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starvation ketones

Discussion in 'Parents of Children with Type 1' started by shannong, Apr 9, 2013.

  1. shannong

    shannong Approved members

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    My DS is on his 3rd day of a nasty stomach bug and fever. We have managed to keep his bg in range. He is getting only basal because he is not eating. Only having some popsicles to keep his bg up. He has developed starvation ketones. I called the on-call endo last night and he didn't seem concerned with the ketones. Because he is still able to keep enough liquid sugar down he said I don't have to take him to the hospital. But now is another day where he doesn't want to eat. His ketones (I'm using the urine strips) are larger now. I realize that non-d people can develop starvation ketones, but are they more of a concern for someone with diabetes? I am taking him to his pediatrician this afternoon to get an opinion on things as well. I'm not looking for any kind of medical advice, but just want more of an understanding of starvation ketones and how they affect someone with diabetes. Thanks!
     
  2. Sarah Maddie's Mom

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    I am firmly in the camp that does not worry much about starvation ketones, especially when testing with pee sticks. If he's not eating real food then he's breaking down fat and the starvation ketones are just the garbage left behind from that process. The only time I would worry, would be if I saw bgs rising, nausea increasing, vomiting beginning in a kid who, in toto, looked, felt "sick".

    Keep him hydrated, watch the bgs and gradually encourage him to start back on simple, easy to digest carbs. Once he's gotten something approximating a meal in him you should see the ketones begin to go down. (keep in mind that pee sicks are hours behind, so you may well see small ketones even the following morning)
     
  3. Brenda

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    First, I know you are relatively new to diabetes but I recommend you get a blood ketone meter (Precision Xtra or NovMax). Blood ketones are much more accurate.

    How are his blood sugars? You may need to give him sips of a sugary beverage (diluted juice, flat Coke, Ginger Ale, Sprite), etc. so you can keep giving him at least part of his usual insulin dose. Diluted Gatorade or such could also help prevent dehydration. That is also a big concern and often the reason you might end up in the ER.

    I'm sure others will chime in with other advice as the day goes on. You can also search the forums using the terms "Starvation ketones" or "High ketones" to find where this has been discussed in the past.

    Make sure you keep in touch with your diabetes team to discuss this.
     
  4. Megnyc

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    I have never really understood the starvation ketone issue. I would assume if he is still getting at least basal insulin you really don't have to be worried about DKA.

    Do you guys have zofran though? In my experience it works really well. If you don't have it I would ask your pediatrician for some. He/she should even be able to give the first dose in the office. It is just a tablet you stick in your mouth-- you don't even have to swallow a pill.

    Also, if you have a blood ketone meter that is a bit more accurate and real-time then the urine strips.

    Hope he feels better soon!
     
  5. Brenda

    Brenda Junior Member

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    I forgot to mention that you should ask for a prescription for Zofran ODT, an anti-nausea medication.
     
  6. StillMamamia

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    From my understanding, DKA does not happen with hypoglycemia, even if large ketones are present.

    Starvation ketones, like Sarah mentioned, is the byproduct of the breakdown of fat for energy. The main issue with starvation ketones is weight loss. Since there's a problem with wanting to eat food and keeping it down, keep a close eye and keep in contact with the endo. Dehydration may be a problem. Check with your endo to adjust bolus/basal dosages as well.

    I echo the advice to get a meter which reads blood ketones.

    When we have this type of situation, I usually keep basal the same, but go easy with the bolus. Things like simple melba toasts usually stay down.
     
  7. shannong

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    Thanks for the replies. I talked to my DS's nurse today and she believed as well that starvation ketones are not an issue as long as they are gettting insulin (even just basal insulin). She did say that large starvation ketones can make him not feel very well and upset his stomach, adding to the issue. I tried getting my DS to eat some chicken noodle soup and bolused him after when I knew he would keep it down so that I could reduce some of those starvation ketones. This seemed to really help. He made a turn for the better and was even able to eat more later on. So, I do believe the nurse that I think starvation ketones were continuing to make his stomach not feel good.

    When I went to the pediatrician, I asked about getting Zofran. She said that Zofran is only prescribed in a hospital setting. She said that the thinking is that if someon needs Zofran, they need to be monitored in hospital. I told her that many people on the CWD forum have used Zofran for their kids, she said that protocol may be different in the U.S. She said that I could check with my son's endo team to find out if it is being prescribed in these situations. My DS is on the mend now, so not really an issue anymore, but I will ask the endo team about Zofran for the future.
     
  8. Sarah Maddie's Mom

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    FWIW neither our primary nor our Endo are quick to prescribe zofran, especially for a run of the mill stomach bug.
     
  9. MomofSweetOne

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    At our last appointment, our doctor told me she wanted us to have it in the house as an option. She said she's seen too many cases where having it makes the difference between ER treatment or not. So we have it, whether we ever use it or not. But, it was not my request; it was hers, so another area where drs. vary. I wouldn't be quick to use it if things are going ok otherwise, though, and not without talking to the 24 hour line first.
     
  10. Jennifer126

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    Joe was just sick a few weeks ago and not really eating. We were told to do the blood ketone test and at his age if he had some we were to take him to the hospital they would treat him for dehydration. Our nurse told us even if his numbers were normal that DKA could happen. So we watched and made sure he was drinking... sugary carb drinks! LOL It worked he didn't go above 1.2 and they would flush right out when we got him to drink + insulin. Technically they wanted us to go in even if it was 1.2 but we didn't want to subject him to iv if we could manage to keep it down.
     
  11. Sarah Maddie's Mom

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    I can completely understand wanting to be cautious about dehydration in a type 1 three year old, but it's my understanding the starvation ketones and in range bgs cannot cause DKA.

    Severe dehydration is nothing to mess around with, but I really can't see how starvation ketones and in range numbers could lead to DKA.
     
  12. Jennifer126

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    I have no idea! I am just relaying what I was told. I know on the urine strips there were multiple things checked.... is that the same with the blood meter? Maybe I am missing something
     
  13. Sarah Maddie's Mom

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    I'm not sure I understand... the usual urine Ketostix are pretty primitive: color coded and not all that precise.

    But to the general question - ketones are always deserving of monitoring, but as long as blood glucose is reasonable, and the child well hydrated and there are no other signs of distress, then I think starvation ketones can be faced without too much anxiety :cwds:
     
  14. nyholli

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    I can't add too much but pushing the fluids will help flush them out. I went to a blood meter after our last stomach virus but our insurance covers the strips. Only used 3 or so in a year. Just wanted to add that our experience with stomach bugs is that insulin requirements can drastically reduce when recovering and can last a few days to a week (again, our experience)! So watch out for lows once eating normally. Speedy Recovery!!!!
     
  15. Mish

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    Ours either

    On the other hand, my older daughter had her wisdom teeth removed and got zofran incase she had nausea from the pain meds. I tucked it away just to have on hand since no one else seemed willing to give it. ;)
     
  16. shannong

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    My DS is on day 4 of vomiting and diarrhea. Thought he was getting better yesterday, but woke up vomiting again. He has thrown up 4 times today. Unbelievably (to me), we still have managed to give him basal and keep his bg numbers in range. But I am starting to get worried. Never have my kids been vomiting into the 4th day. I consulted with pediatrician by phone again today. She still thinks just some stomach bug and that it can last up to a week. She is mainly concerned that we keep him hydrated. Thank god for freezies. It is the only thing he will eat and they sometimes stay down.

    Both endo team and ped. not concerned with ketones since bg's in range.

    Endo said that they don't normally prescribel zofran for stomach bugs, but he is willing to let us try. On the way to the pharmacy to pick up the prescription.

    This is causing me a lot of worry! Everytime he throws up, I am on edge that this will be the time I can't keep bg. up in range, but I check and he is still good. I should be thankful for that. Weird thing is that no one else in the family is sick with this. Also, I asked his principal if anyone has had a stomach bug and she said that she hasn't heard of a single person. This sucks.
     
  17. Beach bum

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    I hope the tides have turned for you today.
    I just wanted to add that after a bout with the stomach bug, even though numbers stayed in range, that you will probably see lows for at least a week.
    Once the vomiting stops, you can try the brat diet (bananas, rice, applesauce,toast) to help fix the problem on the other end.

    Again, hope things are better.
     
  18. SandiT

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    I have a different, but related question. Do we still need to keep giving them insulin and keep their sugars high if they are eating okay?

    Mine's definitely sick, and her sugars are staying high. The doc wants me to sort of bump her up at each 2-hourly testing so that she'll need a correction dose, whenever she's "sick and not eating".

    Do we do it when she's eating okay, though?
     
  19. Amy C.

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    I would get the sugars down. She needs more insulin, as the blood sugar readings show.

    Sometimes, sickness brings on the need for more insulin afterwards.
     
  20. Sarah Maddie's Mom

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    Yes, certainly. If her bg is high she needs insulin. If she's eating carbs she needs insulin.
     

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