[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Paediatric nursing](https://durgical.com/en/nursing/areas/pediatric/) › The child with type 1 diabetes: glucose checks, insulin teaching, hypoglycaemia, sick days and school # The child with type 1 diabetes: glucose checks, insulin teaching, hypoglycaemia, sick days and school - Safe practice The nurse teaches the family to check glucose and ketones, give insulin safely, treat lows, manage sick days and share a care plan with the school. Updated Nov 13, 2026 ## Key points - Never stop insulin completely during an illness (ISPAD sick-day rule). - Vomiting in a child with diabetes means insulin deficiency and ketosis until proven otherwise; blood ketones are preferred to urine ketones. - Low glucose signs: shaking, sweating, fast heartbeat, irritability, confusion, hunger; severe: abnormal behaviour, seizures, fainting. - Treat a low with fast-acting sugar in the amount the child's plan sets, recheck after 15 minutes and repeat if still low. - Every school needs the child's diabetes management plan, trained staff and a supply box with fast sugar and the emergency medicine. ## What it is A child with type 1 diabetes needs insulin every day for life. The family, and later the child, does most of the care, so nursing work is mostly teaching and checking skills: glucose and ketone checks, insulin technique, recognising and treating hypoglycaemia, sick-day rules, and a written plan for school. Doses are set by the diabetes team; the nurse checks, administers and teaches according to the prescription and the protocol. ## What it requires - Capillary glucose and ketone checks at the times and targets the diabetes team sets. - Insulin given exactly as prescribed, by pen, syringe or pump, per protocol. - Sick-day plan taught at diagnosis and reviewed at least once a year. - Emotional support: watch for diabetes distress, especially in adolescence. ## How it is applied (and why) - Check glucose (and ketones when indicated) before giving insulin and record it — the dose follows the reading and the plan. - Check the insulin type, the label and the expiry date; roll cloudy insulin gently, do not shake — the check prevents giving the wrong insulin. - Rotate injection sites and keep a log; avoid bruised, lumpy or scarred skin — rotation prevents lumps that slow absorption. - Teach the signs of a low and how to treat it with fast sugar, then a snack — families must act before the child is confused. - For a severe low or unconsciousness: nothing by mouth, emergency medicine as prescribed, call for help — swallowing is not safe. - Teach sick-day rules: keep insulin, check glucose and ketones often, keep fluids going — illness raises the risk of ketoacidosis. - Teach when to seek urgent care: vomiting, rising ketones, deep fast breathing, abdominal pain, drowsiness — DKA can develop fast. - Help prepare the written school plan and check who is trained there — staff need it to recognise and treat lows. - Teach safe sharps disposal and insulin storage (never frozen, not left in a hot car) — this protects others and the insulin. ## In nursing practice - Gastroenteritis is the most common cause of low glucose during sick days. - Seek urgent review if vomiting persists beyond 2 hours (especially in young children) or glucose cannot be kept up. - Insulin needs often rise in puberty, and low glucose can happen at night or after an active day. - Children want to manage more of their own care as they grow; hand over gradually, with supervision. ## Common mistakes - Telling the family to skip insulin because the child is not eating. - Giving food or drink by mouth to a child who is drowsy or unconscious from a low. - Using only urine ketones when blood ketone testing is available. - Leaving the school without a plan, trained staff or supplies. ## Test yourself Think of the answer, then tap the question to see it. ## What is the most important sick-day rule in type 1 diabetes? Never stop insulin completely; check glucose and ketones often and keep up fluids. ## How is a mild low treated? With fast-acting sugar in the amount the child's plan sets, rechecking after 15 minutes and repeating if still low, then a snack. ## Why should insulin injection sites be rotated? Repeated injections in one spot cause lumps that make insulin absorption unpredictable. ## What should a school have for a child with type 1 diabetes? A written diabetes management plan, trained staff on site and supplies including fast sugar, testing equipment and the emergency medicine. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/the-child-with-type-1-diabetes-glucose-checks-insulin-teaching-hypoglycaemia-sic/) ## Connections ## Related 3 - [Capillary blood glucose testing](https://durgical.com/en/nursing/capillary-blood-glucose-testing/) - [Subcutaneous injection](https://durgical.com/en/nursing/subcutaneous-injection/) - [Patient education and teach-back](https://durgical.com/en/nursing/patient-education-and-teach-back/) ## Related conditions 1 - [Type 1 diabetes mellitus](https://durgical.com/en/conditions/type-1-diabetes-mellitus/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Guías de Práctica Clínica de la ISPAD 2022: Manejo de días de enfermedad en niños y adolescentes con diabetes](https://www.ispad.org/asset/FD1E38F7-A3DC-47C5-87BC5D7A9599AE99) (International Society for Pediatric and Adolescent Diabetes (ISPAD), 2022); [Treatment of Low Blood Sugar (Hypoglycemia)](https://www.cdc.gov/diabetes/treatment/treatment-low-blood-sugar-hypoglycemia.html) (Centers for Disease Control and Prevention, 2024); [Managing Diabetes at School](https://www.cdc.gov/diabetes/caring/managing-diabetes-at-school.html) (Centers for Disease Control and Prevention, 2024); [Giving an insulin injection](https://medlineplus.gov/ency/patientinstructions/000660.htm) (MedlinePlus, U.S. National Library of Medicine, 2024). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/the-child-with-type-1-diabetes-glucose-checks-insulin-teaching-hypoglycaemia-sic/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/the-child-with-type-1-diabetes-glucose-checks-insulin-teaching-hypoglycaemia-sic/