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April 8, 2000

Hyperglycemia and DKA

Question from Virginia, USA:

I am a type 1 diabetic. When I get high blood sugars (250 and up), I get the symptoms of ketoacidosis (thirst, frequent urination, tiredness) but when I check for ketones with Ketostix it's always negative. It does this even if I get a new bottle of strips to recheck with. It would take several days of very high sugars (300-up) just to produce a ketone reading on my strips. I usually get my blood glucose readings down before this happens, but during periods of sustained illness find it difficult to do this. Consequently, I feel like I have ketoacidosis when my urine strips say negative. What could be causing this?

Answer:

If your Ketostix are negative, you don’t have ketoacidosis. During times of illness, it is important to closely monitor your blood sugars, check for urine ketones frequently, and be flexible with your insulin dosing. You might want to check out sick day management guidelines at http://www.uchsc.edu/misc/diabetes/chap15.html.

MSB
Additional comments from Dr. Bill Quick:

You’re describing the symptoms of hyperglycemia. Ketoacidosis has additional symptoms you don’t describe, such as extremely heavy breathing, abdominal pain, nausea, hypotension (dizziness upon standing), and a fruity odor to the exhaled breath.

WWQ