Ketones and Children with Type 1 Diabetes – What’s Important?

What are ketones and when do you check for them in children with type one diabetes? This is a common question I get! I think when children are diagnosed, this a frequent part of the education that is easily forgotten or misunderstood due to the overwhelming amount of information being taught. So let’s look at why we would check ketones, how to check them, what the colors on the strips mean, and what to do if ketones are present.

 Why Check Ketones:

When someone with type 1 diabetes does not not get enough insulin, their blood sugar levels rise, so the body is forced to use fat for energy.  When fat is used for energy for an extended period of time, ketones develop. Ketones are a waste product of fat. If someone with type 1 diabetes does not get enough insulin, diabetic ketoacidosis (DKA) can develop. The length of time it takes and how high one’s blood sugar are varies, however DKA can occur in a few hours.

Symptoms of DKA:

  • high blood sugars
  • ketones in blood and urine
  • nausea, vomiting, and abdominal pain
  • confusion
  • lethargy (tired, sluggish, weak)
  • difficulty breathing
  • unconsciousness

DKA is a very serious and life threatening situation.  Speak with your health care providers to determine how you are to treat ketones and when you are to go to the emergency room.

When to check ketones:

Your doctor can tell you exactly, but usually when your blood sugars are over 250, especially if the blood sugar is not responding to insulin and remaining high after the second blood sugar check.  Always check ketones when your child is sick, even if blood sugar numbers are not high.  Anytime your child has nausea and vomiting, check ketones.

How to check ketones:

Ketones can be checked by using ketone urine strips.  To check ketones, urinate on a strip, or collect urine and dip stick into urine.  Wait the amount of time on bottle instructions, usually around 15 seconds, and then compare the color on the stick to the colors on the chart on the bottle, which range from negative to large.

Ketones can also be checked using a blood ketone meter.  Currently two ketone meters are on the market, the Nova Max Plus, and the Abbott Precision Xtra.  Ketones can be checked exactly as one would check blood sugar.  The strips will have a color code explaining what the number will mean, such as in this picture.  In this picture, the 2.2 would mean high ketones. Blood ketone meters are more accurate and will show the ketones decreasing faster than urine ketone strips. These are also very helpful for younger children.

Treatment of High Ketones:

Ketone rules: Check, Inject, Drink.  This means check your blood sugar, inject quick acting insulin (Humalog/Novolog/Apidra) by using either a “ketone” dose which is given to you by your doctor which is usually slightly higher than a regular correction dose, or your regular correction dose.  If you are on a pump, inject the correction dose with a syringe instead of using your pump, then change out infusion set. Do not use pump for correction dose when ketones are high, because you want to make sure you get the dose!

Drink: Drink plenty of water or non-carbohydrate fluids.  Check with your doctor on if there is a recommended dose, but some doctors recommend drinking your age in fluid ounces.

Check bg and ketones every one to two hours and continue to take insulin as needed.  If your bg continues to rise, or if you have moderate to high ketones, nausea, vomiting, or difficulty breathing, notify your doctor or go to the nearest emergency room.

High ketones can be very serious, thus knowing when to check for ketones and how to decrease them if high is key.  Be sure to speak with your doctor about your clinic’s specific protocol.

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Author: Carol

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