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Illness and Sick Day Rules

Remember, never stop taking your insulin, check blood sugars regularly and test for ketones.

Mild illness

When you are ill your body releases stress hormones which causeyour body to make more sugar even if you are not eating, especially if you have a high temperature. So you may need more insulin than normal even though you might feel like you should use less. This will help prevent ketoacidosis, which can be very serious.

Sugar free paracetamol and ibuprofen are safe to use when someone with diabetes is unwell.

When you are ill you need to:

  • Check your blood sugar levels every 2 - 4 hours
  • Check your blood ketone levels if your blood sugar is above 11mmol/l

  • With blood ketone levels more than 05mmol/l you will need extra fast acting insulin

  • Drink plenty of sugar free fluids to avoid dehydration

  • Try to eat your usual diet

  • If you are unable to eat at all, replace meals with recommended carbohydrate substitutes to avoid hypoglycaemia

  • Contact the diabetes team if you are worried or your blood sugars remain high with ketones. Out of hours, the call is redirected to the hospital switchboard and you should ask to speak to the on call paediatric registrar. Be prepared to tell them your current doses of insulin, blood sugar and blood ketone levels.


See Section 8 of "My diabetes" for more information.   

Recommended carbohydrate substitutes to be given at mealtimes if you are unable to eat

  • Glass of milk

  • Milkshake

  • Drinking chocolate made with milk

  • Fruit smoothie

  • Natural fruit juice

  • Ice cream or ice lollies

  • Fruit

  • Horlicks or Ovaltine made with milk

  • Full sugar yoghurts, puddings or mousse

  • Toast

  • Cereal

  • Full sugar jelly


Follow-up routine

  • Keep in regular contact with the diabetes team or the paediatric registrar via the hospital switchboard (01332 340131).    
  • You will need to do extra blood sugar and ketone monitoring during the night as well as during the day.

  • Maintain hydration with clear fluids eg. water.

  • If there is concern about a child’s condition at any time, he/she should be reviewed in the Children’s Emergency Department.