My four year old daughter has recently moved into foster care. Since being there, her readings have been very high (typically 20-30 mmol/L [360-540 mg/dl]), and I am finding difficult to find out if she has had ketones in her urine. However, I can remember hospital staff commenting on the lack of ketones despite high blood sugars when she was first diagnosed about seven months ago. Should I be concerned about these high readings? Does the lack of ketones reduce the risks of letting her run high?

ketones are chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. The residual endogenous insulin secretion at the time of your daughter’s diagnosis might have been the reason why ketones, despite high blood sugar levels, were not present, but now the picture has changed.

High ketone levels can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then “spill” over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma (DKA [diabetic ketoacidosis]).

That said, high blood sugar levels are always dangerous and must never be let high. The absence of ketones doesn’t reduce this risk at all. Prompt action is required to improve your daughter’s metabolic profile trough an intensified multidisciplinary approach. I strongly advise you to have your daughter’s foster parents contact a pediatric diabetes team.

MS