Managing Type 1 Diabetes
What To Do When Your Child Is Sick
What To Do When Your Child With Type 1 Diabetes Is Sick
Glucose levels may rise due to infection, fever, or illness. Glucose levels may decrease due to vomiting, diarrhea, or not eating.
Ketones are more likely to develop during an illness, and can occur at any glucose level. When ketones are present, the risk for diabetic ketoacidosis (DKA) increases. Additional insulin is often needed to feel better and prevent serious illness.
Close monitoring of glucose and ketone levels is needed when sick.
The information on this site will guide you through diabetes care for sick days, calculating insulin doses for ketones, and what to do in emergencies.
Ketone Correction Calculator
Ketone Correction for Insulin by Injection
Enter your total daily LONG-ACTING insulin amount using the slider below.
Examples include Levemir, Lantus, Basaglar, Tresiba
Select the current ketone level.
The amount of additional SHORT-ACTING insulin to give to correct for ketones is:
Add the Ketone Correction bolus to the carb bolus (if eating) and the high glucose bolus (if any) to determine the amount of the total bolus.
The Ketone Correction bolus is always rapid-acting insulin.
For more information see sick day guidelines.
Call 911 if:
- Your child is working hard to breathe, confused or difficult to wake up
Call the Diabetes Center at +1 (513) 636-3005 if:
- You are unsure what to do or what insulin dose to give
- You have treated high/low glucose or ketones twice without improvement
- Your child has repeated low glucose with moderate or large ketones
- Your child is vomiting, unable to eat or drink, or complaining of stomach pain
Please Note:
- Keep giving basal / long-acting insulin
- Basal insulin is needed even when sick and not eating
Ketone Correction Calculator
Ketone Correction for Insulin by Pump
Enter your total daily BASAL insulin amount using the slider below:
Select the current ketone level.
The amount of additional insulin to give to correct for ketones is:
Add the Ketone Correction bolus to the carb bolus (if eating) and the high glucose bolus (if any) to determine the amount of the total bolus.
The Ketone Correction bolus is always rapid-acting insulin.
- Check pump site and change if used to bolus twice without improvement
- Use syringe to bolus if pump site not working
- Turn off Auto Mode for 3 hours after using syringe to bolus
For more information see sick day guidelines.
Call 911 if:
- Your child is working hard to breathe, confused or difficult to wake up
Call the Diabetes Center at +1 (513) 636-3005 if:
- You are unsure what to do or what insulin dose to give
- You have treated high/low glucose or ketones twice without improvement
- Your child has repeated low glucose with moderate or large ketones
- Your child is vomiting, unable to eat or drink, or complaining of stomach pain
Please Note:
- Keep giving basal / long-acting insulin
- Basal insulin is needed even when sick and not eating
Managing Type 1 Diabetes
Emergency Information
Call 911 if:
- Your child is working hard to breathe, confused or difficult to wake up
Call the Diabetes Center at +1 (513) 636-3005 if:
- You are unsure what to do or what insulin dose to give
- You have treated high/low glucose or ketones twice without improvement
- Your child has repeated low glucose with moderate or large ketones
- Your child is vomiting, unable to eat or drink, or complaining of stomach pain
Please Note:
- Keep giving basal / long-acting insulin
- Basal insulin is needed even when sick and not eating
Managing a Sick Day
*See below for links to injection and pump calculators
What should I do when my child with diabetes is vomiting?
If nausea or vomiting are present call the Diabetes Center to check if Zofran can be used safely and make a plan for close monitoring.
Glucose above 180 mg/dL, above target range:
- Give small sips of water or carb-free fluids every 15-30 minutes. If there is no vomiting after 30 minutes, increase the amount of fluids.
- Bolus for high glucose and ketones if present.
- Pump users should check pump site and change if used twice to bolus without improvement; use syringe to bolus if pump site not working. Turn off Auto Mode for 3 hours after syringe bolus.
- If glucose is above 400 mg/dL three hours after a correction, call the Diabetes Center.
Glucose between 70-180 mg/dL, within target range:
- Give small sips of carb-containing fluids every 15-30 minutes.
- If there is no vomiting after 30 minutes, increase the amount of fluids.
- In manual mode, pump users can temporarily suspend pump for 30 minutes.
- Do not bolus for carbs or ketones until glucose is above 180 mg/dL
Glucose under 70 mg/dL, below target range:
- Treat with 15g of fast-acting carbs and re-check in 15 minutes
- Repeat until glucose is in targe range
- If unable to eat or drink, call Diabetes Center or 911, and consider Glucagon injection or nasal spray
- Do not bolus for carb or ketones
- In manual mode, pump users should suspend pump for 30 minutes or until glucose is within target range.
Glucose Guide
If glucose is above 400 mg/dL three hours after correction dose, call the Diabetes Center.
Glucose above 180 mg/dL, above target range:
- Encourage carb-free fluids and follow 'Managing a Sick Day' cycle.
- Pump users should check pump site and change if used twice to bolus without improvement.
Glucose between 70-180 mg/dL, within target range:
- Encourage carb-containing fluids and follow 'Managing a Sick Day' cycle.
Glucose under 70 mg/dL, below target range:
- Treat with 15g of fast-acting carbs and re-check in 15 min
- Repeat until glucose is in target range
- In manual mode, pump users should suspend pump or lower basal rate for 30 minutes or until glucose is within target range.
- If unable to eat or drink, call Diabetes Center, and consider Glucagon injection or nasal spray.
Ketone Guide
Guidelines if Sick with Large Ketones (Above 1.5 mmol/L)
Glucose above 180 mg/dl, above target range:
- Drink water or carb-free fluids, eat as able, and follow 'Managing a Sick Day' cycle
- Calculate extra insulin for large ketones (rapid acting insulin equal to 15% long-acting or total daily basal insulin).
- Bolus for ketone correction plus high glucose and carbs (if any) every 3 hours.
- Call Diabetes Center if you have treated glucose or ketones twice with no improvement or if your child is vomiting.
- Pump users should check pump site and change if used to bolus once without improvement. Use syringe if pump site not working. Turn off auto mode for 3 hours if using a syringe to bolus.
Glucose between 70-180 mg/dL, within target range:
- Drink carb-containing fluids, eat as able, and follow 'Managing a Sick Day' cycle
- Monitor glucose and check ketones every 3 hours
- If nausea/vomiting, do not bolus for carbs or ketones until glucose is above 180 mg/dL
Glucose under 70 mg/dL, below target range:
- Treat with 15g of fast-acting carbs and re-check in 15 min.
- Repeat until glucose is in target range.
- In manual mode, pump users should suspend pump for 30 minutes or until glucose is within target range.
- If unable to eat or drink, call Diabetes Center and consider Glucagon injection or nasal spray.
Guidelines if Sick with Small to Moderate Ketones (Between 0.6-1.5 mmol/L)
Glucose above 180 mg/dl, above target range:
- Drink water or carb-free fluids, eat as able, and follow 'Managing a Sick Day' cycle.
- Calculate extra insulin for ketones (rapid acting insulin equal to 10% of long-acting or total daily basal insulin for moderate ketones or 5% long-acting or total daily basal insulin for small ketones).
- Bolus for ketone correction plus high glucose and carbs (if any) every 3 hours.
- Call Diabetes Center if you have treated glucose or ketones twice with no improvement or if your child is vomiting.
- Pump users should check pump site and change if used to bolus twice without improvement. Use syringe if pump site not working. Turn off auto mode for 3 hours if using a syringe to bolus.
Glucose between 70-180 mg/dL, within target range:
- Drink carb-containing fluids , eat as able, and follow 'Managing a Sick Day' cycle.
- Monitor glucose and check ketones every 3 hours.
- If nausea/vomiting, do not bolus for carbs or ketones until glucose is above 180 mg/dL.
Glucose under 70 mg/dL, below target range:
- Treat with 15g of fast-acting carbs and re-check in 15 min.
- Repeat until glucose is in target range.
- In manual mode, pump users should suspend pump for 30 minutes or until glucose is within target range.
- If unable to eat or drink, call Diabetes Center and consider Glucagon injection or nasal spray.
Guidelines if Sick with Trace to No Ketones (Below 0.6 mmol/L)
Glucose above 180 mg/dl, above target range:
- Drink water or carb-free fluids, eat as able, and follow 'Managing a Sick Day' cycle.
- Bolus insulin for high glucose and carb intake as usual.
Glucose between 70-180 mg/dL, within target range:
- Drink carb-containing fluids, eat as able, and follow 'Managing a Sick Day' cycle.
- If able to eat without vomiting, bolus insulin for carbs as usual.
Glucose under 70 mg/dL, below target range:
- Treat with 15g of fast-acting carbs and re-check in 15 min.
- Repeat until glucose is in target range.
- In manual mode, pump users should suspend pump for 30 minutes or until glucose is within target range.
- If unable to eat or drink, call Diabetes Center and consider Glucagon injection or nasal spray.
Ketone Basics
Common Questions
What are ketones?
- Ketones are made when the body breaks down fat for energy
- Ketones occur when a person is not eating or does not have enough insulin
Why check for ketones?
- Ketones are more likely when a person with diabetes is sick
- A high level of ketones can lead to diabetic ketoacidosis (DKA)
When to check for ketones?
- When your child is sick, no matter what the glucose number
- When your child is vomiting
What to do about ketones?
- When ketones are present, additional insulin is often needed
How to Check for Ketones in Urine
- Apply a drop of urine onto the square tip of the ketone strip
- Compare the strip color with the color chart on the bottle
- Negative
- Trace 5 mg/dl
- Small 15 mg/dl
- Moderate 40 mg/dl
- Large 80 mg/dl
- Large 150 mg/dl
Please Note:
- When you open a new bottle of ketone strips, write today’s date on the bottle
- Once opened, they are good for 2 to 6 months depending upon manufacturer
How to Check for Ketones in Blood
- Put ketone strip into meter and apply a drop of blood
- Compare the meter reading to the chart below
| Ketone Amount | Blood Ketone Value |
|---|---|
| Large | Above 1.5 mmol/L |
| Moderate | 0.6 to 1.5 mmol/L |
| Negative, Trace, Small | Below 0.6 mmol/L |