When Kylo's poorly

Sick day rules

What we do when Kylo is unwell, from the sick day rules our diabetes team gave us. Kept short so it's easy to follow at 3am.

Always follow your own diabetes team's plan. These rules are from the leaflet our team gave us, and teams sometimes adjust them for each child. If you're not sure, ring your diabetes team. Ring them early.

The golden rules

  1. Never stop the insulin.Even if they're not eating, the body still needs insulin to use glucose and clear ketones.
  2. Check blood glucose every 2 hours.Through the night too.
  3. Check blood ketones whenever they're ill.Even if glucose looks normal. Then use the traffic lights below.
  4. Keep them drinking.Water or sugar-free drinks if glucose is normal or high. Sugary drinks (or carbs) if glucose is low. Avoid fizzy drinks if you can.
  5. Tell the diabetes team early.Don't wait until things are bad to ask for advice.

Extra insulin calculator

Enter the child's weight and it works out the extra fast-acting insulin for amber and red ketones, rounded to the nearest half unit.

kg

Ketones 0.6 to 1.5
–
0.1 units per kg
Ketones over 1.5
–
0.2 units per kg

Give it with an insulin pen. Rounded to the nearest half unit; if your pen only does whole units, ask your team how to round. Some teams use 10% / 20% of the total daily dose instead, so use whatever is written on your own plan. The weight is remembered on this device only. Update it whenever there's a new weight.

Check ketones, then follow the colour

Blood ketones, measured in mmol/L. Re-check glucose and ketones every 2 hours and move between colours as the numbers change.

Green

Ketones under 0.6
  1. If glucose is high, give a normal correction dose, plus the usual boluses for food.
  2. Re-check glucose and ketones in 2 hours.

Glucose coming down? Good sign; keep watching closely. Still going up? Give another correction, using a pen.

Amber

Ketones 0.6 to 1.5
  1. Give 0.1 units per kg of extra fast-acting insulin, using a pen.
  2. Keep them drinking.
  3. Re-check glucose and ketones in 2 hours.

Still amber and glucose rising? Give it again every 2 hours, keep giving the usual food boluses, and keep checking through the night. Ketones over 1.5? Go to red. Under 0.6? Go to green.

Red

Ketones over 1.5
  1. Give 0.2 units per kg of extra fast-acting insulin, using a pen.
  2. Keep them drinking.
  3. Re-check glucose and ketones in 2 hours.

Still over 1.5? Give it again every 2 hours, with the usual food boluses. Dropped to 0.6 to 1.5? Go to amber. Being sick with high ketones? Go to A&E.

Ketones but low glucose

These are starvation ketones, often from a tummy bug. Give sugary drinks (or carbs if they'll eat) and watch glucose very closely. They may need extra insulin once glucose starts to rise.

If you're on a pump

  • Check the pump first: a blocked or kinked tube, a disconnection, or a flat battery.
  • Ketones under 0.6: give the correction through the pump. If it hasn't worked after 1 hour, give the correction again with a pen.
  • Ketones 0.6 or more: give the extra insulin with a pen, not the pump.
  • Needing lots of extra doses? Think about a higher temporary basal rate.

Based on Patient Advice for Management of Type 1 Diabetes during illness in children and young people under 18 years (Sick Day Rules), Association of Children's Diabetes Clinicians and BSPED, version 5, March 2021. We've shortened it; your team's version comes first.

We're a family sharing what we've learned, not medical professionals. If you're worried, call your diabetes team or NHS 111, or in an emergency call 999.

What is T1D?