We have a family history of diabetes, so on a whim, we tested my nine year old daughter’s blood sugar two hours after lunch, and it was 164 mg/dl [9.1 mmol/L]. She went in for a physical, and the doctor called to tell me that there are ketones in her urine. They want to do a first morning urine test on her tomorrow. She is a healthy in both weight and height (75% on the scale). Is there any reason why ketones might be in her urine other than diabetes? Is it okay to keep using urine to test for diabetes? Should I ask for a glucose tolerance test on her?

Neither a single random blood sugar of 164 mg/dl [9.1 mmol] nor the finding of urinary ketones is, on its own, indicative of diabetes in an otherwise healthy nine year old girl with none of the appropriate symptoms of diabetes. The family history however may well have engendered an atmosphere of anxiety which together with the blood sampling created enough stress to account for the single high blood sugar.

In this situation, urine testing is of little value, and the best solution would be to obtain a fasting blood sugar level where the sample is drawn by someone very used to working with children and perhaps using a ‘butterfly’ needle or one of the essentially painless meters. If the value is then less than 110 mg/dl [6.1 mmol], it should allay your anxiety, and if it is higher, it should be repeated before coming to any conclusion.

Even so, I would be reluctant to accept a diagnosis of type�1A (autoimmune) diabetes without having full antibody testing by which I mean tests for anti-insulin, anti-GAD65, and ICA512, not just the screening islet cell antibody test.

There are other causes of urine ketones, but the test is extremely sensitive and can easily be positive after some hours of fasting.

DOB