Sick Day Guidelines

Lainey started throwing up tonight. Isn't that wonderful? My life is so good right now.

While on the phone with my dad tonight, he asked what we did when Lainey was sick. I did not explain it well, so I told him I'd blog about it.

The Basics:

• check sugar every hour
• check ketones every time child urinates
• drink at least 4 oz of water every 3 hours
• keep sugars in the 150-250 range

Ketones are acids that build up in the blood and appear in the urine when your body doesn't have enough insulin. Ketones can poison the body. They are a warning sign that you are getting sick. Ketones can be measured in the urine with a visually read strip, and in the blood by using the Precision Xtra® meter. (Although measuring ketones in blood are more accurate than in urine, it's way cheaper. The Precision meter costs $65, but the strips run $3.75 a piece; whereas the urine strips cost $.40 a piece.)

Situations Where You Could Have Ketones

High blood glucose: High blood glucose means you don't have enough insulin to allow the glucose to get into the cells, so the glucose is piling up in the blood and/or being excreted in the urine. Your body needs insulin to use glucose for energy. So if you don't have enough insulin, your body will start to burn fat for energy.

Illness/stress: When you are under physical or emotional stress, your body needs extra energy to fight it. Hormones are triggered, which tell the body to release stored glucose in an attempt to give you more energy. If you don't have enough insulin to help this glucose get into your cells, your body will again burn fat for energy.

When ketones are a concern with high blood glucose:

If you don't have enough insulin available in your body, and the blood glucose rises, your body will eliminate the glucose by passing it into your urine. As your body takes fluid from everywhere it can to help dilute the urine and pass the sugar out, you'll get dehydrated. Because the glucose is passing out through the urine, the body is starving and fat will burn. If the body burns too much fat too quickly, ketones will accumulate in your bloodstream. Ketones make your body too acidic, which will upset the body's chemical balance. Your body might not be able to excrete the ketones adequately. In this setting, if your glucose is high, you are dehydrated, and your ketones are large, then your body's chemical balance is disrupted and you could develop a life-threatening condition called ketoacidosis.

Here are three basic reasons for moderate or large amounts of ketones:

1. Not getting enough insulin. Maybe you did not inject enough insulin. Or your body could need more insulin than usual because of illness. If there is not enough insulin, your body begins to break down body fat for energy.
2. Not enough food. When people are sick, they often do not feel like eating. Then, high ketones may result. High ketones may also occur when someone misses a meal.
3. An insulin reaction (low blood glucose). When blood glucose levels fall too low, the body must use fat to get energy. If testing shows high ketones in the morning, the person may have had an insulin reaction while asleep.

When Lainey has ketones we follow the ketone correction factor, not the glucose correction factor stored in her pump.

• Small Ketones (0.6-.09 blood ketones): give 3/4 units of insulin every 3 hours.
• Moderate Ketones (0.9-1.5): give 1 unit of insulin every 2-3 hours.
• Large Ketones (1.5-2.5): give 1 1/4-1 1/2 units of insulin every 2-3 hours.
  

It is the hardest thing to get your sick child to eat, but if they're a sick diabetic it's crucial. If they have ketones, you need to give them insulin, which drops their blood sugar. But if their BG is below 150 you need to give them something to eat to bring it back up.

And that, Dad, was what I was trying to explain to you.