SICK DAY MANAGEMENT IN DIABETIC CHILDREN…keeping your patient out of the hospital. Dr M.I.BEG Paediatrician QGH.
Jul 15, 2015
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