People with diabetes get sick like anybody else. However, consistently high blood glucose can make it easier to get sick. When there’s glucose to spare, bacteria grow better. Also, the immune system doesn’t work as well to get rid of germs. This is yet another reason why it’s important to maintain target blood glucose levels.

Insulin needs change during illness. Even if you are not eating well, the stress of being sick can increase the need for insulin. You may need more frequent or higher doses of rapid-acting insulin. On the other hand, eating very poorly or vomiting can lower insulin needs. When you are sick, be in close contact with your health care provider to determine how to adjust the insulin.

Blood and urine should be tested more often for ketones when you are sick. This will help determine what amount of insulin should be given.

• Blood glucose should be checked about 4 times per day.
• Urine should be tested often for ketone bodies.
• Blood and urine should be checked more frequently (every 2 hours) if the child is vomiting or has large amounts of ketones in the urine.

Dehydration can easily develop when you are sick. This can interfere with blood glucose control and can lead to ketoacidosis (DKA). If you can eat, you should drink plenty of water or sugar-free drinks that have few calories (soda, powdered lemonade, iced tea, etc.). If you can't eat, have vomiting or diarrhea, or have ketones in your urine, drinks should contain some carbohydrates and calories (regular soda, juice). If vomiting and diarrhea persist, you may need fluids that have both carbohydrate and sodium to replace electrolytes (Sprite or 7-Up, chicken soup, sports drinks, etc.).

Your regular meal plan should be followed as much as possible. Small meals and more frequent snacks may be better tolerated than three meals. Here are some examples of foods that are easier on the stomach and contain 15 grams of carbohydrates.

• ¾ cup (6 fluid oz) ginger ale or cola
• ¼ cup (2 fluid oz) milkshake
• ¼ cup sherbet
• ½ cup ice cream
• ½ cup cooked cereal
• ½ cup sweetened gelatin
• 2 cups broth-based soup
• 1 cup cream-based soup
• 1 slice of toast
• 6 saltines

The American Academy of Pediatrics recommends foods with complex carbohydrates (such as rice, cereal, fruits, and vegetables) and protein (lean meat, yogurt).

It may be helpful to put together a plan for sick days. This plan should include guidelines for:

• When to call the health provider (include phone numbers next to this information)
• Adjusting insulin and the meal plan
• Checking blood glucose and urine