Keytones and kids that are old enough to manage at school

I am going to admit that we don’t test keytones faithfully. In the occasions where I felt we needed to there have always been no keytones or trace amounts. So unless he’s been ill and if it’s 1 time high during the day we don’t test keytones. I’m curious how everyone else handles it. Today the school nurse called because he had a high reading and asked how come he wasn’t testing keytones. I don’t think he was happy with my answer but that’s the way we’ve been doing it for 8 years.

Everyone manages their diabetes differently, I’m just wondering how everyone else is doing it.

Thanks,
Stephanie

We tested religiously the first few years, any time I was sick or over 250, but then fell off the wagon. I think I stopped testing in early high school and didn’t start again until age 28. blush

I agree that we all should test more often, of course, but I think that life gets in the way and it never seems quite as urgent as knowing that blood glucose value or making sure you’re dosing the right amount of insulin. The truth is that it’s complacent of us to think that way and DKA could take any type 1 without a lot of notice. =/ Does that thought make me test often? No. But it does make me test more than I used to.

You might consider the individually wrapped-in-foil ketostix. They don’t expire as quickly as the bottled version and you can know you have them on hand in a pinch. It’d be great to have one in your purse that you can just hand him and send him off to the bathroom with when you’re out and about. I keep one wrapped strip in my meter pouch at all times.

All of it is so true. But when it’s a little foil stick that I can carry and he can easily carry in his pouch it seems silly not to be doing it. I don’t know why I didn’t think of just keeping one in his pouch. He actually is very interested in those sticks, checking to see if they change color.

In case you have trouble finding them…

I’ve found them online (can’t ever seem to find them at the pharmacy). I have seen them at edgepark.com, diabetesandmore.com, dlife.com, and several other places. You might also give your local pharmacy the NDC number for the foil-wrapped strips and see if you can order them: NDC 0193-2640-20.

We take a similar approach. Since Abbie’s only ever had ketones when she’s sick, we only test if she’s had several high readings in a row, or a high that we have a hard time getting down. And even those are negative or trace.

At school, because ketone testing is in the care plan that our DR signed, they insist that she test if she’s ever over 300. I’ve had the school nurse lecture before as well and have learned to just nod and smile.

My son has only had diabetes for 1 year. At school we test keytones because we have to. At home he tests when its abnormally high like if the test before was around 100 then the next one is 300. Usually we get zero to trace. Only once we got a small to moderate and that week he had a slight cold. Lately his numbers have been really high and it is driving me crazy. We just go along with our lives as normally as we can. Its a part of us now.

We test whenever my son is over 250 - but only since he’s been pumping. Our CDE wanted us to catch it early if his pump wasn’t delivering or something had gone wrong. Before that she said that that if we pretty much knew why he was high we didn’t have to worry about testing. We also got the precision meter so we could test with a finger prick - more accurate and easier to do in my opinion. Do you have one of those?

I will only test if there is a sustained high for hours. Even then he has never been positive for ketones when high. Caleb does not have ketone strips at school. If he were high for an extended period of time I would go in anyway.

The reason I don’t test otherwise is because it would not change my course of action. I would still deliver the same insulin dose and encourage liquids.

The only time Caleb was slightly postive for ketones was when he was ill, sustaining lows and not eating. I would still check under those circumstances as well. The body can produce ketones not only because of high blood sugars but also because it isn’t getting enough insulin into the system, which was the case with Caleb when he wasn’t eating and the illness caused lows, not highs.

Knock wood, he has not had a significant illness since that one time.

Yes, we have a precision meter but rarely use it now. We used it more when he was a toddler, he’s almost 11 now and actually has fun with the sticks.

I’m glad to see we’re not doing much different. I don’t have it in the plan to test his keytones at school because we are next door to the school and if there is ever a need I will bring him home and test him. The dr. was ok with this so that’s how it was written. The nurse today was filling in for the nurse we’ve been with for 6 years so it’s probably why it’s the first time I’ve had the question. I think I still like the idea of having a foil sealed strip in his pouch just in case anyway.

And yes, SFMAMA, we are very good at the smiling and noding!

lol - I like the nod and smile comment! Yes we do get good at that don’t we (as painful as it can be sometimes). I can’t be the only one who does not change the lancet after every finger stick can I? That always seems to raise an eyebrow.

Stephanie,

David keeps what we call an emergency kit in his backpack, separate from his test meter. It contains a bottle of ketostix, vial of insulin, 3 syringes, alcohol packets, spare resevoir, spare infusion set for his pump, set of batteries for his test meter, spare AAA battery for his pump, medic alert card, a business card with all of my coordinates and two quarters for a payphone. It all fits into a small plastic box with one of the good 4-sided lock lids, just a little longer than a sandwich box. Even though it is always handy, he forgets to check for ketones routinely as part of a high BG correction, and he is 16 years old.

You will have to look at how the numbers convert, but normal BG in mmol/l is 4 to 7, 10 mmol/l 2 hours after eating and 8 mmol/l going to bed. He is supposed to test for ketones every time his blood glucose exceeds 17 mmol/l. His kit is handy but he often skips the ketone test before automatically treating high BG’s. If he does not feel well, and has a high BG over 10, he will do both. Earlier this week David tested for ketones with a 14.8 reading simply because he did not feel well at the same time as the high BG. His ketones were slightly elevated so the early catch to correct probably saved him from having a really bad day.

Cheryl

My dad, who is type 2 and only tests every few days, was shocked that I didn’t change my daughter’s lancet every time we tested. At diagnosis, the nurse at Children’s told me we only need to change it every 2-3 days so that’s what we have always done. It does seem to go against the clean needle theory though:-)

My 11 year old daughter carries the foil strips with her to school, but she only checks if she is 250+ two times in a row or when she feels like she might be coming down with a cold/flu (regardless of what her BG is). When getting sick is the only time she has had Ketones so we are pretty on top of it at any sign of illness… and usually her BG is great when Ketones have been present.

Change the lancet? What’s that? only kidding, we religiously changed it the first few years every time. Not any more.

We rarely check for ketones. If she has a high number for more than 2 checks in a row or highs and she is complaining of feeling ill - other than that we just don;t check anymore. We have NEVER had ketones - even at dx. She had a 14 A1c and still no ketones . . .My dh has never had them either - (well except at his dx - but he was an adult at dx and in college and put off going to the doctor until he about passed out and was in DKA.)

We keep ketostiks at school and I think they make her check if she is over 300 - but we have a daily morning spike in the upper 200’s and low 300’s daily at 9:30ish - we have adjusted her basals, her i:c and what she eats and still a spike - but by lunch she is normal range. So I do not worry about ketones then . . .

She has only had trace ketones, no matter how high the BS, even if it takes a few hours to come down. We always give more insulin, increased temp basal and water when high. We put the increased temp basal on if there is no movement in two hours.

Hi Stephanie,
We test for ketones after two high (250+) numbers in a row. My son is 11 and pumps. He has had trace/small ketones before and it seems like once they come it makes everything so much more stressful for me. He gripes more about having to pee on the stick than pricking his finger…go figure!

I think you have to go with what your experience is. Most people here have stated they know they don’t have to worry unless they have had highs repeatedly. But that is because they have experience in testing and getting no results. I will say that we fall into that category too. Unless they have repetitive highs…I don’t force the kids to test. However, that’s because I have learned that they read negative if it’s just one high number.

On a note with school nurses. (and this is my personal opinion) You definitely want them on your side, so you have to be delicate. However, you also need to be firm in this is how you manage your son’s diabetes. You dictate to them, not visa versa. My son is also an epileptic and have learned through the years of both kids being in school with diseases that I had to stand strong and would not let anyone make me feel guilty about how I managed my children’s care. Boy howdy have they tried. There were many years when I was told that I was to follow their rules, until a light bulb went off in my head. “wait a minute, this is my damn kid…” and that was that. From now on, even if it’s the same nurse year after year, I walk in with a plan and all their paperwork filled out. (It’s usualy online in the States.) Then when we sit down for the appointment I have set up, I go over what their part is as the school nurse. Ever since then my relationships with the school nurses have been of one of trust and partnership which is how it should be.

I am new to this site and new to diabetes, but I feel so much better now. Our endo said that we should test ketones when Becky is over 250. She was diagnosed 09/09/09. We haven’t checked ketones in a very long time. Most of the time, if she is over 250, I know exactly why. She is 8 (will be 9 in December). She has brought home a fun size tootsie roll because she was scared to eat it. She has eaten stuff and knew better, but then tells us when the number is high.

We were also told that it is okay to just change the lancet every few days. Becky says that she can tell when one needs to be changed. I was questioning the “clean needle” thing and was told not to worry about it. Just don’t let her drop her lancet into a dirty puddle. If that happens, then change it.