Last night during dance, my daughter was disconnected from her insulin pump for about one hour. When she returned home she complained of stomach pains and nausea. Her blood sugar was 164 mg/dl [9.1 mmol/L], yet she had moderate ketones in her urine. She ate carbohydrates for dinner prior to dance. What could have caused this?

Ketones occur when there is relative insulin deficiency and the body begins to “burn fat” for fuel. Non-diabetics also get ketones: for example when they are fasting and thus burning fat or if they were dieting and not taking in carbohydrates. If you don’t take in carbohydrates you don’t manufacture insulin, thus you burn fat for energy and produce ketones. Diabetics obviously do this also, but in type 1 diabetes, the relative “complete” lack of insulin thus can allow the ketones to accumulate dangerously.

So, I’d hazard a guess that while your daughter was off her pump and while she had eaten carbohydrates, there was a mismatch of sorts that prompted the burning of fat. Was it dangerous? Probably not. But the ketones did probably make her feel a bit nauseated or give a stomachache.

I wouldn’t expect being off the pump only an hour to lead to this. You might wish to confer with her diabetes team about how overall controlled she is. Maybe she is “on the envelope” of less ideal control.

DS