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From Illinois, USA:

I have two questions.

In a recent question, you suggested checking night time blood sugar levels. Can you explain the relationship (if any) between morning ketones and middle-of-the-night hypoglycemia?

Our 4 year old daughter was diagnosed with IDDM 2 years ago. She rarely has ketones, but we only check when she is running high. The other day she complained of a stomach ache. Her blood sugar level was not high at that time, but she had been running high (200-300) for the previous 12-15 hours. We did not check for ketones when she complained her stomach hurt. My second question is, could she have had ketones which would make her feel like she had a stomach ache?


Ketones are produced when the body breaks down stored fat to get extra "fuel for energy." People with diabetes can produce ketones if they go a long time without eating or don't eat enough calories (as in fasting or dieting). Many young children who don't have diabetes have ketones in their urine in the morning, as during the night when they are not eating, their body must break down stored fat to get "fuel." The blood sugar is usually normal or can even be low if they are unable to get enough sugar from their stored fat and from stored sugar in the liver.

Young children with diabetes can have ketones in the urine in the morning for the same reason I just described in children without diabetes. The production of ketones in this case is not related to the blood sugar.

The most common reason for ketones to appear in the urine in children with diabetes is when there is not enough insulin. In this case, the blood sugar is high because the body can't make enough insulin to use the sugar for energy, and fat is broken down. Once ketones are produced, it may take 24 hours to clear them from the body even if the blood sugar is returned to normal. Ketones can cause nausea, abdominal pain, and vomiting. Ketones can also be produced if the child is sick, say with a stomach virus, and the blood sugar goes high because the body can't make extra insulin which is necessary during illness. If extra insulin is not given, ketoacidosis can develop rapidly.

The third reason for ketones to appear is in response to a previous low blood sugar. This is what I was referring to in the question about the child on the pump with ketones in the urine in the morning with a blood sugar of 184. It is well known that people with diabetes can sleep through a low blood sugar during the night and the blood sugar may come back to normal (or even go high) without treatment. This usually occurs because the body makes hormones like epinephrine which cause the body to release sugar which has been stored in the liver. These hormones also break down fat and produce ketones. The ketones may be present in the first morning urine even if the blood sugar is not high and may indicate an undiagnosed low blood sugar hours previously.

(Please note: an "asymptomatic" low blood sugar during sleep can also lead to seizures.)


Original posting 25 May 97


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Last Updated: Tuesday April 06, 2010 15:08:54
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