Then there's the Achilles' heel for some kids with diabetes: the stomach bug. It's hard to avoid them, and they always seem to come in seasons. Knowing how to react and when to call for help is a must when dealing with diabetes.

Signs a Bug Is Coming On

Your child has thrown up more than once and, you can tell, is well on her way to a third time. She may begin to spike a fever and looks lethargic and just plain ill. All these are signs that you may be in for a busy day with a stomach bug.

Often, you've heard that there is something going around school, or you know your child was at a birthday party where another child threw up. Don't ignore the signs. It's time to get busy. Stomach bugs can be the ultimate challenge in sick day management, and the sooner you can get ahead of them, the better off you are.

What to Do

First, try to keep your child ingesting at least some carbs on a regular basis. Even if it's just a spoonful of a soda or a sports drink every fifteen minutes, you're giving your child's body something to use with his insulin, and you're fighting to keep him hydrated; these are important goals as you battle this sickness. As a rule, try to get fifteen grams of carbohydrates per hour and up to one cup of fluid per hour into your child.

At the same time, never is it more crucial to check blood sugars and ketones then during a stomach illness. While some people's blood sugars soar, many have low blood sugars during vomiting bouts, particularly if they are on a peaking insulin such as NPH.

It's important to state this as many times as possible: Even if your child's blood sugars are within normal range, check constantly for ketones during a stomach illness. Use a ketone meter. The sooner you can detect ketones in the body, the easier it is to ward them off. Remember, as discussed in Chapter 6, the information gathered from ketone urine strips is at least two hours behind real time. Meters are up-to-the-minute, and your medical team will appreciate that information when you call them. Don't take in-range numbers for granted. Dehydration can cause ketones, and you won't want to wait until it's too late to find that out.

How can you tell if your child is holding anything down when she is throwing up? Generally speaking, if a liquid stays in her body for more than fifteen minutes, she is probably absorbing something. If her blood sugars remain above a number you and your endocrinologist are comfortable with, your child is probably ingesting at least a little bit of something.

As with any child with a stomach bug, stay away from dairy and stick to clear liquids. Some parents find that sugared Jell-O works well; it slides down the throat and into the belly without the child having to drink anything. Others like using a spoon and sugary liquid. It's up to you and your child. Do what works for you, as long as it works.

Time for More Help

If time ticks by and things are not getting better or, even worse, ketones are large and will not clear, it's time to get hands-on help. Sometimes, the only thing that will get a child with diabetes through a stomach bug is an IV with glucose and constant monitoring until ketones are cleared and he is eating and drinking again. If you feel overwhelmed or scared, push for your endocrinologist to have your child seen in the emergency room. It might be a few hours and it might be overnight. But the best thing is it will be a solution.