Paediatric Clinical Guideline

Endocrine 9.6 Diabetes – Sick Day Rules

Short Title: / Diabetes – Sick Day Rules
Full Title: / Guideline for the management of diabetes mellitus during intercurrent illness in children and young people
Date of production/Last revision: / March 2006
Explicit definition of patient group to which it applies: / This guideline applies to all children and young people under the age of 19 years.
Name of contact author / Dr Tabitha Randell, Consultant Paediatrician
Ext: 63328
Revision Date / March 2009
This guideline has been registered with the Trust. However, clinical guidelines are 'guidelines' only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date.

Diabetes – Sick Day Management

NEVER, NEVER OMIT INSULIN!!!!!

Diarrhoea and/or Vomiting

·  Encourage regular small sips of sugar-containing drinks (NOT diet drinks).

·  Monitor blood sugar levels (BSLs) at least 4 hourly, more often if <5 or >15.

·  If not tolerating anything orally and BSLs are <4, advise attend hospital after giving Glucogel (previously known as Hypostop).

·  If then able to tolerate oral intake (including NG fluids) and BSLs >5, can go home. If not tolerating anything orally (including NG fluids) or BSLs still <4, admit for observation and IV glucose if necessary.

·  If poor oral intake and BSLs are in normal/low range, DECREASE normal dose of insulin by 1/3

·  If BSLs are >10, give normal dose of insulin. If BSL are >18, check for ketones and follow rules for other intercurrent illnesses as detailed below.

·  Once oral intake is tolerated again, give NORMAL dose of insulin.

·  NB: If child has been vomiting and not eating, they can have ketonuria with normal BSLs (‘starvation ketones’). These are NOT DKA ketones.

·  If BSLs are >18 and there is ketonuria, treat as detailed below

Other Intercurrent Illnesses

·  Blood sugar levels (BSLs) will usually run high if unwell, even if not eating.

·  Additional insulin is often required to cover high BSLs.

·  If blood sugar level >18, advise to check for urinary or blood (if have Optium meter) ketones.

·  If has short acting insulin available at home (e.g. Novorapid), can give additional doses as follows:

o  If BSL >18 and ketones show ‘small’ or less, give an ADDITIONAL 10% of total daily dose as short acting insulin.

o  If BSL >18 and ketones show ‘moderate’ or more, give an ADDITIONAL 20% of total daily dose as short acting insulin.

·  E.g. If child has 14 u mixed insulin in morning and 8u in evening, total daily dose = 22u. Thus 10% will be 2u of short acting insulin, 20% will be 4u.

·  Recheck BSL 2 hours after additional insulin given – if has not come down, can repeat dose.

IF CHILD HAS BSL >18, KETONURIA AND VOMITING WITH ABDOMINAL PAIN, THEY SHOULD ATTEND THE EMERGENCY DEPARTMENT TO EXCLUDE DKA.

NB THESE RULES REGARDING ADDITIONAL INSULIN FOR HIGH BLOOD SUGARS CAN BE USED AT ALL TIMES, EVEN IF NOT UNWELL.

Title
Diabetes – Sick Day Rules
Guideline Number / Version / Distribution
9.6 / Final / All wards QMC and CHN
Author / Document Derivation
Dr Tabitha Randell
Consultant in Paediatric Endocrinology and Diabetes / Adapted from ISPAD consensus guidelines 2000 and BSPED guidelines
First Issued / Latest Version Date / Review Date
March 2006 / March 2009
Ratified By / Date
Paediatric Clinical Guidelines Meeting / March 2006
Audit / Induction Programme / Amendments

Tabitha Randell Page 1 of 2 March 2006