Control over diabetes is possible when parents and children know how to balance Steven, a 7-year-old, has had diabetes for one year, and developed his first …

IN CONTROL - MANAGING SICK DAYS FOR CHILDREN WITH DIABETES

Program developed for the
Nevada Diabetes Association for Children and Adults

Sherrilyn Coffman, DNS, RN
Nevada State College, Henderson, NV

INTRODUCTION 2
WHATS WRONG WITH THIS PICTURE ??? 3
PREVENTATIVE HEALTH CARE 3
SICK DAY SUPPLIES / INFORMATION SHEET 4
DIABETIC SUPPLIES AND MEDICATIONS 4
SICK DAY FOODS 5
WHAT HAPPENS TO THE BODY WITH ILLNESS? 5
ALL ABOUT DIABETES KETOACIDOSIS DKA 6
MONITORING AND RECORDING: 7
WHEN TO CHECK BLOOD AND URINE 7
CONTACTING HEALTH CARE PROVIDERS 7
SICK DAY MONITORING WORKSHEET 8
MANAGING YOUR CHILDS DIET DURING ILLNESS 9
GUIDELINES FOR THE CHILD WITH VOMITING 10
HYPOGLYCEMIA AND THE RULE OF 15 11
OVER THE COUNTER SICK-DAY MEDICATIONS 11
EXAMPLES OF CHANGES IN INSULIN INJECTIONS 13
EXAMPLES OF CHANGES IN INSULIN PUMPS 13
GOLDEN RULES OF SICK DAY CARE 14
WHEN TO SEEK EMERGENCY CARE 14
GENERAL GUIDELINES FOR DIABETES MANAGEMENT AROUND SURGERY 15
MAKING THE MOST OF THE HOSPITAL EXPERIENCE 16
CASE
SCENARIOS-JUST FOR PRACTICE 17
2 CASE SCENARIO: THOMAS, 14 YRS OLD, AFTER SURGERY 18
RESOURCES ON CHILDHOOD DIABETES 19
ANSWERS TO CASE STUDY QUESTIONS 20

INTRODUCTION

Control over diabetes is possible when parents and children know how to
balance insulin with diet and exercise When a child is sick, however,
parents may feel they are losing control Common childhood illnesses such
as vomiting or the flu can result in diabetic ketoacidosis DKA This
serious complication can be life threatening, sending many children to the
hospital DKA is responsible for 85 of hospital admissions in children
with known type 1 diabetes The good news is that DKA is 98 preventable
if parents follow sick day rules

The Golden Rules of Care

This online program will educate parents of children with diabetes about
the Golden Rules of sick day management:

Checking ketones and blood glucose
Insulin dose management
Managing your childs diet during illness
Preventing dehydration and DKA
What medical and nutritional supplies to have on hand
When to call your pediatrician or diabetic care provider
What information to report - preparing a Sick Day Worksheet

WHATS WRONG WITH
THIS PICTURE ???

Our program begins with a case study about Steven and his family
When you read Stevens story, think about whether these events could
happen to you and your family

Steven, Coming Out of the Honeymoon Period

Steven, a 7-year-old, has had diabetes for one year, and developed his
first illness since diagnosis He complained of a severe sore throat and
cough His blood sugars were unstable and had gone up steadily over the
past 24 hours His latest blood sugar reading was 348 The ketone strips
from a year ago have expired, and like so many shoulds in busy lives, new
ketone strips were never purchased Is Steven spilling ketones?
Who knows? It is 2 AM Where would a parent get ketone strips now?
Stevens parents question if the current high blood sugar level of 348
could be from the cough medicine he has been taking It did have sugar in
it
Now, in the middle of the night, Stevens temperature is 1025, his
blood sugar is 348, and he has vomited three times His parents remember
some mention of Sick Day Rules, but have no idea of what to do next
PANIC sets in Hopefully, a relationship has been established
that
supports and encourages Stevens parents to seek help from their health
care system They do call the Nurse Hotline, and are referred to a local
emergency room for IV fluids
Could this scene happen to you? What can you do to prevent it?

PREVENTATIVE HEALTH CARE

The key to preventing illness and DKA is just that: PREVENTION The
list below tells just what each health care provider or testing routine can
do for your child

1 Pediatrician Primary Care Provider:
Checkups every 6-12 months
Include weight, height, blood pressure, sexual maturation
Immunizations
Annual flu shot for all family members

2 Dentist:

Regular dental care

3 Diabetes Care Team: Endocrinologist, nurse practitioner, nurse,
dietitian, social
worker
Clinic visits every 3 - 4 months
Physical exam at least every 3-6 months
Diet education at least every 12 months
Diabetes education every 3-6 months
Insulin adjustments every 3-6 months and as needed
Review child and family mental health at each visit

4 Routine Testing
Glycosylated hemoglobin every 3-6 months
Urine microalbumin test every 12 months after
diabetes for 5 years
duration,
or immediately if adolescent
Eye and visual exam every 12 months after diabetes for 5 years, or
immediately
if adolescent

SICK DAY SUPPLIES / INFORMATION SHEET

Another way to prepare for illness is to have essential information
where you can find it and to stock-up on diabetes and sick day supplies
These charts will give you a head start in your planning and preparation

WHAT HAPPENS TO THE BODY WITH ILLNESS?

Being prepared to deal with illness also includes understanding how
illness affects blood sugar and ketones in type 1 diabetes

Illness Stress on the Body

Body requires more energy to fight infection
More insulin is required to help sugar pass into cells more energy

Hormones are Released to Fight Disease

These are stress hormones epinephrine and steroids

Hormones raise blood sugar levels

More insulin is required to burn this extra sugar

Without Enough Insulin, Sugar Cant be Used for Energy

Sugar sits in blood stream; cant pass into cell
Fats break down as a source of energy
Ketones are a byproduct of fat breakdown
Excessive ketones acidosis
DKA diabetic ketoacidosis

How to Stop Fat Breakdown, Once Ketones are Present

If blood sugar is high, give extra short-acting insulin
If blood sugar is low, first eat raise
blood sugar, then give
insulin
Insulin is required to rid body of excessive ketones

ALL ABOUT DIABETES KETOACIDOSIS DKA

The first goal when dealing with illness is to prevent diabetes
ketoacidosis or DKA Read on to learn about DKA, its causes, signs, and
symptoms

Definition
DKA is a serious condition that can develop in a person with type 1
diabetes when his/her body does not get enough insulin It can often be
prevented by careful management of diet, insulin, and activity during
illness

What happens in the body?
When the body does not have enough insulin to use blood sugar for energy or
when not enough food has been eaten, it breaks down fat for energy As the
fats break down, ketones are released and begin to build up in the blood
and pass into the urine Ketones are toxic byproducts of fat breakdown
Ketones cause the body to have a low pH, resulting in acidosis In an
acidotic state, the bodys machines enzymes can no longer work
effectively If left untreated, death will eventually follow

Causes
1 illness
2 forgetting to take an insulin shot
3 not taking enough insulin
4 insulin pump is not working

Time of onset
hours or days

Blood sugar
usually
high over 240

Urine ketones
usually moderate or large ketones

Blood ketones
1 above 06 indicate fat metabolism is taking place
2 above 30 are consistent with acidosis DKA

Signs and Symptoms
Mild Moderate Severe
mod/lg ketones in urine Mod/lg ketones in urine large ketones in
urine
high blood sugar nausea labored, deep
breathing
blood ketones above 30 vomiting extreme weakness
thirst abdominal pain very tired
frequent urination dry mouth confusion
sweet, fruity breath dry or flushed skin coma

MONITORING AND RECORDING:

WHEN TO CHECK BLOOD AND URINE

More frequent monitoring of glucose and ketones is essential during
illness You will need to report these values to your diabetes provider
when seeking guidance about care With experience, you will be able to use
this information to regulate your childs diet, activity, and insulin

Blood sugars

every 2-4 hours with illness
more frequently may be necessary if supplemental insulin given

Urine ketones

at least 2 times a day with illness every 4 - 6 hours

when blood sugars are over 240 for two tests in a row
after any vomiting or signs of DKA
parent and child should both check
foil-wrapped strips or bottle open less than 6 months

Blood ketones

when blood sugars are over 300 for more than 1 - 2 hours
when blood sugars are over 300 once, for insulin pump patients, when
cause is unexplained
with signs of DKA ex vomiting
every 2 - 4 hours with illness

CONTACTING HEALTH CARE PROVIDERS

How do you decide when to seek help in managing your childs illness?
With type 1 diabetes complicating a childhood illness, you may not be able
to manage alone

CALL THE PEDIATRICIAN:
When urine or blood ketones are negative
1 an illness lasting longer than one day
2 nausea, vomiting, stomach pain
3 persistent diarrhea
4 fever over 101 degrees

CALL THE DIABETES CARE PROVIDER:
When blood sugar or ketone values are abnormal
1 Ketones are present
–Urine ketones are mod/large two tests in a row
Note: DKA occurs within 4 - 12 hours after ketones
appear in urine
The honeymoon period may stop at any time and ketones appear
suddenly with
current illness
–Blood ketones are above normal
06 to 15 may require medical assistance
above 15, at risk for DKA, call immediately
2 Blood sugars are very high or low
— 300 or above 2 or more times
— 50 or below
3 Questions on insulin dosage
–Extra insulin is usually needed, either Humalog, Novolog, or
regular every
2-3 hrs
–Amount of insulin varies, depending on blood sugars and diet
intake
4 Suspect diabetes ketoacidosis DKA
–Vomiting occurs 2 or more times with ketones mod/lg
–Antiemetic isnt controlling vomiting after approx 4 hr
–Child has been unable to drink or eat for approx 6 hours
–Other signs of DKA: trouble breathing, confusion, etc

SICK DAY MONITORING WORKSHEET

Print out this worksheet and use it as a guide for
communicating information to your diabetes provider Additionally, it will
serve as a record of how your child responded during this illness, and will
guide you in managing future illnesses

MANAGING YOUR CHILDS DIET DURING ILLNESS

One of the most important ways to treat an illness is to provide the
right type of fluids and food for your child These choices are based on
the type of illness and your childs blood sugar and ketone readings

Drinking
Liquids is Most Important

WHY:
1 To prevent dehydration
— fluids are lost in urine due to high blood sugar
— fluids are lost by vomiting, diarrhea, fever
2 To wash out ketones
— may be enough to rid body of small ketones
3 To reduce high blood sugar

WHAT:
1 Offer whatever your child likes best
— he/she needs 2-4 cups every 6 hours to prevent dehydration
— Gatorade, Pedialyte replace electrolytes
— orange juice and bananas replace potassium

WHEN:
1 offer sugar-containing liquids when:
— child cant eat solids or is vomiting
— blood sugar is below 180-200
— ketones are present and blood sugar is below 180-200
Note: will raise blood sugar so insulin can be given
and will stop body from breaking down fats
2 offer sugar-free liquids when:
— blood sugar is above 180-200
— extra fluid is needed to flush out ketones/high blood sugar

Offer Solids When Child is Ready
1 child has gone a few hours without
vomiting
2 bland, soft foods are best see Sick Day Worksheet
3 extra snacks may be needed if child not eating well

GUIDELINES FOR THE CHILD WITH VOMITING

Vomiting presents a special problem for the child with diabetes,
because it can be part of an illness that leads to DKA and it can
complicate treatment of any illness Vomiting is also a symptom of DKA, so
in a situation where your child has ketones present and you cannot stop
the vomiting, you should seek medical care right away

Avoid solid foods until the vomiting has stopped

If nausea and vomiting persist, many providers recommend giving an
antiemetic, such as:
Phenergan suppository prescription drug, in older children only;
has a sedative
effect, which can cause difficulty in evaluating signs and
symptoms of DKA
Emetrol prescription drug, oral sugar solution, helps prevent
hypoglycemia
If you do not have medication at home, ask for a prescription at your
clinic visit

Wait to give fluids for 1/2 to1 hour, after the medication is working
Gradually start liquids in small amounts Here are examples of rules
for
deciding the amount:
1 1 ounce of fluid multiplied by your childs weight in pounds
Give this over
about 12 hours Give a little at a time until its gone
2 Give liquids in the amount the child is able to take and keep
down:
1 tablespoon every 5 - 10 minutes
1 ounce 2 TBS every 30 minutes
2 ounces every 30 minutes
4 ounces every hour

Give sugar or sugar-free fluids depending upon the blood sugar level:
1 Above 180 - 200, give sugar-free liquids soda, tea, lemonade,
water, gelatin,
popsickles, broth
2 Below 180 - 200, give sugar containing liquids Gatorade,
Pedialyte, fruit
juices, regular soda pop, Kool-Aid, gelatin, popsickles

If there is no further vomiting, gradually increase the amount of fluid
If vomiting restarts, it may be necessary to rest the stomach for another
hour and then restart with small amounts of fluids A repeat antiemetic
may be given after 3 - 4 hours, as directed by your provider

After a few hours without vomiting, gradually return to a normal diet
Soups are good to start with, and they provide needed nutrients

HYPOGLYCEMIA AND THE RULE OF 15

The Rule of 15 provides guidance about how to deal with low blood
sugars The adult target for blood sugar is 70 Check with your provider
about the target level for your child

If Blood Sugar BS is 70-90 or below:
— treat with 15 grams of carbohydrate in older children
5-10 gms in younger children
— check BS in 15 minutes
— If not above 70-90, repeat treatment and recheck BS in 15 minutes

The following have 15 grams of carbohydrate:
— glucose tablets three 5 gm tablets or four 4 gm tablets
— 4 oz fruit juice
— can regular soda pop
— 6 lifesavers
— 1 tablespoon table sugar or honey
— tube of glucose gel especially good if vomiting

Carry carbohydrate with you at all times for treating hypoglycemia

OVER THE COUNTER SICK-DAY MEDICATIONS

Over the counter medications should be purchased with care Here are
some helpful guidelines:

Look at the label to see if sugar is added
Tablets are less likely to have sugar and alcohol than are liquids
Medicines which raise blood sugar for a short time may require
extra
insulin
Follow the directions on the label for any medicine you use

Over the Counter Medications

Nasal Sprays For colds and allergies, a nasal spray is

Ex: Afrin less likely to affect the entire body than
pills or liquid medicines

Antihistamines If long term use is anticipated, as with
Ex: Chlortrimeton, seasonal allergies, antihistamine tablets
Triaminic or liquids can be tried rather than nasal
sprays

Fever Pain To relieve fever, always use
acetaminophen

Ex: Acetaminophen, or ibuprofen Never give aspirin to a
child Ibuprofen

Anti-Diarrhea Listed drugs can be used with children
Ex: Pepto-Bismol, Kao- Lomotil should not be used with children
pectate, Imodium AD

Antacids All of these antacids are sugar-free
Ex: Di-Gel, Mylanta,
Gelusil, Maalox

Cough Medicines Best to use cough medicines only at night,
Ex: CONTAC Jr, since coughing has a protective function
Robitussin Try
a cold air vaporizer first

Sore Throat Remedies Salt water gargles 1/4 tsp salt per glass of
Ex: Chloraseptic Spray, water may help Rule out strep with a
Cepacol, Cepastat, throat culture
NICE lozenges

EXAMPLES OF CHANGES IN INSULIN INJECTIONS

General guidelines for adjusting subcutaneous insulin doses are
summarized below Check with your childs provider to decide just how much
insulin to give

General Rules for Sick Day Changes in Insulin

1 Extra doses of short acting insulin are usually given in addition
to
the childs usual daily dose
2 Ketones block the normal sensitivity of the body to insulin,
which is
why doses may seem large
3 Each child is different; this is why keeping good records during
illness
is important, so that your care can improve with experience
4 If your child is still having high blood sugar and positive urine
ketones
after giving 3 extra shots, call your diabetes care provider for
help

Changes with High Blood Sugar and Moderate/Large Ketones
1 Give an extra dose of insulin as determined by your
diabetes
clinician
–as Humalog or Novolog insulin every 2 hours
–as regular insulin every 3 hours
–until ketones measure small or less

Changes when Blood Sugar is below 150 and Moderate / Large Ketones
1 Give sugared drinks to bring the blood sugar back up before giving
the next
insulin injection

EXAMPLES OF CHANGES IN INSULIN PUMPS

A properly functioning pump is a good tool for controlling blood
sugar during illness If your child is on an insulin pump and has ketones
present, it is important to rule out pump malfunction You may need to
revert to subcutaneous injections temporarily

General Rules for Sick Day Changes in Insulin
1 If blood sugars are above 250 and ketones are moderate or large,
give insulin
by syringe and contact diabetes provider
2 Continue to give insulin by syringe until the cause of high blood
sugar is
identified and corrected
3 If trouble shooting does not locate the cause of high blood sugar,
replace the
reservoir and change the infusion set immediately
4 Check blood sugar every 1 - 2 hours and continue
to take insulin
until blood
sugar reaches target

Changes Based on Insulin Sensitivity
1 Insulin correction dose for high blood sugars is based on insulin
sensitivity
factor: 10 unit of insulin lowers blood sugar ________
mg/dl
2 Rule for determining insulin sensitivity factor:
_________ 1500_________ BS:________mg/dl
total daily dose of insulin amount
that 10 unit of insulin

will decrease blood sugar

When Ketones are Present
1 A higher temporary basal rate may be needed for ketones and high
blood sugar
2 If moderate or large ketones are present in the urine, insulin
doses that
normally would be used to lower a high blood sugar may
need to be increased
by as much as 50 - 100
3 Check readings every one hour until blood sugar control is
regained

Mealtime Insulin
1 If your child is able to eat regular food, continue to give
mealtime boluses
based on carbohydrate intake
2 If he/she is eating less than usual, boluses should be decreased,
according to

carbohydrate intake

Pump Problems
1 If a pump problem occurs, such as a leak, clog, or displaced
infusion set, or if
the pump is removed, the regular insulin infused from a
pump will be
completely used up by the body in 4 to 6 hours Novolog
or Humalog is gone
from the body in 3 hours
2 Ketosis can occur rapidly The greatest danger is ketosis
occurring overnight

GOLDEN RULES OF SICK DAY CARE

The Golden Rules of sick day care are summarized below

Rule 1: Always check ketones with any illness even if BS is low,
when BS
is above 240-300, and if your child vomits even once

Rule 2: Always give your child some insulin

Rule 3: Your child must drink plenty of fluids to prevent
dehydration and DK

WHEN TO SEEK EMERGENCY CARE

If you are not able to manage your childs illness at home, you may
encounter some of the situations presented below Take your child to the
Emergency Department ED right away

If your child has difficulty breathing or has deep breathing you need
to go to the emergency room right away This usually indicates severe
acidosis DKA

If your
child has signs and symptoms of DKA and you are unable to contact
your health care provider, you should go to urgent care or the ED

If moderate or large ketones are present in the urine, and the treatment
suggested by your diabetes provider is not working, they may suggest you
go to urgent care or the ED

If your child has uncontrollable vomiting, he/she will probably need
intravenous fluids

If there is unusual behavior such as confusion, slurred speech, double
vision, inability to move or talk, or jerking, someone should give sugar
or instant glucose The health care provider should be contacted if a
severe reaction occurs Glucagon is given if the child is unconscious or
a seizure occurs In this case, it may be necessary to call the
paramedics 911 or go to the ED Note that Glucagon may not work if
your child has had extended vomiting or lack of appetite

GENERAL GUIDELINES FOR DIABETES MANAGEMENT AROUND SURGERY

Surgery is a stress to the body, just as illness is Careful
planning and monitoring can prevent complications

If possible, schedule surgery in the morning, so that you have more
time to monitor your child
after surgery

Give your surgeon or dentist the name, address, and telephone of your
diabetes care provider, so that they can discuss the best way to
manage surgery and diabetes care

After you know the time and place of surgery, and whether food intake
will be allowed, call the diabetes care provider to discuss your
childs needs

Plan to take the following supplies with you to the surgery center:
o –Blood glucose meter
o –Urine or blood ketone strips
o –Diabetes providers phone number
o –Glucose tablets, glucose paste, or cake icing
o –Glucagon if needed

Always check the urine ketones before surgery If they are moderate
or large, it may be necessary to cancel the surgery If they are
negative, this will serve as a baseline for any changes after surgery
Always check at least one to two times after surgery

If urine ketones are moderate or large, call your diabetes care
provider

Check your childs blood sugar before and approximately every 2 hours
after the surgery, until your childs food intake and activity return
to normal

MAKING THE
MOST OF THE HOSPITAL EXPERIENCE

Although hospitalization is very stressful, it may also provide an
opportunity for you and your child to review diabetes care and plan for
modifications when you return home

Examine and discuss your childs reasons for being in the hospital

Ask for a nutritional consult with the dietitian to review diet
information

Review sick day management with your diabetes educator and plan how to
deal with future illnesses

Discuss realistic goals for your childs care and expected outcomes of
care, with the endocrinologist

Discuss with provider how to best involve your child in decisions and
choices

Sit down with your child, if appropriate, to review information together

Utilize resources: read books on diabetes, parenting, and childhood
illnesses

Discuss experiences with other parents

CASE SCENARIOS-JUST FOR PRACTICE

Work through the attached case studies to test your knowledge about
sick day management Answers can be found after the Resources section

1 CASE SCENARIO: ROBIN, 10 YEARS OLD, WITH FLU

Although no one else in her family had been sick, Robin complained of
a stomach ache after
supper, and at 7:30 pm, vomited most of her supper
She continued to be nauseated Her temperature was 1002 degrees
Blood sugars: Urine ketones:
5:30 pm: 148
7:00 pm: 180 7:00 pm negative
8:30 pm: 285 9:00 pm small

1 At 9:00 pm, how would you describe Robins status in terms of DKA?
a She is in DKA now
b She is not in DKA, but headed in that direction
c It is inevitable that she will develop DKA

2 At 9:00 pm, Robins temperature was 1013 What medication should her
parents give her at this time?
__________________________________________________________

3 How should she manage her food and fluid intake at this time?
__________________

________________________________________________________________________

4 How frequently should they continue to check her BS and urine ketones?

BS__________________________ Urine Ketones______________________________

Robins usual insulin injections were as follows:
7 am: 30 u NPH and 10 u Humalog
5:30 pm: 6 u Regular
9 pm: 20 u NPH

5 Robin gave her 20 u NPH insulin dose at 9 pm At 11:00 pm her urine
ketones were moderate
and her blood sugar was 400 Should Robins parent
give her an extra dose of insulin at 11:00 pm? ____________If so, what
type?_________________________

6 When should her parents call the diabetic care provider, and what
should they report?

7 At 1 am, Robins blood sugar was 300 and ketones were moderate What
should they
do?____________________________________________________________________

2 CASE SCENARIO: THOMAS, 14 YRS OLD, AFTER SURGERY

About six months after starting on the insulin pump, Thomas was told
that he had to get all four of his wisdom teeth removed He worried that
he would be unable to eat after dental surgery, and wondered if he should
take his insulin on the day of surgery

1 What effect is surgery likely to have on Thomass blood sugar levels?
a no effect
b decrease blood sugars
c increase blood sugars

Both Thomas and his mother called the diabetes clinician She told
them that the stress of surgery could make his blood sugars go up She
recommended setting his basal rate slightly higher than usual On the
morning of surgery, Thomas checked his blood sugar and urine ketones before
going to the dentists office The
ketones were negative

2 Why should Thomas check both BS and ketones before
surgery?_________________
_______________________________________________________________________

3 What diabetic supplies should he take to the
office?____________________________
________________________________________________________________________

Just before the surgery began, Thomas set his basal rate at unit
higher than usual The procedure went smoothly, and Thomas went home with
a sore mouth and a prescription for pain medicine

4 If the pain medicine is in pill form, is it likely to contain too much
sugar or alcohol?
a yes b no

5 What type of diet should Thomas eat on the afternoon of
surgery?________________
_______________________________________________________________________

6 Should Thomas take mealtime/ snack boluses?
a yes b no

7 How often should Thomas check his blood
sugar?_____________________________

8 Who should call the diabetic clinician with a progress report?
a Thomas b His mother

RESOURCES ON CHILDHOOD DIABETES

The following resources include information on sick day management

BOOKS:
An
Instructional Aid on Insulin-Dependent Diabetes Mellitus, 1999, by
Luther Travis, Designers Ink, 2210 Denton Dr 104, Austin, TX 78758

Caring for Young Children Living with Diabetes Parent Manual, 2002, by M
Lawlor, L Laffel, B Anderson, and A Bertorelli Joslin Diabetes Center,
Boston, MA

Diabetes 101, 1998, by Betty Brackenridge and Richard Dolinar, John Wiley
and Sons, Inc

Diabetes Care for Babies, Toddlers, and Preschoolers, 1999, by Jean
Betschart, Chronimed Publishing

Outsmarting Diabetes: A Dynamic Approach for Reducing the Effects of
Insulin-Dependent Diabetes, 1994, by Richard Beaser and staff at Joslin
Diabetes Center, Chronimed Publishing

Pumping Insulin, 2000, by John Walsh Ruth Roberts, Torrey Pines Press,
San Diego, CA

Understanding Insulin Dependent Diabetes, 10th Ed Pink Panther Book,
2002, by H Peter Chase, Childrens Diabetes Foundation at Denver

WEB SITES:
American Diabetes Association http://wwwdiabetesorg

Children with Diabetes http://wwwchildrenwithdiabetescom

Juvenile Diabetes Research Foundation International http://wwwjdrforg

National Institute of Diabetes and Digestive and Kidney Diseases NIDDK
http://niddknihgov

Nevada Diabetes Association
for Children and Adults http://diabetesnvorg

QUESTIONS ABOUT THIS EDUCATIONAL PROGRAM:
If you have questions or suggestions about ways to improve this online
program, please e-mail the author, Sherrilyn Coffman, at
sherrilyn_coffman@nscnevadaedu

ANSWERS TO CASE STUDY QUESTIONS

1 Robin, 10 years old, with Flu
Question 1 answer b
Question 2 First give acetaminophen Tylenol to bring Robins fever
down Note, never give aspirin to a child with suspected viral illness
Question 3 Encourage sugar-free liquids in an amount that she can keep
down
Question 4 Check blood sugar BS at least every 2 hours Check urine
ketones every void
Question 5 Yes, an extra dose of short-acting insulin is probably
necessary to eliminate ketones and lower blood sugar
Question 6 Call the diabetes provider now at 11 pm if parents are
unsure how much insulin to give
Question 7 Another dose of short-acting insulin at 1 am is probably
necessary

2 Thomas, 14 years old, after Surgery
Question 1 answer c
Question 2 Check BS and ketones before surgery as a baseline measure If
ketones are positive, the surgery may need to be cancelled
Question 3 Take blood glucose meter and strips, ketone strips,
glucose
paste, glucagon, and phone number of diabetes provider
Question 4 answer b
Question 5 Soup, liquids, or soft foods, in the place of his usual meal
Question 6 answer a
Question 7 Check blood sugar at least every 2 hours
Question 8 answer a or b your call If Thomas calls the diabetes
provider, his mother should be aware and involved in any changes in care
———————–

Source:diabetesnv.org

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