Diabetic Sick Days



Background

Symptomatic hypoglycaemia

Hypostop Gel and glucagon (Glucagen) are provided for the treatment of severe hypoglycaemia at home. If possible the cause should be identified and if necessary the insulin dose adjusted.

Asymptomatic hypoglycaemia

If the blood glucose is low (ie) below 4mmol/L and the child is not vomiting, encourage fluids or sweet drinks containing carbohydrates. When the blood glucose is above 4mmol/L give the insulin.

High blood glucose level

If children have high blood glucose levels but are not unwell and are not ketotic, repeat the blood glucose test in 2 hours. If still high, consider the possible factors:

  1. Too much fast acting sugar in food/drink.
  2. Missed insulin injection.
  3. Inaccurate dose of insulin at injection, either through error, or leakage from injection site.

If blood glucose remains high an extra dose of quick acting insulin may be advised.

If the child is unwell and ketones are present in the urine, extra insulin may be required. In order to calculate the amount of quick acting insulin required the age, weight and usual daily dose of insulin, and blood glucose level should be known.

If a child has high blood glucose level with ketones, and is unwell or vomiting, the child should be reviewed by their GP or in the Emergency Department as soon as possible

Insulin dosage

If the blood glucose is below 13mmol/L continue as normal with daily insulin.

Quick Acting Insulin (Clear Insulin)

  1. Actrapid
  2. Humulin S.
  3. Novorapid.

The most commonly used is Actrapid. Quick acting insulin may be given at four hourly intervals if necessary to control the blood glucose level. 10% of total daily dose is generally a satisfactory initial dose of quick acting insulin. The normal daily insulin will still be required in addition to this.

Examples:

  1. 5 year old on 10 units of Mixtard Insulin or Insulatard and blood glucose is 19mmol/L with ketones: give 1 unit of Actrapid and repeat the blood glucose test in 2-4 hours
  2. 16 year old on 60 units of Insulin in total with blood glucose level above 20mmol/L and ketones: give 6 units of Actrapid and repeat blood glucose level in 2-4 hours

Encourage Fluids – if the child is unable to eat, replace the normal carbohydrate with fluid such as milk, fruit juice, lemonade, lucozade, coke or equivalent sweet drink. In addition aim for at least 3 extra pints of sugar-free liquids in 24 hours.


Children with pain or pyrexia

Sugar free calpol or similar preparation may be administered according to usual directions.


Contents by Dr Íomhar O' Sullivan 08/06/2005. Reviewed by Dr ÍOS 31/05/2007. Next review 31/05/2008.