Sick Day Guidelines

Things to remember:

  • Call before you take your insulin but after you have tested urine for ketones and the blood sugar.
  • You always need to take insulin, but it will probably need to be adjusted.
  • Ketones should be checked as often as 2–4 hours until they are negative.
  • Ketones can be in the urine even if the blood sugar is normal or low.
  • Drink plenty of fluids: Sugar or sugar-free will be determined by the situation.


If you are sick with no ketones:

  • Blood sugars may run above 180mg/dl.
  • Increase insulin or call for an adjustment right away.
  • Do not wait for patterns of high blood sugars before making adjustments.
  • Check for ketones with each blood test even if blood sugar is normal.

Sick with ketones, high blood sugar but can eat:

  • Increase fast acting insulin (Humalog, Novolog or Regular)
  • Eat as tolerated
  • Drink 8 oz. sugar-free fluids each hour until ketones are gone.
  • Call every 2–4 hours until the ketones are gone.

Unable to eat, vomiting and has ketones:

  • If blood sugar is above 160, increase the fast-acting insulin, lower the Nph.
  • If blood sugar is under 160, fast-acting insulin may need to be lowered along with the Nph.
  • Drink small sips of sugared drinks.
  • Give regular Jell-O, popsicles, lollipops, pedialyte products.
  • Call every 2 hours until ketones are gone.

If blood sugar keeps dropping below 70 and your child can’t keep fluids in or is having trouble breathing, you need to go to your local emergency room.

About medications:

  • Steroids cause the need for very large doses of insulin.
  • Anti-histamines take away the symptoms of low blood sugar.
  • Most children’s medications have sugar and so have a warning on the label for children with diabetes, but they can be used.