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.