When should you worry about ketones in your urine?

Question

We have been told my son has impaired glucose tolerance by our family physician. He is six. He is going to see a dietician next week and a peditrician in two weeks. In the meantime, we are monitoring his blood sugar levels and using ketostix. Just this week he started showing mild to moderate ketones in the a.m.
This is a new development. The first morning when he showed moderate ketones his blood was 3.2. His lowest number yet and we were nervous. Is this normal for a child with impaired glucose?

Answer 1

Ketones (sometimes called acetone) are chemicals which appear in the blood and urine when body fat is being broken down for energy. Fat is burned by the body when there is not enough insulin to allow sugar to be burned for energy. Ketones also are formed when not enough food has been eaten to provide the energy the body needs.

Ketone testing is very important because ketones can build up in the body and result in an emergency condition called ketoacidosis. Ketoacidosis is a serious, life-threatening complication of high blood sugar and must be treated immediately. Ketoacidosis is the number one reason for hospitalizing children in the U.S. with known diabetes.

Families are usually taught how to do the urine ketone test on the first day their child has been diagnosed with diabetes. They may later switch to doing blood ketone checks. Frequent ketone tests are important in the first few days after diagnosis to check if enough insulin is being given to turn off ketone production.

A method of testing for ketones must be kept in the home (and taken on trips) at all times.

Ketones must always be checked if your child:

has high blood sugar above 240 mg/dl (13.3 mmol/L) after fasting
has high blood sugar above 300 mg/dl (16.6 mmol/L) during the day
feels sick or nauseated (especially if he vomits, even once). If the child is sick, ketones can be present even when the sugar is not high.
Children who have been recently diagnosed with diabetes usually need to check ketones twice a day (or more often if the test is positive). After the first or second week, if all ketone checks are negative, you can stop routine testing of ketones.

Children who take only 1 insulin injection per day should do a routine morning ketone test to check if their insulin is lasting a full 24 hours. Ketones will usually be present in the morning if an insulin injection is needed in the evening. If the morning blood sugars vary between very high and very low values, check the ketone level in the morning. Morning ketones can be a sign of a low blood sugar during the night followed by rebounding or bouncing back to a normal or high level by morning.

Call your care provider IMMEDIATLY (day or night) if:

the urine ketone test result shows medium or large urine ketones
the blood ketone test is greater than 0.6 mmol/L.
Tell the person answering the phone that the call is urgent.

Your provider will probably have your child take extra insulin to help make the ketones disappear. If the ketones are not detected early, particularly during illness, they will build up in the body and your child will get ketoacidosis. It is the early detection of ketones and treatment with extra Humalog or NovoLog insulin that prevents hospitalizations for ketoacidosis.

Call your care provider during office hours if:

You are concerned about the test result.
You have other questions or concerns.

Good luck to you!

Answer 2

Get your blood sugar checked as you may have gestational diabetes. If your blood sugar is normal, then not eating enough, or eating very few carbs can cause this.

Answer 3

You have to worry,no question on that.
Take care soon.