My son had a bad virus and was not eating properly. His blood sugar was below 75 mg/dl [4.2 mmol/L]. Since he wasn’t eating much, I decided not to inject him with his insulin. When I told the doctor what I had decided, he said that I had not done the proper thing, that whether my son is sick or not, he needs his insulin. Is this true?

Your instincts were very well-intentioned and, given the day-to-day balancing of diabetes management, it does make a certain amount of sense to HOLD an insulin dose when the child is not eating and the glucose levels are lower, for fear of leading to hypoglycemia. But, believe it or not, your insulin requirements are at least the same, if not more, when you are ill! But, the effects on blood glucose might vary because of the various “stress hormones” (examples: hydrocortisone and epinephrine) which not only typically raise the glucose, but can also impact how well the insulin works.

So, on sick days, please do not withhold insulin. THE DOSE MIGHT NEED TO BE ADJUSTED DOWNWARD, but some insulin is typically still required. If you are not comfortable with adjustments on sick days, then you should be able to confer with your diabetes team.

Remember to check the glucose often and to check for ketones often during sick days with type 1 diabetes.

DS

[Editor’s comment: See also Sick Days on our web site.

BH]