Diabetes - sick day management and ketones
Diabetes - sick day management and ketones
Children with diabetes generally do not become unwell any more frequently than children without diabetes. But, when a child with diabetes is unwell, they need extra care and attention from an adult who has received training from a specialist diabetes team.
Key points to remember about diabetes, sick day management and ketones
- ketones in diabetes indicate that there is too little insulin in the body
- ketones can develop when your child with diabetes has an illness
- tell the diabetes team urgently if your child with diabetes is unwell with fever, vomiting, or diarrhoea.
- if your child with diabetes tests positive for ketones, contact your specialist diabetes team urgently
Is my child with diabetes more likely to become unwell?
Children with diabetes generally do not become unwell any more frequently than children without diabetes. But, when a child with diabetes is unwell, they need extra care and attention from an adult who has received appropriate training from a specialist diabetes team.
What should I do if my child with diabetes becomes unwell?
It is important that you tell the diabetes team urgently if your child with diabetes is unwell with fever, vomiting, or diarrhoea.
What can happen if my child with diabetes has an illness with vomiting and diarrhoea?
Illness associated with vomiting and diarrhoea (such as gastroenteritis) may result in low blood glucose levels. Illnesses, particularly those associated with fever, raise blood glucose levels because of higher levels of stress. If the blood glucose level remains high (more than 15 mmol/l) for a number of hours, a child will likely develop symptoms such as thirst, drinking a lot and going to the toilet frequently. They may become very tired and lethargic and feel unwell.
Ketones can develop with illness. High levels of ketones, can contribute to nausea and vomiting, leading to decreased food and fluid intake, higher levels of ketones, and dehydration.
Why are ketones and ketone monitoring important?
Ketones in diabetes indicate that there is too little insulin in the body.
If your child with diabetes tests positive for ketones contact your specialist diabetes team urgently.
Ketones are chemicals in the blood which come from the breakdown of fat. The body makes ketones as an alternative source to glucose in some situations. When there are ketones in the blood they will also be found in the urine.
When your child with diabetes is unwell, they should have frequent ketone testing. This is particularly important if blood glucose levels are above 15.
Tell the diabetes team urgently if your child with diabetes is unwell with fever, vomiting, or diarrhoea.
Please see below for guidelines on how to interpret ketone test results in either the blood or the urine.
How do I do blood ketone testing?
Meters are available that allow for measurement of ketones as well as glucose in the blood. Measuring for ketones in the blood gives an earlier and more accurate picture of ketones in the body than urine ketone testing. Blood ketone testing reports the amount of ketones in the blood as a number.
Blood ketone reading (mmol/l)
|Less than 0.6||Negative or trace only|
|0.6 to 1.5||Small to moderate ketones|
|Above 1.5||Moderate to large ketones|
How do I do urine ketone testing?
You use urine test strips to test for ketones in the urine. Always check the expiry date and the date the bottle was opened.
Your child can wee straight onto the strip or you can dip the strip in a clean container of urine. You can use clean cotton wool to capture wee in babies or toddlers wearing nappies.
You must read the result at exactly 15 seconds by comparing the colour of the strip to the chart on the side of the bottle.
The urine ketone reading should be either
|Negative||No colour change|
|Trace||Just a slight colour change (slightly pink)|
|Small||+ (darker pink)|
|Moderate||++ (dark pink to light purple)|
|Large||+++ (dark purple )|
How should I keep monitoring my unwell child with diabetes?
- check and record blood glucose levels every 2 hours when your child is unwell
- do blood ketone testing frequently or test urine for ketones each time your child goes to the toilet - tell your diabetes specialist team if your child has positive ketones
- your child with diabetes will need extra fluids/drinks when they are unwell - if the BGL is above 10 mmol/l and your child is not eating, offer unsweetened fluids such as diet lemonade, diet cordial, water or diet jelly
- if the BGL is less than 10 mmol/l and your child is not eating, offer sweetened fluids such as 100 percent fruit juice, normal soft drinks, icy poles, jelly
- fluid for hydration should contain salt and water if there is vomiting or diarrhoea (for example, Electral® oral rehydration sachets or Pedialyte®)
- your specialist diabetes team will let you know if they feel it is necessary for your child to be assessed in hospital