Sick Day Management Guidelines
A sick day is when illness, an injury or infection causes the blood glucose to increase. However, some children can have low
glucose levels with illness when not eating/drinking enough carbs.
Urine ketones should be checked at any time glucose is greater than 350mg/dL of if your child vomits, even if it’s only once.
Urine ketones should be checked if blood sugar is greater than 250 three times in a row (such as before breakfast, lunch and after
school).
Insulin pump users: If your child wakes up with a high glucose levels, please check urine ketones and give a correction of insulin by
injection with an insulin syringe or pen and change the insulin pump site of insertion. You must assume that the insulin pump site is
not working correctly even if it was just changed the night before. Do NOT just give a correction with the pump and send them to
school.
1. Urine Ketones that are LARGE (80-160 on the Ketostix and darker purple in color)
 Give a correction dose of Humalog or Novolog insulin every 1 hour. This insulin dose should be given with an insulin
syringe or insulin pen, not with the insulin pump.
 Check glucose in one hour and again check urine ketones, if urine ketones remain LARGE, give another correction
dose of Humalog or Novolog insulin every 1 hour until the urine ketones are moderate or small.
 Please ask your endocrinologist for your correction factor and target glucose levels.
 To calculate you will need to do the following:
The actual glucose level minus the target glucose = X
Then divide X by your correction factor and this will give you
the total units of insulin to give.
Recheck in 1 hour if glucose is still high and urine ketones are still large, your child would need another injection.
2. Urine Ketones that are MODERATE (40 on the Ketostix and a pinkish purple color) or SMALL (15 on the Ketostix and deep pink
color)
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Give a correction dose of Humalog or Novolog insulin every 2 hours. This insulin dose should be given with an insulin
syringe, insulin pen or the insulin pump.
In 2 hours, please re-check glucose and the urine ketones, if urine ketones remain MODERATE or SMALL, give
another correction dose of Humalog or Novolog insulin every 2 hour until the urine ketones are trace/negative
Please ask your endocrinologist for your correction factor and target glucose levels.
To calculate you will need to do the following:
The actual glucose level minus the target glucose = X
Then divide X by your correction factor and this will give you
the total units of insulin to give.
Recheck in 2 hours if glucose is still high and urine ketones are still moderate, your child would need another injection.
Ketones are formed when the body does not have enough insulin and when the body begins to use fat for energy.
Check urine ketones every time your child urinates while they are sick or have high glucose levels.
Follow the directions on your Ketostix bottle for timing and when to read the ketone level. If the bottle has been opened it will be
good for 6 months and then should be discarded.
GENERAL RULES IN ADDITION TO INSULIN CORRECTION DOSES:
 Your child does not feel like eating however has a high glucose levels, does your child still need Humalog or Novolog insulin
at that time? YES, your child needs a correction dose for having the high glucose level every 3-4 hours if necessary.
o Please ask your endocrinologist for your correction factor and target glucose levels.
o To calculate you will need to do the following:
The actual glucose level minus the target glucose = X
Then divide X by your correction factor and this will give you
the total units of insulin to give.
o If ketones remain negative the insulin can be given every 4 hours. If ketones become large please follow #1 (see
above) or if ketones are moderate please follow #2 (see above).
 Check urine for ketones each time your child urinates
 Drink additional liquids to prevent dehydration, 2-4 ounces every hour of sugar free fluid while blood sugar is still greater than
250.
 GLUCOSE LEVELS 150-250mg/dL: If your child has glucose levels of 150 mg/dL between 250 mg/dl, your child will need to
have food/drink with carbs/sugar (2-4 oz), such as regular Jell-O, sherbet, 7-Up or Ginger Ale that has sugar to increase the
glucose levels so that a correction dose can be given the next time blood sugar is checked. If he/she wants to drink more than
4 oz of fluid, then the remaining fluids for that hour should be sugar free.
 GLUCOSE LEVELS less than 150mg/dL: If child has low glucose levels, less than 150 mg/dl, all fluid for that hour should be
sugar containing fluids.
 Notify your health care provider if your child has persistent moderate or large urine ketones that are not improving.
Take your child to the Emergency Department if your child has the following three combined symptoms:
 Vomiting more than once.
 Moderate or large ketones greater than 6 hours.
 Glucose levels that remain high/elevated for greater than 6 hours