As the parents of a very active and accident-prone 13-year-old son, my husband and I have had our share of emergency room visits.

We have rushed Danny to the hospital for stomach flu with ketones, a lacerated cornea, a deeply cut foot, acute stomach pain and a severe bout of croup. With blood sugar control added to our list of concerns, emergencies can become very complicated.

Over time, we have learned that preparation can make the experience safer. And when parents are prepared and calm, the medical team is more cooperative in dealing with a child's diabetes care. With time and experience, we have learned to deal with emergency room visits by taking the following steps.

1. Call ahead to alert the emergency room about your arrival and ask to register by phone. Your hospital may be able to tell you how long the wait is, pre-register your child by phone and start a triage assessment while you are on the way. Be sure to mention that your child has diabetes. On one occasion, our hospital had reached our endocrinologist before we arrived.
2. Bring all your diabetes supplies, snacks and water, just in case that your child is admitted to the hospital. You will want high and low carbohydrate choices, depending upon your child's blood sugar levels, as well as glucose tabs.
3. Know your child's allergies to food and medication and make sure to list them when you arrive.
4. If possible, check ketones and do a blood sugar check before you arrive or while you are waiting. We have found that if you know your child's number and ketone level, you immediately get a better response from your assigned nurse and doctor. In addition, the hospital process for both of these tests takes longer than doing it yourself.
   
5. Closely monitor blood sugar levels throughout the experience. Even if your visit to the hospital is unrelated to diabetes, a variety of factors including stress, illness and adrenaline can make blood sugars change quickly. If you decide to treat a low or give extra insulin to counteract high blood sugars, be sure to tell your nurse or doctor.
6. Encourage your emergency room doctor to consult with your endocrinologist. When our son had croup, our emergency room doctor chose a steroid and our endocrinologist chose the insulin dose that adjusted for the steroid.
7. Before your child receives any medications, be sure to ask whether they affect blood sugars.
8. Wash everyone's hands as often as possible. You and your child are being exposed to a multitude of germs on door handles, light switches, toys, magazines, bathroom fixtures and bed rails. You don't want to have to return to the hospital because you caught someone else's flu!

Emergency room visits are never pleasant, but playing a pro-active role in your child's treatment can help you all have a more successful experience.