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January 17, 2007

Hyperglycemia and DKA, Sick Days

Question from Kuna, Idaho, USA:

About a month ago, my six-year-old daughter, who has type 1 diabetes, had a pretty nasty stomach flu. She was able to hold down fluids, but not solids. She had normal to low readings throughout, but nothing too concerning or low. We were able to treat her with Powerade as needed for lows, plus every two hours. About 24 hours into this, she was able to hold down a few things, like applesauce and rice, but at that point her ketones went from small/medium to large. When I called to get our Pediatric Endocrinologist's advice, he said that the ketones were starvation ketones and that they should start to clear soon now that she was eating solids and just keep an eye on her. We were to call him back or take her to the Emergency Room (ER) if she had signs of dehydration or started to vomit again. I have noticed on the CWD forums that most of the other children need an ER visit at this point, so it made me wonder if I should have taken her in anyway. Could you explain the difference between ketones from starvation and ketones from a high blood sugar? Also, why is no ER visit required for large ketones if they are from lack of food? And, do they require extra insulin still?

Answer:

Large ketones are clearly a sign of problems with your diabetes. Ketones can be caused by a lack of adequate food intake. These are typically called starvation ketones. These are more prevalent when a child has a stomach flu with vomiting and diarrhea and hasn’t been able to eat appropriately. It is more common to have normal or low blood sugars with starvation ketones. These can very easily be confused with ketones from diabetic ketoacidosis (DKA). It is more common to have high blood sugars with these ketones.

Telling the difference between the two ketones can be difficult without a physician’s expertise. I would always suggest that you review your child’s condition with your diabetes physician or team if ketones are moderate or large. Starvation ketones are typically treated with fluids and restoration of adequate food intake. DKA ketones are treated typically with fluids and supplementary insulin under a physician’s guidance.

MSB