We have several questions regarding ketones.
Our 2 1/2 years old son woke up this morning with moderate ketones. He went to bed (9 pm) with a reading of 190 mg/dl (10.5 mmol/l). His standard does is 1/2 N. We always do a check at 1 am before the N will peak as he is very active in the summer, and he had a seizure one year ago, so this gives us peace of mind. His reading was 101 mg/dl (5.6 mmol/l), so we gave him 1 oz of juice. When he woke up at 7:30 am, he was 122 mg/dl (6.8 mmol/l). Since he was acting sluggish, I checked for ketones, and he did have them (in a "moderate" amount).
I know that ketones indicate that he did not get enough insulin. But our questions are:
- What blood sugar level should you check at (we check when he has had a reading of 240 or over)?
- Is it possible he rose up over 240 after 1 am?
- Is it possible that he could of had ketones when he was 190, and they stayed with him even though he was 102 at 1 am?
- How long do they take to form?
This is getting very hard on us, it is hard to make a judgement call at 1 am. You want to give juice, but at the same time, you worry will he go really high? He has his snack around 8 - 8:30 pm (2 animal cookies, and whole milk mixed with ice cream). We give him the extra protein and fat to be released in the am hours. Would cornstarch be better?
Any advice you give us we would appreciate. We are very scared of another seizure.
Contrary to what you stated about "ketones indicate that he did not get enough insulin," we teach our patients that ketones indicate the body is starving: if there are ketones, the body is breaking down fat for energy, and generating fat byproducts (called ketones) as a byproduct.
If your son is waking up with ketones, he may have had an insulin reaction during the night, resulting in low sugar, followed by ketone production by the body as it burned up some fat in order to generate energy. It sounds like he may need a bigger bedtime snack, with protein: discuss it with your Diabetes Team.
If increasing the bedtime snack, we'd advise to add additional protein on the hope it'll result in long duration of caloric protection; we haven't recommending adding cornstarch (since it's a carbohydrate).
As far as your question of when to check for ketones, checking anytime the blood sugar is over 240 mg/dl (13.3 mmol/l) is a good guideline.
How long does it take for ketones to form? Not sure; definitely within 6 hours.
Original posting 14 Jun 96
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