Q: I know it's almost inevitable that my 7-year-old will catch a cold at some point this winter, so how will this affect his type 1 diabetes? It's our first cold and flu season since his diagnosis.
A: When children with type 1 diabetes catch a cold or flu, typically the biggest concern, beyond coughs and runny noses, is keeping blood sugar levels well managed. When a child becomes ill, stress hormones released by the body can interfere with insulin and lead to high blood sugar levels. At the same time, if a sick child can't keep anything down or has very little appetite, it's common for low blood sugar to develop.
No one is able to predict ahead of time exactly how a bug will affect a child's blood sugar. However, parents can put together a good game plan before that first case of the sniffles strikes. Talk to your child's doctor about extra steps to take when monitoring blood sugar on sick days. In general, checking more frequently can be very helpful for detecting highs or lows before they get out of control. Ask your child's doctor for a specific timetable for monitoring sugars; testing every three to four hours or so may be recommended.
To help blood sugar levels stay as normal as possible, keep your child eating and drinking when he's sick; even small amounts of food given every few hours may be enough to stave off a low. If it's too difficult to keep solids down, try drinks or soft/liquid meals with carbohydrates in them, such as juice, Jell-O®, Popsicles®, or broth. Drinking plenty of fluids also helps keep kids hydrated while they have a cold. Even if your child doesn't want to eat or is vomiting, it's important he or she continue to receive insulin, as insulin is needed to prevent the formation of ketones. In this case, your diabetes team will tell you how much insulin to give.
Before using any over-the-counter cold or flu remedy, find out from your doctor which medications are safe for a child with type 1 (some can affect blood sugar). Also be sure to ask your doctor for specific warning signs that warrant a phone call to the office or a trip to the emergency room. This list will include things like vomiting, persistent high or low blood sugar, and the presence of ketones.
Whenever your child is sick, your doctor may want you to test frequently for ketones. If present, they're a sign that your child needs more insulin. You may be able to make adjustments at home to eliminate ketones, but some children will need medical attention when they develop, especially when accompanied by vomiting.
Fortunately, most children with diabetes don't end up in the ER because of their colds and generally take about as long to recover from upper respiratory symptoms as any other child. And just like other kids, children with type 1 can help keep cold and flu viruses at bay through frequent hand-washing and other good hygiene habits.
--Janet Silverstein, M.D., is the division chief of pediatric endocrinology at the University of Florida.
How Other Parents Deal
"Chicken noodle soup is my go-to food whenever my son has a cold. It's got carbs, broth, lots of veggies, and it tastes good (and it usually stays down). Before serving, I even add a little squeeze of lemon for some extra vitamin C!"
--Tamara, mom of Dwight, 6
Disclaimer: The information in these articles is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.
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