Paediatric Diabetes – Illness and Diabetes using Multiple Daily Insulin Injections

Illness and Diabetes using Multiple Daily Injections
Any illness can upset the control of your diabetes. However, if your Type 1 diabetes is
well controlled, it does not mean that you are going to be unwell more often than young
people without diabetes. Your blood glucose level may rise without there being any
change in the carbohydrate food that you eat, or in the usual amount of insulin that you
take. In some young people illness may cause the blood glucose to go down, particularly
with diarrhoea and vomiting. This leaflet aims to give you the advice you need to avoid
additional complications from your diabetes when unwell and keep you out of hospital
where possible.

Diabetic Ketoacidosis (DKA)
DKA is a serious complication of diabetes. It results from having less insulin than is
required (sometimes from missing insulin) which causes a build-up of ketones in the
blood. This can make you seriously ill and can be life threatening if not treated promptly.
During illness the risk of DKA is increased. The following advice is aimed at helping you
manage illness safely and preventing DKA.

Sick Day Rules
 Do not stop taking your insulin: the cells in your body still need insulin to work
properly, even if you cannot eat your normal food or you are being sick. If blood
glucose levels are low, you may require less insulin. If your blood glucose levels
are high, you will need extra insulin. Follow the management plan on PAGE
3

 Do not delay seeking advice: if you are unsure, contact your Diabetes nurse
or, if out-of-hours, Riverbank Ward immediately if you have a problem.

 Monitor blood glucose levels frequently: if you do not have a continuous
glucose monitor, you may need to increase finger-prick testing to 1-2 hourly
during a period of illness to stay safe, even at night.

 Rest: if you have ketones present, activity can make them worse.

 Encourage fluids: ketones and high blood glucose levels can make you thirsty
and at risk of dehydration. Try to drink your usual sized glass of no added sugar
fluid every hour

 Test for ketones: using your blood ketone meter. You need to check for
ketones, especially if your blood glucose level is 14 mmol/l or above.

 The plan on PAGE 3 gives you a guide on management depending on your
glucose level and if ketones are also present. It will tell you when you need to
give extra rapid-acting insulin and how much in a %.

 Know your TOTAL DAILY INSULIN DOSE. This may be near the top of your
clinic letter or it can be calculated by adding up the usual number of insulin units
you have at each meal together with your long acting insulin dose(s). The grid
on PAGE 4 will help you decide how many units extra to give depending if
the advice is 5%, 10% or 20% extra.

 Maintain some intake of carbohydrate containing foods. If you do not
eat/drink carbohydrate you may get starvation ketones with a blood glucose
level that is in the normal range.

What if I don’t feel like eating?
 Try carbohydrate alternatives such as milk, milkshakes, yoghurt, custard, ice
cream, sugar containing ice lollies, fruit juice, fruit smoothies, ordinary cola or other
sugary cold drink, honey, jam or soup.
 Give a bolus of insulin for any carbohydrate you have unless you are hypo. If a
hypo occurs treat as usual and see note below.
 If you really cannot eat, then aim for 10g carbohydrate eg: 90ml Lucozade
Energy, 3 dextrose tablets, or two teaspoons of sugar in a drink every 45
minutes during the day.
 If you are not tolerating food by the evening, then you or your parents need to
monitor you blood glucose levels 2 hourly overnight. If you are unsure,
immediately contact your diabetes team or Riverbank Ward if out-of-hours.

Hypoglycaemia when you are unwell
You must never stop taking your insulin. However, you may need less meal time insulin
and also a reduction in your long acting insulin if the illness is prolonged. Seek advice
from your Paediatric Diabetes Nurse.

Other tips
 Seek advice from you GP if you feel there may be an infection causing the illness
which may need further treatment.
 Use Paracetamol/Ibuprofen for treatment of a high temperature or discomfort.

*IF BG AVOVE 14MMOL/L AND KETONES 3MMOL/L OR HIGHER – HIGH RISK IF DKA – SEEK URGENT MEDICAL ADVICE.

Frequently asked questions
Why are my glucose levels high?
Common reasons for glucose levels to be high are:
 Illness
 Stress
 Taking less insulin or missing insulin
 Eating too much

What will happen if my glucose levels remain high?
If left untreated, high blood glucose levels can make you feel unwell, dehydrated and
may result in DKA (Diabetic Ketoacidosis)

What are the symptoms of DKA?
 Increased thirst
 Passing more urine
 Feeling sick or vomiting
 Feeling tired
 Dryness in mouth and lips
 Drowsiness
 Breathing fast
 Breath smelling of acetone or pear drops
 Severe tummy pain

How do I know it is DKA and not a tummy bug?
With DKA both your blood glucose and ketone levels will be quite high. With a tummy
bug your blood glucose will be normal or low and your blood ketones will be negative or
minimally raised. So monitoring ketones at home will help to determine whether it is DKA
or an infection.

What are ketones?
Ketones are produced in the liver when there is a lack of insulin and your body cannot
use glucose to provide energy. Your body breaks down fat for energy instead and
ketones are produced as part of this process.

What are other causes of raised ketones?
Ketones are also produced during starvation (fasting) or strenuous exercise. In both
these situations the blood glucose is low/normal and not raised.

Contact your Diabetes nurse or, if out of hours, Riverbank Ward immediately if:
 Vomiting persists.
 Blood glucose levels continue to rise and/or
 Blood ketones persist after using management plan on PAGE 3, the young person
is becoming exhausted, confused, is breathing fast, has tummy pain or is
dehydrated.
 Difficulty maintaining blood glucose levels above 4mmol/l.
 You are concerned.

If your symptoms or condition worsens, or if you are concerned about anything,
please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you
and your loved ones. If you have any questions or concerns, please do speak with a
member of staff on the ward or in the relevant department who will do their best to
answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well
and where improvements can be made. There are lots of ways you can share your
experience with us including completing our Friends and Family Test – cards are
available and can be posted on all wards, departments and clinics at our hospitals. We
value your comments and feedback and thank you for taking the time to share this with
us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the
nurse in charge or the department manager in the first instance as they are best placed
to answer any questions or resolve concerns quickly. If the relevant member of staff is
unable to help resolve your concern, you can contact the PALS Team. We offer informal
help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf,
if you feel unable to do so, to resolve your problems and where appropriate refer to
outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate
your concerns. You can make a complaint orally, electronically or in writing and we can
advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please
be aware that you may need to leave a voicemail message, but we aim to return your
call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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