TABLE 1:

‘Sick day’ rules for young children with diabetes

Check blood glucose concentration and urine ketones every 4 h around the clock. Make sure that the child continues to receive fluids and calories; if the child is unable to eat, offer clear glucose-containing fluids (eg, juice, ginger ale, Jell-o or popsicles). Do not discontinue insulin: the dose may need to be adjusted. Treat the underlying illness. The effect on metabolic control will not be alleviated until the illness resolves or is treated. Call the diabetes team immediately or go the nearest emergency room if the child refuses to eat, drink or vomits more than twice in a short space of time; the blood glucose concentration remains low despite appropriate food intake and insulin doses adjustment; or the blood glucose remains high with positive urinary ketones despite appropriate illness management.