Have a Plan and Keep the Supplies well stocked!
Keep the sick day supplies available! Our sick day supplies had seriously dwindled because (thankfully) Josh had been healthy for over a year. I’d raided the juice, life savers, sugar free and non-sugar free pops, and soda. Big mistake.
The stomach flu arrived at our house at 3 a.m. and Josh couldn’t keep any solid food down for about 12 hours. We cobbled together our sick day supplies and my husband made the 6 a.m. dash to the supermarket to replenish our depleted sick day food stuff.
Here’s what’s in our sick day kit and how we use them.
1) A water bottle clearly marked with the amount. I designated one water bottle at the start of the illness, especially if it’s in the middle of the night. That way I can see how much my child drinks. Hydration is important for any child but for a child with diabetes it can mean the difference between staying home and a trip to the hospital. With a single filled bottle we can see if he’s getting the minimum he needs an hour. If you do end up talking to the doctor she’ll want to know how much your child’s been drinking.
2) Blood ketone meter and urine ketone strips. We use the Precision Xtra. The strips are individually wrapped to stay fresh which is great because we can go months without needing them and then use up an entire box with stomach flu. Ketones appear in the blood before they appear in the urine so monitoring there can help you get on top of treating ketones. The ketone meter also allows you to check for ketones if a child is sleeping or not urinating much. We have urine ketone strips (Ketostix) as well. Make sure you label the bottle when you open it because once opened they only have a six month shelf life. If ketones are present we treat with insulin, fluids and continue to check for ketones every two hours until they clear.
3) Juice boxes with straws. Sipping juice helps hydrate as well as give needed sugar to balance out insulin. Something clear like apple juice is good but any juice or soda (not sugar free!) your child will drink will work. Some experts (Barbara Davis Center’s Pink Panther book) recommend Orange Juice because it replaces potassium lost in vomiting.
4) Cakemate icing tubes or glucose gel to treat low blood sugar. Who wants to chew a chalky sugar tablet when your mouth is parched and you’ve been vomiting? One tube of gel squirted between the cheek and the gum absorbs quickly and can get a fast dose of sugar to even a sleeping child.
5) Extra Syringes. I know many people will continue to use the pump to treat for ketones, but we always give an injection of Josh’s “ketone dose” of insulin at the first sign of ketones. That way if there is a pump problem we still know he got the needed insulin. You’ll also usually go through more injections on a sick day if you are on MDI (multiple daily injections).
6) Extra Glucose test strips. We fly through them during an illness. You should test at minimum every 2-4 hours.
7) “White foods”- saltine crackers, clear broths, unsweetened applesauce, bananas. After a stomach bug it’s important to introduce easy to digest food gradually. Dairy should be avoided.
8) Glucagon. Check periodically to make sure it is not expired.
9) The doctor’s number and on call number should ketones be “moderate to large” or fail to respond to treatment (extra insulin and water). Everyone with Type 1 should have sick day plan (see below).
Sick Day Plan
A sick day plan should include when to call the doctor, the minimum liquid needed to maintain hydration, and the dosage of rapid acting insulin to treat ketones (our rule of thumb is 10% Josh’s total daily dose of insulin). Check with your doctor and make sure you know yours. It will change as your child grows and insulin needs increases.
It’s important to check ketones anytime blood sugar is over 240 AND when you are ill. You can have a normal blood sugar and still have ketones when you are sick. Ketones must be treated!
Your body really does use more insulin when you are ill. I’ll never forget the first stomach flu when Josh’s blood sugar was normal (around 120 mg/dl) and the doctor talked me through giving the ketone dose of insulin. When his blood sugar dropped low he responded with a one cakemate icing. Honestly he didn’t go as low as I thought he would. His body did need the extra insulin to clear the ketones. I now trust that the body needs the extra insulin and I don’t waver at all about giving it.
Know your sick day plan. Be ready to give the insulin. Hydrate.
Finally, know if you reach a point you can’t keep up with the ketone-insulin- hydration challenge, and then get to the emergency room. If you’ve been in touch with your doctor’s office they can call the ER to expedite processing at your arrival. An IV to replenish lost fluid and sugars and extra insulin administered at the ER will make anyone feel better quickly and head off DKA.
Published On: February 16, 2007