March 7, 2006
Diagnosis and Symptoms
Question from Albany, New York, USA:
I had heard back from the pediatrician after my daughter had moderate/large amount of ketones in urine but, no sugar. I decided to check her blood sugar since I have a home glucose tester. Her readings varied. Fasting levels were 86 mg/dl [4.8 mmol/L], 104 mg/dl [5.8 mmol/L], 127 mg/dl [7.1 mmol/L], and 142 mg/dl [7.9 mmol/L]. After meals, the highest it’s been was 122 mg/dl [6.8 mmol/L], while the lowest was 80 mg/dl [4.4 mmol/L].
Her CBC (Complete Blood Count) and CMP (Comprehensive Metabolic Panel) both came back normal. She had no sign of infection or things like that. She still complains her stomach hurts and is hungry and thirsty a lot. I just don’t know what is going on. I was hoping to get an explanation as to why the ketones were present. If there were that many ketones and she was dehydrated or starving, wouldn’t blood work show that? Or, shouldn’t the doctor have been worried if she were that dehydrated to show that many ketones? She is not on a low carbohydrate diet. She is four years old and carbohydrates are her friends. I guess I was just hoping to have a real answer from the doctor, not just “I don’t know.” I also don’t want to go into the office demanding tests either. I am just trying to get an informed reason as to why!
Answer:
It is not normal for a four year old to have fasting blood glucose levels above 100 mg/dl [5.6 mmol/L]. Ketones only indicate that the body is using fats for energy. If insulin deficient, ketones associated with high sugars can be potentially dangerous. If normal or hypoglycemic at the time the ketones are present, this just means the body metabolism has shifted from utilizing carbohydrates (and proteins) to using stored energy (fats). So, the key issue metabolically is what is driving all of this and that is the medical detective work that needs to be done. If the pediatrician cannot answer such questions, perhaps you should get a consultation from a pediatric endocrinologist in your area or a metabolism specialist.
SB
