My 10 year old son was diagnosed about 14 months ago, and, in the past few months, I started checking his urine for ketones more carefully. I find with illness, even though he may have good glucose numbers, he still gets mild ketones. Today he has a slight illness coming. I tested him this morning and he has plus 2 ketones. He was 88 mg/dl 4.9 [mmol/L] at bedtime and woke up at 163 mg/dl [9.1 mmol/L]. So there was a rise over night but I would not think it was enough to cause this sort of ketone problem. If I suspect type 1B, how can I have this clarified?

There are two common reasons why your son might have ketones in his urine. The first is not exclusive to people with diabetes; any child may show ketones in the urine if they do not eat enough carbohydrate to meet basal energy requirements. They then have to use body fat stores for fuel which results in the production of ketones The most common cause for this is a diminished appetite often due to an infection.

A similar mechanism is involved in DKA [diabetic ketoacidosis] but, in this case, the problem is not due to not having enough carbohydrate in the diet, rather it is due to having insufficient insulin to metabolise the sugar that is available. Both conditions can exist at the same time. However, if blood sugars are normal then the problem is likely to be primarily due to diminished appetite.

type 1A (autoimmune) and type 1B diabetes both have an acute insulin dependant onset, but, in the case of the latter, the antibody tests at this time are negative.

The underlying pathology of type 1B is not yet well understood. Although it seems to be another form of insulin deficiency, it is sometimes possible after some weeks or months to dispense with insulin and to manage glucose control with oral hypoglycemic agents or even with diet and exercise. The thinking is, however, that insulin dependence will one day recur.

DOB