7 Tips for T1D Cold and Flu


The Sound of Mucus

Tissues on tables and temperatures rising.

Cold, flu, I don’t know. My wits are capsizing.

Blood sugar battles and ketones they bring.

These are a few of my least favorite things.

By Erin and Alese

Sniff. Cough. Suddenly my kids are velcroed to my side and their foreheads could fry eggs. Sigh. Here we go again. Dealing with sickness and type 1 diabetes at the same time is tricky. From our experiences with T1D since 2013, here are a few of our favorite things that help us when the flu bites, when a cold strikes. Please note that this is not to be taken as medical advice. If you or your child have type 1 diabetes and you are dealing with sickness of any kind, follow your doctor’s guidance.

1. Sick Day Plan

If this is your first time with sickness and type 1 diabetes, call your endocrinologist for a sick day plan. Or even if it is your 100th time and you need some advice, call your endocrinologist. Keep that number saved in your phone and know how to reach your on-call endocrinologist for those late night questions. In our house sickness likes to strike at 3 A.M. on a Saturday on a long holiday weekend. Having that on-call number handy is a huge relief in the wee hours of the night when I know I won’t be able to reach our regular endocrinologist or even our pediatrician for a few days.

As of this post we are 8 years into this T1D diagnosis. I still refer to the sick day guidelines in the booklet we received at Grasshopper’s diagnosis. Our endocrinologist’s sick day plan includes instructions on how often to hydrate, how often to check blood sugar and ketones, suggestions on what to drink, and how to handle his insulin needs.

If you don’t have a written sick day plan, ask your endocrinologist for one.

2. Hydrate


When you have sick kids, keeping them hydrated is important. It is especially important when dealing with sickness + type 1 diabetes because dehydration increase the risk of developing diabetic ketoacidosis (DKA). But kids get bored and don’t want to drink as much water as they need. So we play! During one sick day we watched the NOVA l PBS Special, “Kīlauea: Hawaiʻi on Fire.”  Naturally we chose LAVA as our game word. Time to take a drink of water!

In addition to making drinking water more fun by making it a game, we offer multiple kinds of beverages on sick days. I originally wrote this list of drink options for my post about summer and T1D, but I have added it here with a few extras.

If you are trying to avoid artificial sweeteners and dyes, here are some beverages to try:

  • Add a slice or two of lemon, lime, or your favorite fruit to your water for a hint of flavor.
  • Plain hot chicken broth or vegetable broth.
  • Spindrift is unsweetened carbonated water with a hint of flavor from real juices. There are 8 flavors with between 0-3 grams of carbs.
  • Zevia soda is carbonated, sweetened with Stevia and available in 14 zero carb flavors including fruit flavors, cola, caffeinated and non-caffinated.
  • Hint is water with a hint of flavor in over 15 zero carb flavors.
  • La Croix is carbonated water with a bit of flavor in 20 varieties, all at zero carbs per can.
  • Celestial Seasonings herbal teas make great zero carb iced tea for the summer.
  • Stur liquid water enhancing drops and powders are sweetened with stevia, use organic flavorings and colorings, and have between 1-5 grams of carbs per serving.

Other drinks we use which DO have artificial sweeteners and colors include:

  • Pedialyte comes in many flavors and contains electrolytes. Pedialyte freezer pops are also an option.
  • Gatorade Zero is a carb free version that is a favorite at our house.
  • Sparkling Ice is a carbonated, fruit flavored soda sweetened with sucralose in 16 varieties, all at zero carbs.
  • Crystal Light is a well known zero carb powdered drink option sweetened with aspartame which comes in many flavors.
  • Crystal Light Pure comes in five flavors, is sweetened with Truvia and sugar and is 1 gram of carb per serving. There are 2 servings per packet.
  • Sprite Zero has zero carbs, a classic lemon-lime flavor and is sweetened with aspartame.
  • Mio liquid water enhancing drops feature 10 original flavors, all zero carbs and sweetened with sucralose.
  • Koolaid makes a water enhancing drop in 7 flavors, sweetened with sucralose and zero carbs.
  • Dasani drops are sweetened with sucralose, and come in 6 zero carb flavors.

The list above focuses on low carb or zero carb drinks. Sometimes when Grasshopper is sick and we need to get his ketones down we will focus instead on drinks WITH carbs so we can give him some insulin to help bring down the ketones. In that case we offer full sugar sodas, regular Gatorade, full sugar popsicles and the like.

3. Treat the symptoms

In addition to all the hydration, we have some other tools we use to relieve Grasshopper’s flu and cold symptoms.

  • Fever
    • We use fever reducers like acetaminophen (Tylenol) and ibuprofen (Motrin).
    • Tepid baths help to bring down fevers as well, and often help soothe bored kids who are sick and tired of  being sick and tired.
  • Congestion
    • We use some over-the-counter remedies to help thin congestion, but we also use a humidifier at night.
    • During the day nasal saline helps, as well as steamy bathrooms.
    • Vicks Vapo-Rub is another tried and true help for congestion in our house. Here we put a dab on a washcloth, fold it up, pin it together, and put it on a pillow at bedtime.
    • Hydrate, hydrate, hydrate.
  • Fatigue
    • Rest is best! (Daniel Tiger is right.)
    • It can be hard to get children to rest, even when they are sick. Here sick days mean movies, watching favorite tv shows, and reading together. 

4. Medications

Before taking over the counter (OTC) medications to relieve sickness symptoms, check with your primary care doctor and endocrinologist.

OTC medicines are considered supplements instead of food, so manufacturers are not required to print nutrition fact labels on their packages. This makes it difficult to know if a dose of cough syrup contains zero grams of carbs or 15 grams of carbs. When we are already having trouble keeping Grasshopper’s blood sugar down because of illness, adding 5, 10, or 15 grams of fast acting carbs in the form of a cough and cold syrup can make his blood sugar go sky high.

We have found that some OTC medicines raise Grasshopper’s blood sugar and others have no effect. We read the ingredients on the medicines to determine whether or not we will dose for a few grams of carbs or not. We have also called manufacturer’s phone numbers listed on packages and asked for carbohydrate information.

Our family doesn’t eat a ketogenic diet, but this handy list of ingredients often found in OTC medicines helps us determine carbs in medicines. The ketogenic diet was originally developed to help people with seizures.

From “Medication Management on the Ketogenic Diet” by Jeff Curless, Pharm.D.

Also this chart helps us navigate whether or not to dose for medicines. LUCILE SALTER PACKARD CHILDREN’S HOSPITAL AT STANFORD

5. Insulin

Often when Grasshopper is sick he needs more insulin than usual. Stubborn high blood sugar is sometimes our first indication that his body is fighting an infection. In that case we increase his basal rate and bolus for high blood sugar until we can get his blood sugar back in range. However, if he isn’t eating due to not feeling well, his blood sugar might go low. Ask your endocrinologist for guidance with sick day insulin dosages.

This article from Beyond Type 1 gives additional advice on Cold and Flu and What To Do.

6. Ketones

When Grasshopper is sick we have to be especially vigilant of ketones. Ketones develop as a result of the body not having enough insulin. Without insulin to allow glucose to enter cells, the body turns to its own muscle and fat for energy. When these are broken down as fuel sources, ketones build up in the blood as a byproduct. Diabetic ketoacidosis (DKA) is often seen in conjunction with high blood sugar, but it can develop with blood sugar that is in range or low as well.

Sick days call for more frequent ketone checks, no matter what Grasshopper’s blood sugar is. Whether we are using urine ketone sticks or a blood ketone meter, it important for us to keep track of Grasshopper’s ketone levels so that we know if we need to give him more water and insulin to flush it out of his system.

Urine ketone sticks are fairly inexpensive and available at most pharmacies over the counter. However, it is important to know that the ketone level in urine is old information. Ketone urine readings are a few hours behind what is happening in the blood. It can be difficult to match the color on the ketone stick to the chart, so readings can be vague.

Blood ketone meters are more expensive, as are the test strips used in them. They work the same way that glucose meters do. The user inserts a test strip in the meter, uses a lancet to draw a drop of blood, and applies the blood to the test strip. The meter shows the blood ketone level as a number. Blood ketone meters provide more accurate and timely information compared to urine ketone sticks.

This article from DiaTribe discusses ketones and Ketosis vs. Ketoacidosis.

7. Know When to Fold ‘Em

We don’t look forward to going to the hospital for illnesses. Of course not, who does? But we know from our personal experience that sometimes it is necessary for a person with type 1 diabetes fighting a common virus, bacterial infection, stomach bug, influenza, or even a cold, to get help at a hospital. Many can recover at home with some TLC, but we know that T1D throws a big wrench in the works.

When Grasshopper was sick for the first time after his type 1 diabetes diagnosis, we managed as best we could at home with his sick day plan, hydration, OTC medications, and monitoring blood sugar and ketones. But after a while he refused to eat or drink. He was only two years old. We couldn’t get any carbs in him or any fluid to replace what he was losing. We couldn’t keep his blood sugar up, and we couldn’t get his ketones down. We consulted with our endocrinologist and took Grasshopper to our local ER for IV fluids.

This was our first experience with T1D at an ER. If at all possible it will be our last. Emergency Room doctors and nurses do what they do well. They provide needed emergency care. However, they tend to be unfamiliar with how to treat type 1 diabetes and especially pediatric type 1 diabetes.

Mr. Mister has a way with analogies. It is one of the many things I love about him. “Going to your average local ER with type 1 diabetes is like taking a Lamborghini for a tuneup at a Chevy dealership. Sure they might figure out how to change the oil but will they use the right kind? They are a Chevy dealership and can handle 90% of the cars out there but NOT all.”

My point is if you do need to go to the ER, go with the knowledge that you need to advocate for yourself and your loved one. Do not expect to be able to hand over care of your loved one’s type 1 diabetes needs. Bring your own insulin and supplies. Bring your own low blood sugar supplies. Call your endocrinologist. This is yet another reason to have your endocrinologist‘s after hours phone number handy. Let them know you are going to the ER and why. Ask their advice. Have your endocrinologist speak to the ER doctor.

This is what has served our family well so far over the years. Tell us about your experience with T1D, colds and flu. What works best for your family?