If my son were ever to need to have emergency surgery i.e., appendectomy, what do I need to know about how his blood sugar would need to be managed?

Great question. The answer really depends on how his insulin is typically delivered. If he were on multiple daily injections of insulin, I would suggest leaving him on his typical Lantus (or other long acting insulin) dose. I would use Humalog/NovoLog/Apidra (fast acting insulins) for high blood sugars — or to cover carbohydrate intake only. You should already have a scale that your diabetes team has given you for treatment of high blood sugars (for example, 1 unit for each 50 mg/dl [2.8 mmol/L] greater than 150 mg/dl [8.3 mmol/L]). He will need much more frequent testing during any illness — I usually recommend testing every two to three hours during illness. He also should have urine ketone testing with every void for the duration of his illness with a prompt response to any ketones present in his urine. The hospital team that is taking care of him should consult with a member of his diabetes team for advice on how to manage diabetes through an illness. If your son were on an insulin pump, I would recommend the same advice, but he also should remain on his insulin pump on his typical basal rate making minor modifications, if necessary. Kids need insulin throughout the duration of illness. You should also review a standard approach to sick day management for more details about how to handle diabetes through an illness. A great review can be found in Understanding Diabetes, 11th Edition, Chapter 16.

MSB