sick day managment in diabetic children and adolescent

SICK DAY MANAGEMENT IN DIABETIC CHILDREN…keeping your patient out of the hospital.

Dr M.I.BEG

Paediatrician

QGH.

What are “sick days”?

“Sick Days”

High BG with Ketones.

Infections

Medical emergencies

Elective and Emergency

Surgeries/Accidents

Medication side effects

Any interruption of insulin

Impact of sick days on my child diabetes?

High Or Low

sugar?

Varying insulin requirement during sick days

Increase counter-regulatory hormones

Peripheral insulin resistance

Reduced oral carbohydrate intake

CONSEQUENCES• HYPOGLYCEMIA

• HYPERGLYCEMIA

• HYPERGLYCEMIA+KETOSIS= DKA

• KETOSIS ,INDEPENDENT OF HYPERGLYCEMIA

Sick day rules

How can I help my

child

Get organised,know “the rules”

Diabetic“sick days” rules

1.Prevent dehydartion

2.Continue feeding

3.Treat nausea

4.Rest & avoid exertion

5.Frequent BS monitoring

6.Check ketones

7. Give schedule insulin

8. Extra insulin as needed

9.Know when to call doctor

Rule1……Prevent dehydartion* water is best

S * sugar free popsiclles/jello

*diet soft drinks

* low carb sport drinks Small sips: YES Big gulp:NO

RULE 2…..Continue feeding

You need energy to fight back

“a carb is a carb is a carb”

liquid carb can be traded for solid carb

if BS <100 offer sugary drinks and food

Rule 3…Treat nausea

• Ondasetron(Zofran)

• Promethazine(Phenargan)

• Prochlorperazine(Compazine)

Rule 4….Rest & Avoid exertion

Exercise is a stress too

Rule 5….Frequent BS monitoring

How frequent?

“Any BS monitoring is betterthan no monitoring”

At laest 3-4 hrly including through the night(sometimes 1-2 hrly)

Rule 6…check ketonesHow frequent?

4-6 hrly/after each void.

How do I measure ketone?

Which method is best?

urine dipstick

50 strips $10.86

Ff Fingerstick method

meter $68.08

10 ketone strips $51.84

When should I be concerned?

concerned very concerned

When should I be concerned?

Rule 7…Never stop Insulin

• Give schedule Insulin if oral intake is sufficient and BS is not low.

• Reduce insulin dose if oral carb intake not sufficient and BS not high.

Reduce daily dose of NPH by30-50%

Basal Insulin dose(Long acting/insulin pump) need no change.

Rule 8…Give extra insulin as needed

• Elevated BS(>250) with –ve/small ketones

5-10% of TDD(0.05-0.1 u/kg) as short/rapid acting insulin,repeated q2-4 hrly.

• Elevated BS(>250) with mod-

large ketones

10-20% of TDD(0.1-0.2 u/kg)

as sort/rapid acting insulin.

repeated q2-4 hrly acc to BS

response and clinical condition

“ Don’t rely entirely on urine ketone”

Rule 9…Know when to consult Doctor

Uncontrolled vomiting

Fast breathing Drowsiness/poor concentration BS and/or Ketone continue rising

despite extra insulin Child is just not “looking right”

Help, Doc!

References

• Special situations in children and adolescent in type 1 dibetes mellitus.UP-TO-DATE july 2014.

• ISPAD:Clinical Practice guidelines 2014.

• Silverstern et al :Care of children and adolesceny with T1DM:A statement of the American Diabetes Association 2005:28:186.

Diabetic“sick days” rules

1.Prevent dehydartion

2.Continue feeding

3.Treat nausea

4.Rest & avoid exertion

5.Frequent BS monitoring

6.Check ketones

7. Give schedule insulin

8. Extra insulin as needed

9.Know when to call doctor

Thanks for your

kind attention