Ketones.......

I'm going to start by saying Ketones are scary. Just uttering the word can be frightful. Normally we test for Ketones once a day every morning with our KetoDiastix's. But on occasion when Cliffy's blood sugar runs higher, or if he is sick we test more frequently. Yesterday was one of those days.

Let me back track a bit for those that might not know what Ketones really are.

What are ketones?

Ketones are produced when the body burns fat for energy or fuel. They are also produced when you lose weight or if there is not enough insulin to help your body use sugar for energy. Without enough insulin, glucose builds up in the blood. Since the body is unable to use glucose for energy, it breaks down fat instead. When this occurs, ketones form in the blood and spill into the urine. These ketones can make you very sick

When should I test for ketones?

• Anytime your blood glucose is over 250 mg/dl for two tests in a row.
• When you are ill. Often illness, infections, or injuries will cause sudden high blood glucose and this is an especially important time to check for ketones.
• When you are planning to exercise and the blood glucose is over 250 mg/dl.

If ketones are positive, what does this mean?

There are situations when you might have ketones without the blood glucose being too high. Positive ketones are not a problem when blood glucose levels are within range and you are trying to lose weight.

It is a problem if blood glucose levels are high and left untreated. Untreated high blood glucose with positive ketones can lead to a life-threatening condition called diabetic ketoacidosis (DKA).

What should I do if the ketone test is positive?

Call your diabetes educator or physician, as you may need additional insulin. Drink plenty of water and fluids containing no calories to "wash out" the ketones. Continue testing your blood glucose every 3 - 4 hours, testing for ketones if the blood glucose is over 250 mg/dl. Do not exercise if your blood glucose is over 250 mg/dl and ketones are present.

I'm usually quite confident when Cliffy has Ketones that we can drink some water, get some insulin in him and flush them out. I can usually handle caring for him at home when he is sick, and feel confident we don't have to run to the hospital. However yesterday by confidence took a nose dive. First off he was the darkest level you see in that picture "Large" ketones. The strip turned right away. Okay I thought let's get some water in you, the insulin was already in, made no sense as I increased his breakfast, and lunch dose because his blood sugar had been crazy high all morning. After lunch he got sick. (Not a good combination with ketones), however I knew it wasn't really from what was making him ill, but rather his belly was feeling icky from the ketones, and he tried to down the water like a crazy man. Come 2pm we were still sitting at "Large" ketones, and this concerned me. But what concerned me more was when I went to check on him while he was napping. I put my hand on his chest to see if he seemed congested when he was breathing. No congestion, yay, but he was at rest and his heart was racing, his breathing was increased. The only thing I could think about was those stupid ketones, and DKA!. Yes, my mind went there, how could it not, he was sitting with large ketones, rapid breathing, and a racing heart. I called his endo team, and she assured me I was doing a great job with increasing the insulin to get them out and bring him down. But we just needed to up the insulin a little more, and still encourage him to drink the water.

Ever have a conversation with your sick child that involves you telling them we need to drink this water or they would end up in the hospital with an iv in them or worse? That is the reality of every time Cliffy is sick and has ketones. It's not please drink some water to stay hydrated. It's you NEED to or your going to the hospital. Cliffy has too many times after diagnosis been in the hospital with IV's and he is not a fan of them at all. He'd rather stay home and rest. So after the scary part of our conversation, I told him as long as he does his part, and with me doing mine we'll kick it like a team. So he asks, "What is my part". I told him "To listen to me" .. "Drink the water when I tell you, eat when I tell you, pee in the cup when I tell you, and rest". Then he asked "What is your part". to which I replied "Everything else". We shook hands, made a deal we would work as a team and kick it. Bedtime rolled around and we tested for ketones , and there were none!! And even more importantly his blood sugar had gone down to 116! This was a huge victory for us so we celebrated with a high five! Now another day starts, and it's time to see where we sit with these dreaded invaders once again, but I'm going into it this time feeling more confident we can kick it as a team.