Sick Day Guidelines for Syringe Injections

  • Blood Sugars usually are high during illness, and ketones are usually present. Ketones can be present even if the blood sugar is not high.


    • NEVER stop taking your Lantus or Levemir, even if you can not eat. This is very important because a person needs more insulin on sick days or when ketones are present. Certain hormones released when your child is sick can make it more difficult for insulin to lower his or her blood sugars.

Sick day rules should be followed when a child with diabetes is ill:

  1. Make sure your child takes his/her diabetes medication. Do Not Skip daily insulin doses, unless you health care provider or diabetes educator instructs you differently. Even if you child can not eat his or her usual meals, make sure long-acting insulin is given (Lantus/Levemir).
  2. Check blood sugar (at least every 2-4 hours) and urine for ketones (every time your child goes to the bathroom or at least every 4 hours) when he or she is sick.
  3. Make sure you child drinks plenty of fluids.
  4. A special sick-day meal plan may be followed, which may include liquids that contain sugar. Fluids should be taken every hour.
  5. Exercise is discouraged on sick days.
  6. Please do not use anti-vomiting medicine before you contact our diabetes team.
  7. Call your child's diabetes doctor for any of the following reasons. 
    • Vomiting more than three times in an hour. Make sure you check your child's urine or blood for ketones. Do not use medication to stop vomiting unless told to do so by your child's doctor.
    • If your child has moderate to large ketones with nausea, vomiting, or stomach cramps.


If your child can eat regular meals, then add 1/2 cup of sugar-free and caffeine-free fluids every hour while you are awake, such as:

  1. Broth or bouillon
  2. Unsweetened tea (you can add a sugar substitute such as splenda or another brand)
  3. Sugar-free, caffeine-free sodas
  4. Water

If your child can not eat regular meals, try to get your child to drink fluids that have 15 grams of carbohydrates every hour while awake such as:

  1. 1/2 cup orange juice, apple juice, or regular soda (not diet)
  2. 3/4 cup ginger ale (not diet)
  3. 1 1/2 cup chicken noodle soup
  4. 1/2 cup sherbet
  5. 1/2 cup regular Jell-O (not sugar-free)
  6. 1 cup chilled Gatorade

Call the diabetes office at 205-638-9107 to report blood sugar readings the next business day after your ED visit

***Check your insulin (discard after 30 days of opening) and rotate injection sites***