Pediatric Type 1 Diabetes Sick-Day Insulin and Fluid Guidelines
Green Zone: dosing for TRACE ketones
Blood ketones: 0.1-0.5 mmol/L, Glucose value - mg/dL
Drink sugar-free fluids based on age.
*If glucose is less than 80 mg/dL. drink sugar-containing fluids (15 grams).
Check glucose every 15 minutes until above 80 md/dL.
You can give correction bolus through the pump
Check glucose and ketones 2 hours after treating using the pump. If you don't see improvement give the next correction dose through a pen or syringe and consider a pump site change.
Yellow Zone: dosing for SMALL ketones
Blood ketones: 0.6-0.9 mmol/L, Glucose value - mg/dL
Volume to drink
<80 md/dL: 15 grams with sugar
80-150 md/dL: Based on age*
151-250 md/dL: Based on age*
>250 md/dL: Based on age*
What fluids to drink
<80 md/dL: 15 grams with sugar
80-150 md/dL: Sugar-containing
151-250 md/dL: 1/2 sugar-containing, 1/2 sugar-free
>250 md/dL: Sugar-free
How much insulin to take
<80 md/dL: None
80-150 md/dL: 5% TDD
151-250 md/dL: 10% TDD
>250 md/dL: 10% TDD
When to recheck glucose/ketones
<80 md/dL: 15 minutes
80-150 md/dL: 1 hour**
151-250 md/dL: 2 hours
>250 md/dL: 2 hours
Red Zone: dosing for MODERATE ketones
Blood ketones: 1.0-105 mmol/L, Glucose value - mg/dL
Volume to drink
<80 md/dL: 15 grams with sugar
80-150 md/dL: Based on age*
151-250 md/dL: Based on age*
>250 md/dL: Based on age*
What fluids to drink
<80 md/dL: 15 grams with sugar
80-150 md/dL: Sugar-containing
151-250 md/dL: 1/2 sugar-containing, 1/2 sugar-free
>250 md/dL: Sugar-free
How much insulin to take
<80 md/dL: None
80-150 md/dL: 10% TDD
151-250 md/dL: 15% TDD
>250 md/dL: 15% TDD
When to recheck glucose/ketones
<80 md/dL: 15 minutes
80-150 md/dL: 1 hour**
151-250 md/dL: 2 hours
>250 md/dL: 2 hours
Red Zone: dosing for LARGE ketones
Blood ketones greater than 1.5 mmol/L, Glucose value - mg/dL
Volume to drink
<80 md/dL: 15 grams with sugar
80-150 md/dL: Based on age*
151-250 md/dL: Based on age*
>250 md/dL: Based on age*
What fluids to drink
<80 md/dL: 15 grams with sugar
80-150 md/dL: Sugar-containing
151-250 md/dL: 1/2 sugar-containing, 1/2 sugar-free
>250 md/dL: Sugar-free
How much insulin to take
<80 md/dL: None
80-150 md/dL: 15% TDD
151-250 md/dL: 20% TDD
>250 md/dL: 20% TDD
When to recheck glucose/ketones
<80 md/dL: 15 minutes
80-150 md/dL: 1 hour**
151-250 md/dL: 2 hours
>250 md/dL: 2 hours
* Volume to drink: 1 ounce per year of age, every hour until ketones are negative. For children ages 16 or older, do not exceed 16 ounces.**If glucose value is > 150 mg/dL at the 1-hour glucose check, change fluid type.
