda = 15 grams carbohydrate
    • 1/2 cup regular gelatin = 15 grams carbohydrate
    • 1 regular popsicle = 15 grams carbohydrate
  7. Call your diabetes center at 214-456-5959 (Dallas) or 469-303-2424 (Plano) for: vomiting or moderate or large ketones. Listen to the prompts to reach the on call CDE/MD.

When should I call the diabetes emergency line?

  • If your child has moderate-to-large ketones.
  • If your child is vomiting.
  • If your child is having deep, rapid respirations.
  • If your child has a fruity odor to their breath.

The above symptoms are signs of diabetic ketoacidosis (DKA) that need immediate attention.

Our Diabetes Emergency lines are 214-456-5959 (Dallas) or 469-303-2424 (Plano). Listen to the options to speak with a diabetes educator or physician on-call. These lines are available 24 hours a day, 7 days a week.

How much insulin should I give during a sick day?

An illness can cause high blood glucose levels. Use the correction scale at meals and bedtime based on the glucose level. Extra insulin may be needed if ketones are positive.

The following are guidelines for extra rapid acting insulin when your child is sick and is able to eat and drink.

Do not give insulin more often than every two to three hours. Your diabetes educator will use this guide when you call our center. Please notify us if your child has moderate or large ketones.

  • Determine your total daily dose (TDD) of insulin by adding up all (rapid and long acting) dosages of insulin taken per day, to equal the total daily dose:

breakfast + lunch + supper + bedtime = total daily dose

  • The diabetes educator will use the following guidelines to determine your child’s insulin dose.

Vomiting: An Emergency

What do I do if my child is vomiting?

  • Call your diabetes emergency line at 214-456-5959 (Dallas) or 469-303-2424 (Plano). Vomiting is an emergency because your child can become hypoglycemic or dehydrated.
  • Always test for urinary ketones when your child is vomiting or ill.

Should I try to give liquids if my child is vomiting?

First, try Emetrol following the directions on the bottle. Emetrol is over-the-counter at your local pharmacy. Give your child nothing to eat or drink for 30 minutes to an hour after vomiting. After 30 minutes to an hour and no further vomiting, give sips of carbonated beverages, ice chips or popsicles.

If no vomiting after two hours, try larger amounts of liquids according to the following guidelines:

  • If the blood glucose is above 150, use sugar-free liquids.
  • If the blood glucose is below 150, use liquids with carbohydrates.
  • Try to keep the blood glucose around 150.

If vomiting continues, call your diabetes emergency line at 214-456-5959 (Dallas) or 469-303-2424 (Plano).

Insulin guidelines with vomiting

For insulin guidelines if your child is vomiting, call the diabetes emergency line at 214-456-5959 (Dallas) or 469-303-2424.

  • Your child must have some active insulin to prevent the formation of ketones. Do not omit your child’s long-acting (basal) insulin. If your child is not eating, a smaller dose of insulin may be ordered to avoid low blood glucose (hypoglycemia) yet stop ketones from forming.
  • Stress hormones are released during an illness. These may result in high blood glucose levels even if your child is not eating.
  • Test your child’s blood glucose and ketones every two to three hours while sick. If no longer vomiting, use the “Sick Day Management” guidelines section to give your child extra insulin, if needed.


Diarrhea may cause the blood glucose to be either high or low. Diarrhea can cause loss of body fluids and result in dehydration. To avoid dehydration, your child needs to drink lots of fluids. Please refer to Sick Day Rules for suggestions on types of fluids. If your child has large liquid stools four to six times per day, contact your pediatrician or family doctor.


  • Do not give your child Pepto-Bismol as it contains aspirin. It may cause an illness called Reyes Syndrome.
  • Sugar alcohol sweeteners (sorbitol, mannitol, xylitol) can cause diarrhea if consumed in large amounts.

If the individual with diabetes is sick and vomiting, contact the clinic and follow the guidelines given to you from the nurse and/or physician.

Sick Day Management Carbohydrate Exchange

It is important to consume carbohydrates during an illness.  If your child is not vomiting, follow the guidelines below for proper diabetes management during illness.

  • Give the usual dose of insulin.
  • Use fluids and solid foods as tolerated.
  • Consume foods slowly if they contain a large amount of simple sugar.
  • Drink plenty of water to maintain hydration and flush ketones from the body.

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