Having a sick child is a stressful situation for any parent. However, when your child has type 1 diabetes, you may worry about how their blood glucose (sugar) levels will be affected. Symptoms like vomiting and nausea can be particularly concerning if your child isn’t eating their usual foods on a regular schedule. Here’s what you should know to keep your child safe while they recover.

Monitoring for High and Low Blood Sugars

When a child with diabetes isn’t eating as much food as they usually do — due to illness, for example — they can develop hypoglycemia (low blood sugar levels). This means they’ll need less insulin to keep their glucose levels in the normal range.

However, depending on the child’s sickness, they may develop hyperglycemia — high blood sugar levels — from the stress of being sick. Stress hormones cause the release of stored glucose from the liver. In addition, if your child is eating less food overall but more carbohydrates — from juice or crackers, for example — their blood sugar may be higher than usual.

Kids who are sick can have unpredictable blood-sugar changes in either direction. That’s why it’s important to keep a closer eye on their blood sugar control with more frequent glucose testing. You should do a blood test at least every four hours.

In addition to glucose monitoring, you can use ketone test strips to watch for diabetic ketoacidosis (DKA). In this condition, fats are broken down for energy into acids called ketones. The symptoms of DKA can be similar to that of the flu or other stomach bugs, so testing is the best way to know whether your child is entering ketoacidosis, which is a serious complication.

Some signs of DKA include:

• Confusion
• Dry mouth and thirst
• Frequent urination
• Fruity-scented breath
• Nausea
• Stomach pain
• Vomiting
• Weakness and tiredness

As with blood sugar, check for ketones at least every four hours while your child is sick. Your child’s doctor can provide the right target range to aim for, and general guidelines on when to seek emergency care. Untreated DKA is life-threatening, so it’s important to be prepared and know what to do in an emergency.

Managing Insulin and Other Medications

Giving your child the right amount of insulin when they’re sick is critical to preventing blood sugar spikes and dips. Keep in mind that even children who don’t normally take insulin daily may need extra insulin when they’re sick. It’s a good idea to discuss a sick plan with your child’s doctor so you know what to do when they’re not feeling well. When in doubt, call your child’s diabetes team for advice on how to give enough insulin during illnesses.

Additionally, over-the-counter medications can affect your child’s blood sugar and may not be safe for children with diabetes. Ask the pharmacist before purchasing cold medicine whether it will affect your child’s diabetes management. They may suggest a safer alternative or provide instructions on what to expect and how to adjust insulin doses accordingly.

Keeping Your Child Fed and Hydrated

It can be a struggle to get your child to eat and drink enough when they’re not feeling well. On days they’re sick, don’t worry as much about them eating healthy foods. It’s more about eating somewhat consistently to maintain their blood sugar control than about following a strict meal plan.

Try to give them small portions of meals if they have nausea or vomiting. You can give solid foods like crackers, cereals, rice pudding, noodles, bread, or bagels. You can check the food label to see how many carbohydrates are in different foods, especially if it’s not something your child typically eats.

It’s also critical to ensure they’re taking in enough fluids to stay hydrated. In addition to plain water, fluids that aren’t likely to raise your child’s blood sugar include:

• Chicken broth
• Diet soda
• Club soda
• Tomato juice
• Sugar-free fluids

If your child’s blood sugar is running low and they aren’t eating much, you can include some fluids that contain sugar, such as fruit juice, frozen fruit bars, tea with honey, and Gatorade or other sports drinks. Just monitor the grams of carbohydrates as you would with food. Rather than having your child take in a lot of fluids at once, encourage them to sip throughout the day.

When To Call a Health Care Provider

If your child is really struggling to keep food or water down, or if they are vomiting or have diarrhea for more than two hours, it’s important to contact their doctor.

Always treat low blood sugars right away, but call the doctor if you’re having trouble getting them to reach the target range at home. If your child has moderate or large amounts of ketones and seems to be experiencing DKA, call 911 or head to the emergency room. For high blood glucose levels that aren’t responding well to insulin, a call to their regular health care team should be fine.

It’s normal (and beneficial) for your child to rest when they’re sick. Let them get plenty of sleep and avoid strenuous activities until they feel better. However, if your child seems confused, dizzy, or has other concerning symptoms like a very high fever, reach out to their doctor or emergency services. Circumstances can change quickly with diabetes, and you’ll need to be extra cautious on sick days. Staying calm and having a plan with clear goals will help you feel prepared to tackle any challenges that come up.

Talk With Others Who Understand

On myT1Dteam, more than 2,000 people with type 1 diabetes and their loved ones come together to ask questions, give advice, and share their stories with others who understand life with type 1 diabetes.

Do you have a diabetes care plan for when your child is sick? How do you monitor and manage their symptoms? Share your comments below, or start a conversation by posting on your Activities page.