Ketones Management

What are ketones?

Ketones are byproducts of fat breakdown which can occur when the body cannot use sugar to make energy. It often occurs when there is not enough insulin in the body or when a patient is sick or dehydrated. A large amount of ketones in the body can cause stomachache, vomiting, or lead to ketoacidosis. A large amount of ketones also causes a sweet odor to the breath. Ketones can be detected in blood or urine.

What are the main causes of ketones?

  • Illnesses

  • Missing insulin doses

  • Expired insulin

  • Insufficient amount of insulin for meal

  • Insulin pump malfunction such as bent catheter

When to check for ketones?

  • Morning blood sugar above 240 mg/dl

  • Anytime blood sugar is above 300 mg/dl

  • Student is ill or vomit.

  • Student has excess thirst or frequent urination.

How to check for ketones?

Urine strip

  • Have the student void into a clean cup and dip the test strip into urine.

  • Most test system use color to indicate the level of ketones.

  • Read specific instructions regarding the time needed for the interpretation

Blood ketone meter

  • Same method as checking blood sugar

Ketones management

  • Contact the healthcare provider immediately if the student has moderate to large ketones in the urine or the blood level is above 1.0 mmol/L.

  • If the student has moderate to large ketones and has high blood sugar, extra amount of rapid-acting insulin is required every two to three hours to stop the production of ketones (refer to the slides from webinar)

  • If the students is using a pump, the rapid-acting insulin should be given by injection. The pump site may need to be changed (discuss with the healthcare provider).

  • Allow the student to drink plenty of water to maintain hydration.

  • Avoid exercise as the ketones level may increase.

Hyperglycemia and Ketones.pptx

SIides from 2020 School Diabetes Management Webinar

Video instruction for ketones testing (