Sick day management and ketones

Sick day management and ketones

Children with diabetes generally do not become unwell any more frequently than children without diabetes. When a child with diabetes is unwell, however, they need extra care and attention from an adult who has received training from a specialist diabetes team.

Ketones can develop with illness

Children with diabetes generally do not become unwell any more frequently than children without diabetes. When a child with diabetes is unwell, however, they need extra care and attention from an adult who has received appropriate training from a specialist diabetes team.

It is important that you notify the diabetes team urgently if your child with diabetes is unwell with fever, vomiting, or diarrhoea. 

Illness associated with vomiting and diarrhoea (for example, 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 persistently 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.

Ketones and ketone monitoring

Ketones in diabetes indicate that there is too little insulin in the body.

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.

Ketone testing should be done more frequently when your child with diabetes is unwell and particularly if blood glucose levels are above 15.

If your child with diabetes tests positive for ketones contact your specialist diabetes team urgently. Please see below for guidelines on how to interpret ketone test results in either the blood or the urine.

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

See a video about ketone testing at the Starship Children's Hospital website

Thumbnail image of a video still showing hands in the process of doing ketone testing

Urine ketone testing

Testing for ketones in the urine is done using urine test strips. Always check the expiry date and the date the bottle was opened.

Urine can be passed directly onto the strip or by dipping the strip in a clean container of urine. Clean cotton wool can be used to capture urine in babies or toddlers wearing nappies.

The result must be read 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 )

Monitoring

  • check and document blood glucose levels every 2 hours when your child is unwell
  • carry out 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

The Paediatric Society of New Zealand acknowledges the cooperation of the Starship Children's Hospital, Auckland District Health Board.  The content on this page has been produced in collaboration with the National Clinical Network Children and Young People's Diabetes Services. 

This page last reviewed 29 July 2016.
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