May 18, 2002
Sick Days
Question from Michigan, USA:
When a child has ketones in the urine, and is sick, is it a problem if the ketones are more than “small”? How do they get ketoacidosis? Is it from being sick? How do we prevent it?
Answer:
Ketones in the blood or urine just mean the body is burning fats. This can happen unrelated to diabetes when one does not get sufficient calories (during periods of starvation, lack of food or illness associated lack of food; for example, vomiting and diarrhea). They can also happen with lack of insulin so that blood glucose levels climb since insulin is unavailable to allow glucose entry into the body cells. The body tries to protect itself from such lack of energy at the cell level and utilizes stored fats. Whenever fats are being utilized for any reason, ketones would then be present.
DKA [diabetic ketoacidosis] from insulin deficiency (total lack as at diagnosis or relative lack as during an illness, severe stress, surgical stress etc), is associated with hyperglycemia plus ketones, and if left unrecognized (a person not monitoring and therefore unknowing) or untreated (someone who does not know sick day guidelines and does not respond with extra fluids, salty fluids and insulin), then dehydration and ultimately death can occur with untreated DKA. Therefore, knowing this allows one to monitor ketones any time blood glucose levels are above 240 mg/dl [13.3 mmol/L].
In addition, with high sugars and high ketones together, this is an indication to call your diabetes team for advice or to learn how to adjust insulin and salty fluids to compensate. With gastrointestinal illnesses, sometimes there are low sugar levels and positive ketones and this means the same or less insulin if this occurs plus sugary and salty fluids like Gatorade, Lytren, Pedialyte, regular ginger ale, etc., for the one or two days of the illness.
You should review all this with your diabetes team so that they can give you more specific advice such as how much extra insulin to administer and when to call them.
SB
[Editor’s comment: See Sick Days for some additional advice.
SS]
