August 25, 2003
Diagnosis and Symptoms
Question from Seattle, Washington, USA:
Recently, my husband went on the Atkins’ diet, and as he entered ketosis the odor of his breath changed. It alarmed me as our daughters breath often smells just like that. I often referred to it as her “sick breath”, and she always got that smell around the time she was getting a cold, flu, or infection. Now, she gets that breath more frequently without being sick.
The other day I tested her urine and she tested high for ketones. Then for several days she tested negative. Yesterday she woke up and the odor was back. She tested very high for ketones all day. By 9:00 in the evening she finally tested negative. We have not yet tested her blood glucose level or tested her for glucose in her urine. We have not noticed an increase in drinking or urinating. We have noticed that she does go through severe mood swings which seem to ease up if she eats more frequently. She does eat a high amount of carbs.
When we called the doctor, she said that high ketones like that is not normal. We are confused. Why would her ketone levels fluctuate so much? Is this an early indication that perhaps her pancreas is not consistently producing enough insulin? We are very concerned and don’t want to wait until she goes DKA. Is diabetes a concern?
Answer:
You are mixing up ketones associated with high sugar levels which may lead to DKA [diabetic ketoacidosis] with ketones present in blood, breath or urine. Ketones only indicate that fat is being burned/metabolized. So, it’s unlikely that your daughter has diabetes if she has normal sugar levels and high ketones. However, I wonder if she is hypoglycemic and having something called ketotic hypoglycemia. Another possibility is she doesn’t eat sufficient calories and therefore burns her own fat to supply energy to her body. You should discuss this with your child’s physician to decide what, if anything needs to be done.
SB
