My 3 year old daughter (diagnosed a year ago at 2 years old) wakes up with ketones frequently and always has them after breakfast, whether she woke up with them or not. It’s like the Humalog is not working for an hour. She takes H and N in the morning. They always go away. Is this a problem I should be worried about? I usually wait 30 minutes after her shot before I give her breakfast.

It is unlikely that Humalog has a delayed action in the morning only; but you might begin by considering other explanations such as whether you mix the morning Humalog and NPH some time before you give the injection. Another possibility is that you are measuring before breakfast ketones on diaper urine and after breakfast on a normal specimen.

Otherwise you need to collect all the data on blood sugars, insulin doses, snacks, etc. and work with the doctor or the nurse educator in your diabetes team to solve the presence of the ketones. If the blood sugars are high before breakfast as well as in the middle of the night and the fact that you were giving the Humalog 30 minutes before the meal suggests that they may be, then the probable explanation is not enough long acting at supper time the evening before. On the other hand even a normal two year old who has fasted for twelve hours may show trace ketones so you might find that a bedtime snack solved the problem. Again, the dietitian on your diabetes team may be able to help you and snack recipes can be found in most books for childhood diabetes such as Understanding Insulin-Dependent Diabetes.

DOB