What should I do when I get sick?

Having diabetes does not mean you will get sick more often than before you had it. Being sick is stressful for your body. Stress causes blood sugar to go high in a person with diabetes.

It is important that you pay attention to and check your blood sugar more often than usual when you are sick.

It is important to check ketones each time you are sick, even if your blood sugar is not high. You will probably get ketones every time you are sick.

The information on the following pages will help you care for your diabetes when you are sick. If you don’t know what to do, call your diabetes doctor or nurse for help right away.

  • They can give advice about how to care for diabetes during an illness.
  • Remember that they specialize in diabetes and do not know the most current advice to give for a general illness, such as fever, rash, or sore throat.
    • Call your primary care doctor if you have questions about your illness.
    • Call your diabetes specialist to help with blood sugars and ketones that happen during the illness.

What medicines can I take?

You and everyone who lives with you need to get an influenza vaccination (a flu shot) each fall. Influenza causes fever, chills, congestion, and body aches. It does not cause nausea and vomiting. Influenza is very serious. It will cause ketones and can cause diabetic ketoacidosis (DKA), which is a very serious and life-threatening problem.

Approved medications

There are several over-the-counter and prescription medications that are okay to take. If you need them and they help you feel better, take them. They do not affect blood sugar.

  • Tylenol
  • Ibuprofen
  • Allergy medicine
  • Antibiotics

Do not give children under the age of 4 cough or cold medicines per The American Academy of Pediatrics recommendation. They do not help young children much and can have serious side effects.

Steroids may affect blood sugar

Steroids taken by mouth, such as prednisone, will raise your blood sugar very high and cause ketones.

Call the diabetes nurses or doctor as soon as you take your first dose of steroid. We will help you raise your insulin doses during this time.

What do I do if I need surgery?

Your surgery should be scheduled first thing in the morning since you will need to go without food and drink when having sedation (sleeping medicine).

Call your diabetes doctor or nurse right after you schedule your surgery. We will tell you what to do with your insulin doses before and after surgery.

School or work excuse

We will give a:

  • School excuse if you have an illness that affects your diabetes and we helped you with it
    • If the illness did not affect your diabetes and we did not talk to you the day you were sick, we will not give a school excuse. You will need to get the school excuse from your primary care doctor.
  • School excuse for missed school on days you had a diabetes appointment
  • Work excuse for parents on days your child is sick and we helped with blood sugars and ketones
  • Work excuse for days a parent brought their child to diabetes appointments

What do I do if I have ketones?

Do not exercise when you have ketones. Ketones can get worse with exercise.

What to do for ketones when you have not vomited (thrown up)

Urine Blood What to do
Negative Less than 0.6 Drink extra water or carbohydrate-free drinks.
Trace Less than 0.6 Drink extra water or carbohydrate-free drinks. Check ketones each time you pee.
Small or moderate 0.6 to 1.5

If your blood sugar is over 240:

  • Calculate your total daily insulin dose.
  • Take 10 percent of your total daily insulin dose of extra rapid-acting insulin (Humalog, Novolog, Apidra). Round to the nearest half unit.
    • Give the extra insulin dose right away if it is not close to a meal time.
    • Give the extra insulin with the meal time dose of insulin if it is close to a meal time.
  • Drink extra water or carbohydrate-free drinks.
  • Check ketones each time you pee or at least every 1 1/2 to 2 hours.
  • Do not exercise.
Large 1.5 to 3.0

If your blood sugar is over 240:

  • Calculate your total daily insulin dose.
  • Take 20 percent of your total daily insulin dose of extra rapid-acting insulin (Humalog, Novolog, Apidra). Round to the nearest half unit.
    • Give the extra insulin dose right away if it is not close to a meal time.
    • Give the extra insulin with the meal time dose of insulin if it is close to a meal time.
  • Drink extra water or carbohydrate-free drinks.
  • Check ketones each time you pee or at least every 1 1/2 to 2 hours.
  • Do not exercise.
  Over 3.0 Call the pediatrics diabetes nurses or doctor on-call or go to the closest emergency room.

If your blood sugar is not over 240 and you have ketones, try to get your blood sugar up by drinking a drink with carbohydrate in it. When your blood sugar is over 240, check ketones. If you still have ketones, treat with insulin as shown above. Call your diabetes doctor or nurses right away if you have tried to get your blood sugar over 240 for more than 1 hour without success and you still have ketones.

How to find your total daily dose:

  1. Add up all of your rapid-acting insulin meal time doses plus your long- acting insulin dose that you usually take in 1 day (24 hours).
    • For example:
      • Breakfast dose: 8 units
      • Lunch dose: 5 units
      • Supper dose: 7 units
      • Long-acting dose: 20 units
      • Total daily dose: 40 units
  2. For small or moderate ketones:
    • Total daily dose × 0.1 = number of units of rapid-acting insulin. For example:
      • 40 units × 0.1 = 4 units of rapid-acting insulin. Round the number of units to the nearest 0.5 unit. Take this dose right away.
  3. For large ketones:
    • Total daily dose × 0.2 = number of units of rapid-acting insulin. For example:
      • 40 units × 0.2 = 8 units of rapid acting insulin. Round the number of units to the nearest 0.5 unit. Take this dose right away.

What to do after you treat the ketones with insulin:

  1. 1 1/2 hours after you take your rapid-acting insulin for ketones:
    • Check your blood sugar.
    • Check for ketones.
      • Do not take more insulin if you still have ketones.
    • Keep drinking water or carbohydrate-free drinks.
  2. 3 hours after you take your rapid-acting insulin for ketones:
    1. Check your blood sugar.
    2. Check for ketones.
  3. Call your diabetes doctor or nurse right away if you still have small, moderate or large ketones after 3 hours.

What to do for ketones when you have vomited (thrown up)

  • Check your blood sugar every hour.
  • Check ketones each time you pee or at least every 2 hours.
Blood sugar Ketones Insulin What to do
Less than 45 No None Follow low-dose glucagon instructions.
45 to 180 No None Call your diabetes doctor or nurse right away.
80 to 150 No None Take small sips of sugar-drinks or hard candy.
Over 150 No None
  • Wait 2 hours with nothing to eat or drink (no ice chips, water, juice, or food)
  • After 2 hours, if you have not vomited again, drink small sips (less than 1 ounce) of water or diet soda every 10 to 15 minutes.
  • If you vomit again and your blood sugar is over 150, wait 2 hours then try sips again.
  • If you do not vomit again, slowly start drinking more, and then start eating food.
Over 200 Small or moderate Rapid-acting insulin is needed right away. Give 10 percent of the usual total daily dose of rapid-acting insulin right away.
Over 200 Large Rapid-acting insulin is needed right away. Give 20 percent of the usual total daily dose of rapid-acting insulin right away.
Less than 200 Small, moderate, or large No insulin can be given until your blood sugar is above 200. Take sips of sugar-drinks until your blood sugar is above 200. Then treat based on ketones. Try to get your blood sugar above 200 for 1 hour. Call your diabetes doctor or nurses right away if it does not go above 200 and you still have ketones.

Do not take extra insulin to treat ketones more than every 3 hours.

Never skip a long-acting insulin dose, even if you are sick, vomiting, or have surgery.

Low-dose glucagon

glucagon with insulin syringe, photoWhat do I do if I vomit and my blood sugar is low?

If you vomit (throw up) and cannot eat or drink to get your blood sugar up, you can give yourself low-dose glucagon with an insulin syringe to get your blood sugar up at home.

Give yourself low-dose glucagon if you:
  • Vomit (throw up), cannot eat or drink, and your blood sugar is less than 45.
  • Vomit (throw up), cannot eat or drink, and your blood sugar has been between 45 and 55 for more than 45 minutes while trying to drink carbohydrate and your blood sugar is not going up.
Give yourself low-dose glucagon by following these steps:
  1. Gather the supplies:
    • Glucagon kit
    • Insulin syringe
  2. Mix the water in the syringe from the glucagon kit with the glucagon powder in the bottle until the fluid is clear.
  3. Draw out the glucagon with the insulin syringe.
    Age Glucagon dose
    2 years old and younger 2 units
    3 years old 3 units
    4 years old 4 units
    5 years old 5 units
    6 years old 6 units
    7 years old 7 units
    8 years old 8 units
    9 years old 9 units
    10 years old 10 units
    11 years old 11 units
    12 years old 12 units
    13 years old 13 units
    14 years old 14 units
    15 years old and older 15 units
  4. Inject the glucagon into the fat, in the same place insulin is given.
  5. Put the cap back on the needle and keep it closed. You might need to give yourself another dose of glucagon.
  6. Wait 20 minutes.
  7. Check your blood sugar. If is it still less than 70, double the original dose and give another low-dose glucagon injection.
  8. Wait 20 minutes.
  9. Check your blood sugar. Call your diabetes doctor or nurse if it is still less than 70.
    • If it Monday through Friday between 8 a.m. to 4:30 p.m., call 1-319-356-2229 and ask for a pediatric diabetes nurse educator to be paged.
    • After hours, on weekends, or on holidays, call 1-319-356-1616 and ask for the pediatric endocrinologist on-call.
  10. Throw away the unused glucagon 1 hour after mixing it. Get a glucagon kit refill soon.