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09 Dec 2008 - Ketones


Ketones:

The presence of ketones in the urine, regardless of blood sugar level, shows that the body is in serious need of insulin. This could become a life-threatening situation if not corrected. If you find ketones in the urine (or blood), give additional insulin and lots of fluids. If the ketones do not clear  in a few hours, call your doctor.

If your child is ill, check for ketones, even if your child is running low. They do not need to be high to spill ketones.  Ketones may be present during any illness.  This is caused by the insulin's lack of effectiveness due to the stress that hormones undergo from the body fighting infection.  It is important to test your blood glucose and ketones frequently during illness and stay in close contact with your health care team.  

There are two ways to check for ketones.  The Precision Xtra meter is a great tool.  It gives you fast, accurate and up to the minute ketone readings by doing a simple finger stick.  Ketostix measure ketones by testing the urine.  They give great results as well, however, when testing the urine your results will show whether you have had ketones in the past few hours.  So for more up to the minute results, go with the Precision meter.

Always be sure to take your basal insulin during illness.  Without it, your blood sugars will go dangerously high and you will be at risk for DKA.  In most situations, extra basal insulin is required during illness.  If your blood sugar is high without ketones, an increase in your basal insulin of 25% may be necessary.  If you have small or moderate ketones, increase by 50%.  And for Large ketones, increase by 100%.  An easy way to increase doses is to give 10% of your childs TDD (total daily dose) of insulin for moderate to large ketones and 5% of their TDD for trace or small ketones.  These increases should be used along with your usual bolus doses for food and high blood sugar corrections.  See the DKA Decision Tree to help determine the best course of action for getting rid of ketones.

Helpful hint:  When testing a baby for ketones, put a cotton ball in the diaper to collect urine!


Blood Ketone/Urine Ketone Chart


Blood Ketone
                Urine Ketone
(mmol/L) Strip Color Level Action to Take
less than 0.6 slight / no color change negative normal - no action needed
0.6 to 1.0 light purple small to moderate extra insulin & fluids
1.1 to 3.0 dark purple moderate to large call doctor
greater than 3.0 very dark purple very large GO TO ER!

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