Just when you thought you had this whole blood sugar management thing down, along comes a cold, flu, or some other common bug. Not quite sure what to do when your child is sick? From blood sugar-friendly foods that will stay down with an upset tummy to managing unpredictable highs and lows, here are some T1D sick-day tips.
Dos & Don’ts
When a child becomes ill, stress hormones released by the body can interfere with insulin. In a child without diabetes, the body can simply produce more insulin to compensate, but when a child has type 1, being sick often results in high blood sugar readings that require correction.
How out-of-range can you expect your child’s numbers to go? There’s really no way to predict, according to Kathy O’Malley, R.N., B.S.N., C.D.E., a certified diabetes educator at Children’s Hospital & Medical Center in Omaha, Neb., who explains, “Blood sugars may vary depending on the type of illness and the severity.”
Numbers may also fluctuate suddenly, which is why O’Malley’s first piece of advice for parents with a sick child is to check blood sugars more frequently and treat highs (and lows) as needed.
Also on her sick-day to-do list: test urine more frequently for ketones. When these chemical compounds start building up in the blood, it’s a sign that the body is using fat and muscle for energy. Ketones are often present when blood sugar readings are high; elevated ketones typically mean that a child with type 1 is not getting enough insulin. Very high levels of ketones can be a sign of diabetic ketoacidosis (DKA), a health complication that requires immediate medical attention. “When a child is sick, ketones should be checked with each [urine] void,” says O’Malley’s colleague, Kevin Corley, M.D., staff endocrinologist at Children’s Hospital & Medical Center. Also try to increase your child’s fluid intake to prevent dehydration, especially if he or she is vomiting or has diarrhea.
Speaking of tummy troubles, not sure what to do about insulin if your child is having trouble keeping food down? “Don’t skip insulin doses without checking with your diabetes care team; give insulin as scheduled,” O’Malley recommends. How you calculate your child’s insulin dose typically doesn’t change, but if vomiting or ketones are present, O’Malley recommends calling your child’s diabetes care team right away for help before dosing.
When it comes to over-the-counter or prescription medications, including those to control nausea or vomiting, always check with your care team first before administering. Certain medications can interfere with insulin and/or blood sugar levels, says Corley.
Your child may not be in the mood for a big meal when he’s sick, but eating and drinking to keep up carbohydrate and fluid intake are two key ways to keep diabetes from adding to a child’s illness.
Says Amy Hess-Fischl, M.S., R.D., L.D.N., B.C.-A.D.M., C.D.E., an advanced practice dietitian and coordinator for the University of Chicago Kovler Diabetes Center’s Teen In Transit program, “It is important to take in enough calories on sick days, otherwise the body will start to break down fat for fuel, leading to ketones in the urine and blood. While there are no right or wrong foods during illness – it’s more about whatever your child feels like</br> eating -- having liquids and soft, easy-to-digest foods on hand is a good idea.”
The following are a few of Hess-Fischl’s recommendations, each containing approximately 15 grams of carbs:
1/2 cup applesauce
1/2 medium banana
1/2 cup custard
1/2 cup cooked cereal
3 graham crackers
6 saltine crackers
1/2 cup regular gelatin
1/2 cup ice cream
1/3 cup frozen yogurt
1 slice of toast
1/2 cup mashed potatoes
1/3 cup cooked rice
5 vanilla wafers
1/4 cup sherbet
1 cup broth-based soup
To keep up fluid intake, Hess-Fischl recommends having on hand a few different types of beverages and other liquids to keep kids interested. “Depending on blood sugars, choose between non-carbohydrate fluids and carbohydrate-containing fluids,” she adds.
Besides water, other non-carbohydrate fluids include broth, sugar-free gelatin, sugar-free Popsicles®, and sugar-free soft drinks and drink mixes. (Be sure to double-check the labels to be sure whether you're using sugar-free or regular versions.)
If blood sugars are in range, consider some of the following fluids, each containing approximately 15 grams of carbohydrates:
1/2 cup apple or orange juice
1 cup children’s meal replacement beverage like Pedialyte®
1 cup sports drinks
tea with 1 tablespoon honey or sugar
1/2 cup regular soft drink
1/3 cup grape or cranberry juice
1/2 cup fruit drink
1 double stick regular Popsicle®
When to Get Help
Ideally, Hess-Fischl recommends talking to your care team before illness strikes as a way to get some general guidelines on what to do when it does and what symptoms mean it’s time to call your team for help.
It’s important to touch base with your doctor or care team if any of the following occurs, says Hess-Fischl: blood sugars remain above 400 mg/dL for more than four hours (even with extra insulin), your child develops a fever of greater than 101 degrees F, your child has had nausea, vomiting or diarrhea for more than four hours, or your child has other serious or unusual symptoms such as chest pain, confusion, listlessness, or trouble breathing. Your healthcare provider may have additional or different guidelines.
Corley adds that you should contact your child’s diabetes team immediately if you notice signs of dehydration (dry mouth, sunken eyes, or poor urine output) or signs of ketoacidosis, which include fruity breath, deep rapid breathing, or vomiting.
Now that you’ve heard from the medical professionals, here are a few more practical tips for navigating sick days from fellow parents of children with type 1:
Train a backup. “As soon as you can, line up additional trained caregivers who are available during the day so you don’t miss so much work. I once hired an on-call nurse through a local agency because I had a big meeting at work that I couldn’t miss. It wasn’t cheap, but I knew my son was being cared for, and I was less stressed out,” says Kim P., a mom from Andover, Mass., whose 12-year-old son Seth has type 1.
Know when to call the doctor. “Make a list of all the warning symptoms and keep it on the fridge, along with all emergency phone numbers, adds California mom Andrea L. Her daughter Katie, age 7, was diagnosed less than a year ago.
Plan for missed schoolwork. “When you sit down to make up your child’s educational plan at the beginning of the school year, put in writing how you want to handle make-up work after an excessive health-related absence. In our case, any time he’s absent for more than three days, our accommodation is to cut down make-up work to only the basics needed to understand instruction,” says Kim.
Rely on the basics. “From my experience so far, parents will be glad to know that the same things that worked to soothe and comfort their child during an illness in the past before diagnosis still work now,” says Andrea. “In other words, kids with diabetes can still benefit from what I call the 3 Cs of sickness: couch, cartoons, and plenty of chicken soup.”
Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the "typical" experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring.
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