Managing Sick Days and Taking Medications

Contributed by

 Kelly Alladina, RN, BSN, CDE

There is no instruction manual to follow for perfect parenting…a dab of this, a drop of that, a pinch of patience– and you still may end up pulling your hair out! Now add diabetes into the mix and you’ll most likely need to get through a few roadblocks—blood sugar checks, insulin injections, treating lows, dealing with school–it’s a lot to think about!  

We do our best every day to care for ourselves and our children with diabetes.  And while there may be times when blood sugars are very hard to control, it’s important to be equipped with information and supplies when someone with diabetes gets sick. Remember…when you are sick your body is under stress.  It’s very important for you or your child to be receiving enough insulin while you are sick to prevent ketone build-up, and eventually DKA.  Here are some pointers to remember if this ever happens: 

• Always make sure to take your long-acting insulin or keep basal rates running on the pump, even if you are not eating (this background insulin is ALWAYS necessary.) 
• Check the blood sugar every 2-4 hours, or more often if needed (correct any high blood sugars with fast-acting insulin, even if not eating) 

• Check for blood or urine ketones at least every 4 hours 
• Because insulin works to “turn off” ketone production, it is very important that you are getting enough insulin.  It is helpful to have some form of carbohydrate intake during illness (Gatorade, soda, etc.), so that insulin can also be given. 
• In order to prevent dehydration, make sure to drink plenty of fluids and avoid caffeinated drinks. 
• Make sure to contact the doctor with signs of illness, especially if there are moderate or large ketones present.   

Many parents also ask whether over-the-counter medications are safe to administer during illness.  Always consult with your doctor if you are prescribed a new medication, but typically over-the-counter medications are safe to give.  Some medications, such as liquid Tylenol/Motrin or some cough syrups, may contain sugar.  Most of these medications will have less than 5 grams of carbohydrate so they will not affect the blood sugar significantly.  However, in the case that a larger dose of these medications may need to be given, consult your doctor or pharmacist to assist with insulin dosing. As a reminder, be careful with sugar-free medications–some contain sugar alcohols, which can give you bloating and diarrhea (adding to your current problem)! 

Some of the following medications may affect the blood sugar, so be sure to consult with your doctor if any of them are prescribed: 

• Steroids (Orapred, Prednisone)- can increase blood sugar 
• Birth Control- can increase blood sugar 
• Seizure medications- can increase blood sugar 

• ADHD medications- may cause changes in appetite, so may need dosing adjustments 
• Some immunosuppressive medications 
• Some antipsychotic medications 

Hopefully, you will not be using these tips often, but it’s always good to keep these important reminders on hand!