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Blood vs. urine ketones

Discussion in 'Parents of Children with Type 1' started by polly, Feb 24, 2011.

  1. polly

    polly Approved members

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    Hey there! Can anyone give me some info regarding pros/cons of blood vs. urine ketones? My son was diagnosed 6 weeks ago and we were told in the hospital that checking ketones via urine strips was fine. Since then, I have read several articles that imply blood testing is much more accurate, etc. However, when I brought this up to our diabetes educator, she dismissed the idea and said urine was just fine. Our 5 yo is still having many highs as he adjusts to the insulin injections so we are testing for ketones regularly. Any advice appreciated!! :)
     
  2. TheFormerLantusFiend

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    Will your insurance cover blood ketone testing?

    The two big advantages of urine ketone testing over blood ketone testing are that the urine strips are much cheaper, and that it's less invasive to test urine than blood.

    The disadvantages of urine ketone testing versus blood ketone testing are that the urine tests take longer to turn negative after leaving the danger zone, correlate less with what is actually dangerous, can be hard to read, and require a person to be able to pee.
     
  3. mamamccoy87

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    I prefer blood ketones. It takes about 2 hours for ketones to show up in urine vs blood it shows up asap. Plus I want to know asap:rolleyes:

    If insurance will pay for blood ketone strips - go for it. They are expensive - we pay $40 for 10 strips.:(
     
  4. Sarah Maddie's Mom

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    Strips that measure blood ketones provide far more timely information but are expensive and may not be covered by insurance. That said, we almost never see ketones and haven't bothered to get the strips.

    The pee sticks, if you use them knowing that the information is hours old, can be helpful in navigating illness, but obviously if a child is very young and or very prone to spilling ketones then the blood strips would probably be a better choice.
     
    Last edited: Feb 25, 2011
  5. Kaylas mom

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    Our insurance won't cover the blood ketone strips. Kayla gets ketones at the drop of a hat and uses so many urine strips, I can't imagine what the cost would be if we got the blood ones.
     
  6. Brenda

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    From the CWD Care Suggestions Page:


    Ketones in the blood can be detected well before ketones in the urine be detected, offering you the opportunity to treat sooner than you would if you waited for urine testing. (Have you ever tried to make a three year old pee on command?) Also, being able to test with a finger stick eliminates the need to find a bathroom to test if you're away from home. (How many of you carry urine ketone strips when you're out shopping or at an amusement park? And if you do, do you like the thought of peeing on a strip in a filthy public bathroom?)

    Two recent studies (February 2006) demonstrate clear medical benefit from blood ketone testing. The first study (Diabetic Medicine 23 (3), 278-284) showed a significant reduction in hospitalizations during sick days (38 vs. 75 per 100 patient days) for people who used blood ketone testing compared with urine ketones testing. Staying out of the hospital is a very powerful argument for using blood ketone testing. The second study (Diabetes Technol Ther. 2006 Feb;8(1):67-75) showed that, for patients using insulin pumps, blood ketone testing could identify interruptions in insulin flow faster and more accurately than even blood glucose monitoring and could thus help pumpers prevent DKA better than if they didn't use blood ketone testing.

    While some argue that the cost of blood ketone testing is much higher than urine ketone testing (about $4 per blood ketone strip versus as low as $0.10 per urine ketone strip), annual testing costs will likely be about the same if you check for ketones about 10 times per year, which is about what our readers reported in a recent poll. Urine test strips have a 90-day lifetime, after which they must be replaced. Priced at about $10 per 100 strips, the annual cost of urine testing is about $40. At $4 per test for blood ketone testing, if you test 10 times a year, the annual cost is also about $40 per year. If you check for ketones more often, then urine testing might be more economical, but the clinical benefits described in recent studies still argue for using blood ketone testing.

    Of course, the benefits of feedback on what's happening in your body at that instant, not having to force toddlers to pee on demand, not having to drag a sick teenager out of bed to the bathroom, and not having to go into a public bathroom when you're out and not feeling well are -- as the advertisement says -- priceless.

    The references to this are at http://www.childrenwithdiabetes.com/clinic/care.htm should you want to read them.
     
  7. heamwdevine

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    I find the urine strips fine except for when there are ketones at night. It's hard to get someone to pee every hour when they are sleepy if you have some heavy ketones going on.
     
  8. mom24grlz

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    Hi there first, I'm sorry to hear about your son's diagnosis. From my understanding the ketones in the blood can show up hours before they show up in the urine. Our endo is also fine with urine testing. However we find blood ketone much easier, by the time Ashleigh realizes she's high she normally doesnt' have to pee or when she's sick she has a hard time walking to the restroom (she has passed out a couple of times when sick), because of this our endo has given us a script for the blood ketone strips. They are expensive, and if we weren't given a prescription we would have stuck to the plain old urine kind.
     
  9. Sarah Maddie's Mom

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    Is there a concern about the "once opened" expiration of blood strips? or did I imagine that?
     
  10. khannen

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    The blood strips are individually foil wrapped. There is just the normal expiration date for the package usually several months out... just like any other test strips. There isn't any 'once opened' issue as far as I understand, because the strip isn't opened until it's time to be used anyway.
     
  11. dejahthoris

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    Really stupid question. If we had large ketones, besides calling the endo, which we would of course due, does anyone have any insight or tips on tackling that problem? We havent had to deal with ketones yet but of course it will happen someday I imagine! The only thing I know to do is make sure you give carbs in some form and cover them w/insulin to avoid starvation ketones when ill. Thanks
     
  12. heamwdevine

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    You're supposed to do 1 unit of insulin per hour/~15 g carbs until the ketones are cleared. This is in addition to anything they eat or drink.
     
  13. Sarah Maddie's Mom

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    That's good to know. ;)

    I was always led to believe that once you opened a package (10?) that they expired within something like 30 days. Good to hear that that's not the case.
     
  14. Sarah Maddie's Mom

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    If a child isn't eating for hours but is maintaining normal range bgs and you see ketones, they are most likely starvation ketones. Starvation ketones are hard to avoid if a kid can't eat. And if a child is sick and you force food and insulin you can end up with a kid who is throwing up and had IoB, which is no fun.
     
  15. frizzyrazzy

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    also, try making a 5 year old pee on demand..... in the middle of the night....or while sick and not drinking..
     
  16. mom24grlz

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    yes forgot to mention that we too use the urine at school and the blood ones at home.
     
  17. hawkeyegirl

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    We almost never check for ketones (maybe 10 times in 3+ years? Even that seems high...), but when we do, we use the blood strips. Much more accurate and also easier in the middle of the night.
     
  18. virgo39

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    That seems like a lot of insulin -- wouldn't you take the child's ISF and I:C ratio at least partially into account?
     
  19. Brenda

    Brenda Junior Member

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    Two things: many people who use urine ketone strips do not use the foil wrapped ones (I always had to have the pharmacy special order them for use at school). The issue with the strips expiring is the ones in a vial, maybe 25 or 50 in a vial. I don't remember since I haven't had them for many years.

    Secondly, I would recommend you ask your diabetes team for dosing guidance in the presence of moderate to large ketones. With trace, I think you can push water to help flush them out. I agree that giving 1 unit per 15g carbs could be way too much insulin. And, why would you be basing corrective doses on carbs? Wouldn't it depend on the BG/IOB/ketone level? My thinking is that most people with large/high ketones would feel awful and not be eating, just taking extra insulin to bring down their BG.

    Ketones and low BG are a whole different story.
     
  20. Sarah Maddie's Mom

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    A critical distinction that is often lost in the conversation. ;)
     

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