My son is 15. Diagnosed 3 yrs ago, pumping for 2 years. I started a non-profit charity about a year ago (Type 1 Diabetic Moms) I have met a lot of parents of T1D kids in the last year. My son spills ketones ALOT! His A1c is 6.5 so he is well controlled. But if his BG is normal at lunch and accidentally forgets to bolus at dinner, he will have large ketones (urine stick almost black) at bedtime. He can have BG’s in range all day and one BG over 250 and he will have moderate ketones. He has only forgotten to bolus 3 times. He has ketones ranging from small to large about 3 times per week. None of the other parents’ kids ever have ketones unless they are vomiting. Does anyone else have issues like this?

all I can say is wow he is sensitive my son who is 16 can run high 200 to 300 all day and barely have any ketones, if he misses a bolus or if he has a pump issues he is much more likely to carry some but never large, what does his doctor think? I would say perhaps your test strips are old but I think if they are old they just read negative but I guess keeping the big picture in mind, how high is he, has he forgotten a bolus does he feel sick? I know most people here suggest the biggest sign of problematic ketoacidosis is vomiting some report issues with blood sugars in the 200s with vomiting and bad ketoacidosis, like they say every one is different, learning to 'work' your body or help your child do so is the secret! best wishes, amy

He always knows when he has moderate to large ketones because his stomach will hurt and he feels nauseated. I thought that too about the ketostix but we go through them quickly and the lot numbers are different. It just worries me what those ketones are doing to his body over the long run. Maybe he is just sensitive. His doctor never seems concerned, about anything ever. Guess that’s what happens when you are a nurse’s kid!! Thank you for your response!

Ask your health care provider if you can get a blood ketone meter to check your son with. It is much more accurate than the urine strips. Providers often have samples that you can have for free. Sometimes insurance balks at the cost of the strips, but a reminder that it is less expensive than hospitalization due to ketoacidosis could change their mind, especially if it seems your son is going to have this level of ketones regularly. How frustrating that this is happening in spite of doing all the right stuff! Also, maybe you are already aware that the urine test strips are only good for 3 months once opened, but if not, perhaps that is part of the problem? I hope you are able to find an answer soon! Make sure your son drinks extra (carb-free) fluids to flush out the ketones. That really helps, too. Good luck to you on finding some answers!

well he clearly isn't having to many days like that as his A1c is excellent, is he a big water drinker that definitely offsets ketones, I am like the water police around here. i think his A1c is a better indicator of complications and from that he is doing very well. funny your doc is so neutral but i guess they see it all. best of luck with the battle, not a good one around here today hoping he comes down before bed. i was pretty over the top with my mom today with worry but she understands better than most.

He does drink a lot of water. And we go through ketostix well before the 3 month mark. I think I will call the nurse Practioner. I seem to get a better response from her. It is really frustrating. We do everything right but he gets ketones so easily. Thanks for the tip about the blood test strips. I will definitely ask for some!

What is his basal setting? He should not have ketones unless he is getting zero insulin during the time frame his bolus insulin isn't operating. I am puzzled as to how he can produce ketones when his A1c is so low and his BGs are in range — ketones almost always means he isn't getting enough insulin, but that would also make his BGs high, and they're not.

The only explanation I can think of is that he is staying in range because he is bolusing the crap out of all his carbs but his basal is way too low, hence the ketones.

Here's a quick test: Figure out what the total amount of insulin is that he uses in a day. Then divide the amount bolused by the total. If you get a number that is over 0.6, he is out of bolus-to-basal balance (it should be at most a 60/40 ratio, closer to 50/50 is better). If he is over 0.8, then your most likely answer is that he's getting way too little basal and way too much bolus... but I don't think that's it unless his basal is turned all the way off somehow. Do check the pump's settings though — my 7-year-old has occasionally messed up his programming out of sheer curiosity.

Could also be that as a teenager, he just needs a lot more insulin at certain times of day than he's getting due to growth hormone.