Sick day management in children and adolescents with diabetes

ISPAD Clinical Practice Consensus Guidelines

  1. Lori M. Laffel - Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
  2. Catarina Limbert - NOVA Medical School, CHLC-Hospital Dona Estefania, Lisbon, Portugal
  3. Helen Phelan - John Hunter Children's Hospital, Newcastle, New South Wales, Australia
  4. Anju Virmani - Max, Pentamed & SL Jain Hospitals, Delhi, India
  5. Jamie Wood - University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
  6.  Sabine E. Hofer - Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
Lori M. Laffel, MD, MPH, Pediatric, Adolescent & Young Adult Section, Section on Clinical, Behavioral & Outcomes Research, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215. Email:


  • The tried and true “Back to the Future” approach of frequent monitoring of glucose and ketones, preferably of blood over urine ketones, with timely administration of supplemental insulin along with 24 hour, 7 day a week access to expert health care team advice can successfully manage sick days and prevent progression to diabetic ketoacidosis (DKA) in young persons with insulin-treated diabetes.

  • Use of continuous glucose monitoring (CGM) devices may aid in sick day management; greater penetration of CGMs with use of CGM trend arrows for insulin dose adjustments can reduce glycemic excursions and provide benefit.

  • There are particular clinical situations when ketogenesis can be common, such as in the setting of disordered eating behaviours, use of SGLT1/2 inhibitors, and low carbohydrate diets, when frequent glucose and ketone monitoring along with sick day management are needed to prevent development of DKA.


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