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Why check ketones? What would you do differently if your child has ketones?

Discussion in 'Parents of Children with Type 1' started by denise3099, Nov 4, 2014.

  1. denise3099

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    Went to the endo. Dd is doing great and her A1c is way down, thank you Nightscout. The nurse/educator lady asked what scripts we needed. When she asked if we needed ketone strips I didn't want to admit the truth but had to say that we NEVER check ketones. We did at first but dd never gets ketones. The few times she did, bad pump site, I didn't have to check since I already knew she must have ketones--crazy high bs and vomiting.

    So the question is, what would I do differently if dd had ketones? Basically, with a high bs, I'm just pushing insulin and fluids and keep checking until it comes down. Switch out the pump site and keept dosing and drinking until it's down. Ketone or not does not change that treatment. I suppose if she were sick and had ketones with a normal bs I would push juice and insulin, but if she were sick, I'd probably do that anyway. If she were sick and throwing up, and couldn't keep food down, that would be a trip to the doc anyway. So, not to be a lazy D mom, since I do know how and why ketones come aobut and the danger of them and the need and ways to clear them, I just see that the treatment for high bs or sickness seems to be the same with or without ketones. Drink, dose, check bg, repeat, repeat, repeat.
     
  2. KatieSue

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    We very rarely check, only with illness. And yes treatment is pretty much the same but we have had the nausea/throwing up from the ketones and it's good to know that's what's causing it and probably not something else. Also if they're not going down you may need to call the docs or go into the ER.

    And my lovely insurance won't cover either blood or urine ketone strips.
     
  3. Mimikins

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    I notice that I develop ketones very easily (had moderate ketones with a 219 BG one time), so I've been doing ketone checks every time I am over 200. It's a way for me to easily determine if I am receiving insulin or not in those situations where I might be debating if it is a post-meal high or pump issues (like a high reading after eating breakfast post-site change). If I have ketones, it tells me to drink fluids, correct with an insulin pen, switch everything out of my pump, and avoid exercising. If I don't have ketones, it's a simple high that I can treat with a pump correction, fluids, and exercise.
     
  4. jacks101

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    We only check during illness typically. We've gone from trace to high in a short period too, so good to have them on hand I think.
     
  5. jenm999

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    Our first clinic (at diagnosis and through the first few months) says check for ketones every time he's over 250. We don't always do that, but we do check when the high is unexplained, prolonged, or he feels cruddy (and of course with any fever or vomiting), and then every once in a while when he's got a nice big drop of blood. Supposedly their (Boston Children's) rates of DKA are much lower than average because of this policy; not all D parents can make that judgement call, so setting up a strict protocol (if this, then this) is critical. In other words, the rule is for the lowest common denominator.

    The good news is that the strips are individually wrapped and last forever, so you can stock up with 1-2 months' copay and that should last you a long time.

    Keep in mind that nighttime hypoglycemia, which I think I can say is our biggest collective fear and the cause of a lot of discussion here about how much testing is enough/too much/CGM/alarms/DADs etc... but that DKA accounts for 70% of diabetes-related deaths in kids under 10 (http://emedicine.medscape.com/article/118361-overview#aw2aab6b2b7).
     
  6. nebby3

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    We rarely check. I would do so more often if dd was still pumping. It can help with the decision to change a site or not. It takes more insulin to clear ketones they say. Basically I would check with illness or anytime insulin might have been missed.

    I looked at the article saying 70% of diabetes related deaths under age 10 are from DKA. It doesn't distinguish deaths that happen at diagnosis from ones that happen later. I wonder what the numbers would be for kids who survive diagnosis as ours have.
     
  7. Sarah Maddie's Mom

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    Never check, BUT, if she were to be really sick (and she never gets sick) I'd probably be glad to have them so that I could see if my response to treating them was making a dent or if the ketones were getting worse and possibly so that I could best describe all of her symptoms should I need to call he endo for help or advice on whether or not to go to the ER. (though we've gotten by without them most of these last 12 years and never needed the ER so it's all theoretical)
     
  8. Nancy in VA

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    If we were to check every time over 250, we'd be checking ketones every other day!

    For us, we check when she's sick, mainly because she has had lows with ketones and then we would treat differently - we would push carbs so we could add insulin in to help fight ketones. The one time I KNOW Emma had ketones, we ended up with a pump malfunction, we were out of town and I had just changed her site and she spiked to 500 and was vomiting. I knew pretty quickly that was ketones and just pushed insulin and more insulin through a syringe. She came down and didn't vomit again.

    If she had sustained highs and vomiting, I'd probably check more frequently.
     
  9. Mish

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    You've been at this long enough that you know what to do, and I don't think you'd be doing anything differently if you were testing ketones more often (certainly not as often as our endos / CDEs all think we should be testing lol) . We're sort of the same, my son never gets ketones. Ever. And he's almost never sick enough for ketones, so I have almost no sickness / ketone experience to go by. So, I keep two boxes on hand until they expire, just in case. This way, even if I know he's probably got ketones, and even if I"m not testing right away, I can use them to judge if they're coming down or not.
     
  10. GChick

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    I also never check for ketones. I suppose its also because I am rarely sick, so if its just a matter of being high, I'd treat it the same way.

    When I was inquiring about the pump, the lady at Tadem was asking me various questions to see how well I understood things and if I was controlling my diabetes (I think it was almost like a "test" as I wanted skype training and they dont generally do that for first time pump users).

    Anyway, one of the questions was how often I tested for ketones and I had to admit that I haven't even had a bottle in the house in years. She then commented on how important it was to test for ketones on the pump because of the whole no background insulin thing... and I did get myself a bottle for that reason, but I still find, if I'm testing as often as I usually am, there's still kinda no reason for them ~for me~ as the methods for treating things are still basically the same.

    Kids however I think should at least always have a bottle on hand though even if they dont test them for "every" high.
     
  11. Beach bum

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    This last appointment with our doc, she asked if we needed a ketone strip refill. I said yes, but only get us two boxes. She said, at this point in our D journey I figure you know when to check for ketones. We really only check when she's sick, or if it's a stubborn high and I want to make sure it's not a set gone bad. My daughter also can feel ketones, so she will randomly check if she feels she needs to.

    But, for all the newbies, go with your gut. If you feel you need to check for ketones, by all means, do it.
     
  12. denise3099

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    So I'm seeing here that some actions you take as a result of testing is:
    1. You might do a site change if high with ketones vs. pushing more insulin if high without ketones. This sounds like a good idea. Generally I'd just dose and if the high doesn't respond then I'd do a site change.
    2. You might go to the ER if a high harge large ketones vs. a high without ketones. If you do go to the hospital, they will ask or the endo will ask so you may as well have that info.
    3. You might push carbs with a normal bg if there are ketones (like illness) vs. just pushing non-carb fluids.
    4. Throwing up with ketones if they don't clear might send you to the ER vs. ketones are coming down and you wait it out at home.

    All good reasons. I think I'll order up the precision xtra and some strips. DD never gets ketones unless it's an hours long complete pump failure, which only happened once at night (or I would've caught it sooner). That was before cgm. Now that she has her dex and nightscout, I'd be on a high early and know pretty quickly if it wasn't responding. I don't see doing anything differently unless she is sick or vomiting (so rare) but for those unlikely times I guess it's better to have them to at least know if what i'm doing is working or not. I guess the real difference in treatment of a high with or without ketones is the urgency with which you would seek outside help. You could wait for a high bs to come down and even avoid a site change but there's only so long you would wait on ketones before heading to the ER. In 8 yrs we've never had an ER visit and only had one incident of vomiting with that bad site. Thanks so much for your opinions--the nurse said how important enough and how you'd want to do site changes and push indulin and use a syringe but I just kept thinking that those are things I'd do anyway. Thanks.
     
  13. mom24grlz

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    Ashleigh rarely gets ketones either. A couple weeks ago she went 8 hours with no insulin (came unhooked at night) and never developed ketones. i think the last time she had ketones was November 2012, and that was following surgery. I'll test if she's feeling sick (which isn't to often) or if she has 2 or more readings of 300+ in a row.
     
  14. nebby3

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    My dd rarely gets ketones either and it does seem some kids are more prone to them but I would like to caution everyone that this is something that can change over time. If there are unexplained highs, vomiting or any reason to think insulin has been missed then it is important to check. DKA does kill.
     
  15. denise3099

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    Mom24 and nebby, I get when to check but what do you do with that information? And wouldn't you have done the same things anyway? If you find out there are ketones, after two 300 readings, you would give insulin and fluids. But wouldn't you do so anyway? You might change a pump site. But wouldn't anyway if you corrected a 300 and hours later it's still 300? With an unexplained high you'd pulled out a syringe and rage bolus but how is your course of action idfferent with or without ketones?

    Some others have said that they might be more aggressive with ketones, or go to the ER sooner, or if you find ketones with a normal bs then you'd push carbs AND insulin. That makes sense, although how often do you check ketones with a normal bs? So a better rule is to check for ketones if you kid is sick or vomiting no matter what bs is so you can know whetehr to let the kid sleep or pour some juice and toast into him with a nice fat bolus. Makes sense.

    Or do you add a specific amount of insulin extra, based on ketones? I add extra with a super high anyway since she tends to need it plus I'd rather juice on the way down than wait all day at 250.
     
  16. mmgirls

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    because a reading of 1.5 is much less worrisome than a reading of 4.5.

    We use Zofran when ketones are interfering with my efforts to hydrate and nurish my sick kiddo, so we can not use "symptoms" and an indicator of whether we have inproved the situation if BG stays elevated. Both my kids get ketone tummy. they can usually both ask to be ketone tested with tummy aches. With higher ketones I also feel like I can be more aggressive in trying to bring down ketones and BG, because I know that some of that first insulin will be going towards turning off ketone production instead of actually lowering BG, very helpful for a tummy bug when BG might actually be in the low to normal range.

    My kids have a blood ketone meter and strips in there daily kits, ketone testing is also required at above 300 in our school district.
     
  17. MomofSweetOne

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  18. Mimikins

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    You have to remember that exercise is not recommended with ketones (exercise burns fat and produce more ketones). I have been using exercise as a way to treat hyperglycemia (in combination with a correction bolus and fluids), but if I am positive for ketones, I cannot exercise.
     
  19. wilf

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    This is an important point, not understood by many. Thanks for posting.
     
  20. denise3099

    denise3099 Approved members

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    Nice. That's a really good point. I'll try to get some jumping jacks out of dd is bs is being stubborn, but ketone info would defintiely change that plan. Thanks.
     

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