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Type 1 diabetes sick-day management — DCH MCQ

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HardChronic conditionsType 1 diabetes sick-day managementDCH

The parents of a 12-year-old with type 1 diabetes managed with multiple daily insulin injections telephone his paediatric diabetes team. He has had one episode of vomiting during an intercurrent illness. His blood glucose is 17 mmol/L and blood ketones are 1.2 mmol/L. He is alert, breathing normally, not clinically dehydrated and can retain small amounts of fluid. The family has his individual written sick-day plan. What is the best immediate advice?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Continue basal insulin, give the additional rapid-acting ketone or correction dose specified in his sick-day plan, offer sugar-free fluids and repeat glucose and ketones in 2 hours

The correct answer is A. Glucose of 17 mmol/L with ketones of 1.2 mmol/L indicates hyperglycaemia with moderate ketonaemia, suggesting relative insulin deficiency despite the child currently lacking features of established DKA. Basal insulin must never be stopped. The family should use the child’s individual sick-day plan to administer additional rapid-acting insulin, encourage sugar-free fluids while glucose is high, and repeat both glucose and blood ketones after about 2 hours. Withholding correction insulin, as in A, risks rising ketones. Sugary drinks are generally reserved for low or falling glucose or inability to take carbohydrate, so B is inappropriate here. Stopping basal insulin in D can precipitate DKA. Ketones below 1.5 mmol/L are not insignificant, making E unsafe. Persistent vomiting, inability to retain fluids, increasing ketones, dehydration, drowsiness or laboured breathing requires urgent reassessment.

Reference: Royal United Hospitals Bath NHS Foundation Trust. Sick day management for children and young people with Type 1 diabetes. March 2023. https://www.ruh.nhs.uk/patients/services/clinical_depts/paediatrics/paediatric_diabetes/documents/patient_info/Sick_Day_Management.pdf