Diabetes and Your Child: Sick Day Plan

Diabetes and Your Child: Sick-Day Plan

When your child is sick, his or her routines for regular eating, taking insulin, and exercising will be interrupted. This may make his or her blood sugar harder to manage. You will need to monitor your child closely and check his or her blood sugar more often. You may also need to adjust your child’s insulin dosage. To be prepared, work with your child’s healthcare team to create a sick-day plan. The healthcare team will help you keep your child safe while he or she is sick.

Boy sitting and testing his blood sugar level with mom sitting beside him.

Caring for Your Child

Infections, the flu, and even a simple cold can cause your child’s blood sugar to rise. Here are some tips to follow when your child is sick:

  • Have a sick-day box ready. Before your child gets sick, make a sick-day box. The box should include: a thermometer, ketone testing strips, and a suppository that helps stop nausea and vomiting. Also, add a can of soup, crackers, sugar-free juice and regular juice. And keep some frozen juice bars, some with sugar and some without sugar, in the freezer. Check the expiration dates on the contents of the sick-day box once a month.

  • Stick to the usual meal plan if your child can eat. This will help regulate your child’s blood sugar and keep him or her from becoming dehydrated.

  • If your child can’t eat, have him or her sip fruit juices, soft drinks with sugar, or ice cubes made from juice or sugar water. Or try gelatin, frozen juice bars, or low-fat ice cream.

  • Make sure your child drinks plenty of water. Your child has to stay hydrated.

  • Test blood sugar often. Test as often as indicated in the sick-day plan. And continue checking your child’s blood sugar even if he or she isn’t eating. A rise in hormones can cause the blood sugar level to rise. That means insulin must still be injected to keep your child safe and his or her blood sugar in the target range.

  • Do NOT skip insulin. ALWAYS continue giving insulin. Adjust the amount of insulin you give your child according to the sick-day plan. But do NOT skip insulin, even if your child is vomiting. Skipping insulin could lead to ketoacidosis (see below). Call your child’s doctor if you aren’t sure how much insulin you should give your child.

What Are Ketones?

The body needs glucose for energy. If the body doesn’t get the glucose it needs, it starts burning fat. But fat is not the best fuel for the body. And burning fat produces a waste product called ketones. Ketones can build up dangerously in the blood and urine. Your child’s body can’t handle large amounts of ketones. Always test for ketones when your child has:

  • Blood sugar above 240.

  • Diarrhea or is vomiting.

  • Fever of 100.4ºF (38ºC) oral or 101.4°F (38.5°C) rectal or higher, or as directed by your child’s healthcare provider

Call your child’s doctor right away if ketones are present in the blood or urine.

What Is Ketoacidosis?

When ketones build up in the blood, it can cause ketoacidosis. (Ketoacidosis is sometimes called diabetic ketoacidosis or DKA.) The biggest cause of ketoacidosis is a lack of insulin. This can happen if your child misses taking his or her insulin injections. Symptoms of ketoacidosis include:

  • Nausea and vomiting

  • Stomach cramps

  • Rapid, deep breathing

  • Fruity-smelling breath

  • Blurred vision

Ketoacidosis is very serious. If you suspect ketoacidosis, take your child to the hospital emergency department (ER) right away.

Call your child’s doctor if:

  • You’re not sure how much insulin to give when your child is sick.

  • Your child’s blood sugar is over 240 and doesn’t go down after getting insulin.

  • Your child has ketones.

  • Symptoms of ketoacidosis are present. If you test your child for ketones and suspect ketoacidosis, take him or her to the hospital emergency department (ER) right away.


For more information about diabetes, visit these websites:

  • American Diabetes Association

  • Children with Diabetes

  • Juvenile Diabetes Research Foundation International

NOTE: This sheet does not give all the information you need to care for your child with diabetes. Ask your child’s healthcare team for more information.