Sick day rules

Navigating sickness with a type 1 toddler

Everybody knows that kids get sick, a lot. They’re snotty more often than they’re not. Its just part of being a kid and its part of being a parent too. But what happens when that snotty kid is a type 1 diabetic? How does sickness affect them? How does it change their management? What do parents need to know and what are sick day rules?

Well, I’m no expert, and I’m writing this post at midnight, sat next to my snotty T1 toddler waiting for blood sugars to come back into range, but after a hard couple of weeks of sickness, here’s what I’ve learnt.

What happens with a type 1 kid (or adult) gets sick?

Sickness messes up blood glucose levels. FACT. But just for fun, different illnesses mess them up in different ways. Whilst a lot of illnesses caused by viruses (colds and flu for example) make patients more insulin resistant (so blood sugars spike), a lot of bacterial infections do the opposite and make blood sugars plummet.

Any kind of vomiting illness holds a special place of horror for any type 1 child’s parents. Lower than normal blood sugars plus a child who understandably has no appetite and wont eat is a really challenging and worrying situation. The bottom line is, you have to get sugar in and you have to still inject insulin.

Managing type 1 diabetes during illness

Any carer managing type 1 diabetes during illness is governed by the “Sick day rules.” Simply put, if the patient has become more insulin resistant, insulin dose needs to be increased by 20%. If blood sugars are running low, insulin dose should be decreased by 20%. That’s not very easy if you’re child is small and they’re on tiny doses of 0.5 units.

What do parents need to know?

Check ketones

The really dangerous part of illness for a type 1 diabetic is the potential for a build up of Ketones. Ketones are released into the blood when glucose is not available. They acidify the blood and if left unchecked, can cause organ failure and death. So during times of illness, the real kicker is having to check these every 1 or 2 hours. That’s a lot of blood tests for any child to have to cope with. Having a back up ketone meter and test strips is absolutely essential during periods of illness.

Insulin works to reduce Ketones BEFORE it works on blood glucose, so if ketones are high, insulin dose needs to be increased. You also have to (somehow) get the type 1 toddler to drink as much water as possible to flush the Ketones out. That’s far from easy if a vomiting bug wont even allow them to keep water down. If Ketones are high and they’re struggling to drink liquids, it often means a trip to hospital, even if it’s just a cold virus making them sick.

Getting through sick day rules

Managing illness in type 1 diabetic kids is hard. Appling sick day rules is nerve wracking and repeat blood testing is heartbreaking. Having to juggle work commitments, family commitments and general life can feel overwhelming and exhausting when they’re sick. The ever present mum guilt is magnified tenfold but you can do it. You have to do it!

More information on Diabetes and sickenss can be found here.

A list of essential kit can be found here

Would you like to share your experiences of managing type 1 diabetes in children? Are you a relative or carer? We would love to hear from you and read your story. Get in touch.