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November 11, 2002

Diagnosis and Symptoms

Question from Cullman, Alabama, USA:

My three year old son has had type 1 diabetes diagnosed at age 17 months. I have just checked my seven year old child (who does not have diabetes), and got a blood glucose reading of 498 mg/dl [27.7 mmol/L]. I also tested her urine for ketones, but she was negative for this. Would she have ketones if she was developing diabetes? My son was in DKA [diabetic ketoacidosis] with a very high blood glucose, so I have never known what other symptoms can lead to a diagnosis. I will be calling his diabetes team just to let them know of this event if her blood sugars do not return to normal, but the ketones have me puzzled.

Answer:

Ketones are a reflection of the breakdown of stored body fat. They generally are a natural waste product. When the body is “starving” for food, there is the natural metabolism of fat that leads to ketone production. So everyone, whether or nor they have diabetes, will have ketones on occasion, especially during illnesses.

Diabetes has been called “starving in a sea of plenty” meaning that despite an abundance of glucose sugar (“sea of plenty”), the body is unable to use it well (“starving”). Therefore, ketones can start. Most often, the threshold to begin ketone production in a patient with type 1 diabetes is around 240-250 mg/dl [13.3-13.9 mmol/L]. So, it is commonly advised that when someone with type 1 has a glucose more than that, to start checking urine for ketones. Some blood glucose monitors also have special strips to test for blood ketones.

Not all people with type 1 diabetes will have ketones at diagnosis, but most do. Be certain that your urine ketone strips are not-expired and that they are giving accurate information. In humid places, if you don’t have the strips that are individually wrapped in foil, the humidity can make the strips go bad. An easy way to test your ketone strips is to place a drop of acetone on the strips. Some nail-polish removers have acetone. Be careful since some newer nail-polish removers are labeled as “acetone-free” or “non-acetone.” To test your urine ketone strips, you would want to use a nail-polish remover with acetone. Common symptoms of ketone accumulation is nausea, stomachache (can be severe), vomiting, headache, and mental confusion.

DS

[Editor’s comment: See symptoms of diabetes.

SS]