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Chapter 13: Sick day management in children and adolescents with diabetes

Chapter 13: Sick day management in children and adolescents with diabetes

Lori Laffel, Catarina Limbert, Helen Phelan, Anju Virmani, Jamie Wood and Sabine Hofer


Understanding sick day management for young persons with insulin treated diabetes is important as children and adolescents may experience multiple acute illnesses annually, placing them at risk for diabetic ketoacidosis (DKA). It remains important to frequently monitor glucose and ketones levels during any intercurrent illness and to provide supplemental insulin doses every 2-4 hours along with maintaining hydration status. Provision of sick day education to patients and family members along with availability of 24 hour, 7 day a week access to expert health care team advice can successfully manage sick days and prevent progression to DKA in young persons with insulin-treated diabetes. 

Modern diabetes treatment advances can facilitate sick day management; these advancements include blood ketone monitoring in place of urine ketone checks and use of continuous glucose monitoring (CGM) devices that provide frequent glucose data along with trend arrows that can assist with fine-tuning insulin dose adjustments.

Lastly, there are special clinical situations that place young persons with diabetes at high risk for ketogenesis and progression to DKA, including youth with disordered eating behaviors, use of SGLT1/2 inhibitors, and low carbohydrate diets. In these circumstances, frequent glucose and ketone monitoring along timely implementation of sick day management can prevent progression to DKA.


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