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What should I expect when my child is sick?

Children with diabetes can fight off an illness like a child without diabetes, but an illness can affect your child’s blood sugars and insulin requirements. Children who are ill also have a higher risk of developing ketones.

Blood sugars:

Illness can make blood sugars go up or down. For example, the stress or pain of an illness might make your child’s blood sugars higher than usual. If your child has a gastrointestinal illness, such as a stomach bug, he or she might have low blood sugars from vomiting or diarrhea.


Sick children with Type 1 diabetes also have a higher risk of developing ketones. They might develop ketones along with high blood sugars. However, sick children can also develop ketones with blood sugars that are normal or low, because of not eating or drinking normally. Your child can also develop ketones if he or she isn’t absorbing the nutrients from food.

How often should I check blood sugar and ketones?

  • Check blood sugars at least every 3 hours during the day and overnight. If you are unsure, it is better to check your child’s blood sugars more often.
  • Try to keep your child’s blood sugars within a safe range (between 80mg/dL and 250mg/dL). It is important to check your child’s blood sugars even if he or she is not eating.
  • Check for ketones at least every 3-4 hours and overnight, even if blood sugars are normal or low. Call the Pediatric Endocrine Unit if your child’s urine ketones are greater than trace or the blood ketones are 0.6 or higher.

What should my child eat or drink?

  • Encourage your child to drink fluids. Whether your child should drink liquids with or without sugar depends on his or her blood sugars. See the chart below to see which types of drinks your child should have.
  • If your child is not eating solid foods, he or she should drink broth or bouillon to make sure he or she is getting enough salt. Many sugar-free drinks have low amounts of salt that will not help your child get the right amount of salt.
  • If your child can’t keep down clear liquids, call the Pediatric Endocrine Unit at 617-726-2909.

If your child's blood sugars are...

Under 100 mg/dl

Drink liquids with sugar

100-200 mg/dl

Drink a mix of liquids with sugar and sugar-free liquids.

200mg/dL or higher

Drik sugar-free liquids


How should I manage my child's insulin?

Sick children always need some BASAL insulin even if their blood sugars are low. While the doses might need to be changed, you should continue to give some basal insulin. Basal insulin is the pump basal, glargine (Lantus® or Basaglar®), detemir (Levemir®) or degludec (Tresu=iba® or NPH).

See the chart below to figure how much BOLUS insulin you should give to your child. If your child has a pump and has ketones, please replace the pump site. Give the correction insulin by injection.

If your child...

Hass blood sugar levels under 70-80 mg/dL

Treat low blood sugar with simple sugars (juice, syrup) and recheck in 15 minutes.

Has blood sugar levels between 80 mg/dL and 250mg/dL AND can eat and drink normally

Give your child the usual amount of insulin.

Has blood sugar levels of any level AND has urine ketones that are small, moderate or large OR has blood ketones that are 0.6 or more

Call us for advice on insulin dosing


How do I dose insulin if my child eats the same number of carbohydrates every day?

Regimens that require your child to eat the same number of carbohydrates every day at the same time can be tricky when your child is not eating well. These regimens include NPH, 75/25 insulin, sliding scales or fixed doses. Please call the Pediatric Endocrine Unit at 617-726-2909 for advice about these insulin doses.

When should I call my child's pediatrician or endocrinologist?

  • When blood sugars are constantly low or high despite trying to manage them, if your child is vomiting constantly or if your child has ketones (as shown in the chart)
  • If you have questions about your child’s illness or you think your child needs to see the pediatrician.
  • Follow your child’s pediatrician’s advice when giving your child medications for fever, cough, stuffy nose or the flu. Some cough and cold medicines have small amounts of sugar in them. This small amount of sugar should not affect your child’s diabetes. You can give your child the same cough and cold medications as you would for a child without diabetes.
Rev. 11/2018. Massachusetts General Hospital and Mass General for Children do not endorse any brands mentioned in this webpage. This webpage is intended to provide health information so that you can be better informed. It is not a substitute for medical advice and should not be used to treatment of any medical conditions.