For children, teenagers, families, school staff and diabetes teams
Illness can raise glucose and increase the risk of ketones even when a child is eating less. Schools need a simple route for recognising illness, contacting families and following the clinician-approved sick-day plan.
Quick answer
The instructions differ by diabetes type, insulin regimen, medicines, age and previous history. A plan may include more frequent monitoring, ketone checks, fluids, medication instructions and thresholds for calling the clinical team. It should not be replaced by generic internet advice.
Key points
- Keep written sick-day instructions with the DMMP and ensure staff know where they are.
- Have a clear policy for vomiting, fever, reduced intake, ketones and sending the child home.
- Ensure the child is not left without insulin or monitoring when insulin is prescribed.
Why Type 1 diabetes in young people matters
Children and teenagers need diabetes care that changes with growth, development, activity, illness and family circumstances. A plan that worked last term may need review after puberty, a device change, recurrent glucose events or a change in the student’s independence.
Safety depends on clear instructions and reliable adult backup. General education can explain the principles, but insulin doses, ketone thresholds and sick-day actions must come from the individual’s diabetes team. Patterns should be reviewed clinically rather than copied from another person or adjusted through guesswork.
A practical step-by-step plan
1. Keep written sick-day instructions with the DMMP and ensure staff know where they are
Keep written sick-day instructions with the DMMP and ensure staff know where they are. Use the current written instructions from the diabetes team. The safest action is specific to the child’s treatment, recent patterns and level of independence. A useful check is to ask: What should happen if the child vomits at school?
2. Have a clear policy for vomiting, fever, reduced intake, ketones and sending the child home
Have a clear policy for vomiting, fever, reduced intake, ketones and sending the child home. Make sure the action is possible in the real setting. Staff, supplies, food, water, monitoring and communication all have to be available when needed. A useful check is to ask: When should ketones be checked?
3. Ensure the child is not left without insulin or monitoring when insulin is prescribed
Ensure the child is not left without insulin or monitoring when insulin is prescribed. Record enough information to identify a pattern without turning every reading into a judgement. Context such as illness, activity, meals and timing can matter. A useful check is to ask: Which symptoms require the diabetes team or emergency services?
4. Record readings, ketones, fluids, medicines and symptoms for the family and care team
Record readings, ketones, fluids, medicines and symptoms for the family and care team. Escalate repeated or severe problems for clinical review. General guidance should never be used to improvise an insulin dose or delay urgent care. A useful check is to ask: How will fluids, medication and supervision be provided?
What good support looks like
Good clinical support uses current, individual instructions and reliable adult backup. Families and staff understand common symptoms, know where supplies are and recognise when a recurring pattern needs review by the diabetes team.
Glucose data are treated as information rather than a mark of effort or character. Medication and insulin decisions remain tied to the person’s prescribed plan, especially during illness, growth, puberty or a change in technology.
A real-life test for the plan
Imagine that the circumstances around sick days at school change at short notice. The usual routine is disrupted, a key person is unavailable, a device or supply cannot be used, or the symptoms do not match what was expected. A robust arrangement should still show where the current instructions are kept, who can make the next decision, how essential information will be shared and when professional advice is needed. It should not depend on memory or an improvised treatment change.
Rehearse the plan by asking What should happen if the child vomits at school? and When should ketones be checked? The answers should name a person, place, communication route or decision point. If they only describe what normally happens, add a backup for delays, absences, technology failure and unexpected symptoms. A written fallback does not need to be long, but it should be clear to someone who does not know the usual routine. This short rehearsal often finds practical gaps before they become stressful or unsafe.
Common mistakes to avoid
- Using universal insulin or sick-day rules instead of individual instructions.
- Leaving the student without trained adult backup.
- Making repeated dose changes without reviewing the wider pattern.
- Waiting through vomiting, ketones or altered consciousness instead of escalating.
Questions to discuss
- What should happen if the child vomits at school?
- When should ketones be checked?
- Which symptoms require the diabetes team or emergency services?
- How will fluids, medication and supervision be provided?
Use the latest clinician-approved plan for medication, monitoring, ketones, illness and emergencies, and replace outdated copies when treatment changes.
Frequently asked questions
What should happen if the child vomits at school?
Keep written sick-day instructions with the DMMP and ensure staff know where they are. The answer should be specific to the person and setting rather than copied from a general checklist. Confirm who will act, what information or supplies are needed, and what the backup will be if the usual arrangement fails. Review that answer whenever the circumstances affecting sick days at school change.
When should ketones be checked?
Have a clear policy for vomiting, fever, reduced intake, ketones and sending the child home. The answer should be specific to the person and setting rather than copied from a general checklist. Confirm who will act, what information or supplies are needed, and what the backup will be if the usual arrangement fails. Review that answer whenever the circumstances affecting sick days at school change.
Which symptoms require the diabetes team or emergency services?
Ensure the child is not left without insulin or monitoring when insulin is prescribed. The answer should be specific to the person and setting rather than copied from a general checklist. Confirm who will act, what information or supplies are needed, and what the backup will be if the usual arrangement fails. Review that answer whenever the circumstances affecting sick days at school change.
When to get urgent help
Repeated vomiting, moderate or high ketones, deep or rapid breathing, dehydration, abdominal pain, drowsiness or confusion may indicate ketoacidosis and require urgent assessment.
Do not wait for a routine appointment if there is severe hypoglycaemia, loss of consciousness, a seizure, repeated vomiting, marked dehydration, difficulty breathing, significant ketones, suspected diabetic ketoacidosis or another immediate safety concern. Use the person’s emergency plan and local emergency services.
The bottom line
For sick days at school, clarity matters more than an exhaustive checklist. Keep written sick-day instructions with the DMMP and ensure staff know where they are. A useful next action is straightforward: Have a clear policy for vomiting, fever, reduced intake, ketones and sending the child home. Record anything that still needs clarification. The strongest plan is one that a patient, family member, clinician or staff member can actually follow when the day becomes busy or unexpected.
Related Livingdiabetes guides
- Understanding Type 1 diabetes
- Hypoglycaemia or low blood sugar
- Building diabetes independence and self-management skills
Sources and further reading
This article is for general education. It does not replace an individual diabetes medical management plan, diagnosis or advice from a qualified healthcare professional.