When kids with diabetes get sick, their blood sugar levels can change in ways parents might not expect. So you may need to do a few extra things to keep your child’s sugars under control. With some planning and advice from your doctor, you'll be ready to handle sick days when they happen.

How Do Blood Sugar Levels Change During an Illness?

Blood sugars can rise or fall more than usual when a child is sick. Even a minor illness can throw off the delicate balance between carbohydrates and insulin.

When your child or teen with diabetes is sick, watch to see if:

• Blood sugars rise (hyperglycemia). When kids are sick or injured, the body's stress hormones can make blood sugars rise and insulin not work well. So your child might need more insulin than usual.
• Blood sugars fall (hypoglycemia). Some illnesses can make a child feel sick to their stomach, vomit, or not want to eat. When a child with diabetes who takes insulin eats less than usual or less than expected, their blood sugar can fall. Then, they need less insulin than usual.

How Can I Be Prepared for an Illness?

There are some simple things you can do now. That way, you’ll be ready when your child doesn’t feel well:

• Know what’s in your child's diabetes care plan. It will tell you what to do on sick days.
• Get extra glucose and ketone test strips. You will use more than usual when your child is ill, and you don’t want to run out.
• Stock your pantry. To keep your child hydrated, keep a big supply of sugar-free and sugar-containing fluids on hand. Expect your child to drink a lot more than usual and want to eat foods that are gentle on the stomach. Essentials to get include:
  • sugar-free fluids (water, broth, soup, sugar-free soda, and tea)
  • regular soda or juice for low sugars
  • sports drinks (like Pedialyte or Gatorade)
  • crackers
• Find your thermometer. You’ll need it to monitor your child’s temperature.

What Should I Do When My Child Is Sick?

Your child’s care plan is your best guide. Look in it to find specific sick-day advice from the doctor.

Here are some general guidelines for sick days:

• Check blood sugars more often.
• Keep giving insulin. Your child might need more or less than the usual plan. Some kids with type 2 diabetes who don’t take insulin every day will need insulin when they’re sick.
• Check for ketones. Belly pain, nausea, or vomiting could be signs of a stomach flu or symptoms of diabetic ketoacidosis (DKA).
• Encourage your child to drink to avoid dehydration.
• Use medicines wisely. Before giving your child over-the-counter or prescribed medicines, ask the pharmacist or doctor how they might affect your child’s diabetes.
• Take notes. Keep track of your child's symptoms, medicines taken and their doses, food and drink, any weight loss or fever. Be sure to record blood sugar and ketone levels.
• Help your child rest. Encourage your child or teen to take it easy as much as possible.

When Should I Call the Doctor?

Call your doctor if your child is sick and:

• isn’t hungry, or can't eat or drink
• has vomiting or diarrhea that lasts longer than 2 hours
• has low blood sugar. Treat any low blood sugars before calling the doctor or going to the ER. Call 911 if you can’t raise your child’s blood sugar.
• has high blood sugar levels that don’t come down after giving insulin as described in the care plan
• has moderate or large amounts of ketones
• you think they may have symptoms of DKA

What Else Should I Know?

To help keep your family healthy and prevent illness:

• Keep vaccinations up to date. This includes the pneumococcal conjugate vaccine (PCV), a yearly flu shot, and the COVID-19 vaccine for whoever is eligible.
• Teach kids to wash their hands well and often. Good handwashing can prevent the spread of germs.
• Avoid contact with people who are sick. Illnesses like the common cold spread easily.