Thoughts on ketones in urine for friend's son

I have a friend who has a little boy with Autism. I believe it was last month that one of his doctors mentioned they may need to start monitoring him for diabetes because he had an elevated fasting blood sugar ( I think it was 145) She and I had talked about symptoms and such and I offered her some Ketostix to check his urine for ketones if she needed to. She had mentioned times when his breath and urine had a fruity smell. She had checked a few times since then and they were always negative, but this morning he woke up with a soaked diaper and fruity smell to it and she checked the ketones and they were positive. She said she just held it to the diaper because it was saturated and it showed positive. She had called me but I was at work, and didn’t get her message until later and she said he had seemed fine and she sent him to school. I met her after school and we had decided I could check his blood sugar and it was normal 124 ( he had popcorn snack around 1pm) So she was relieved but left wondering what the ketones were from? I asked how he had been eating and drinking and she said he has been dong well, so it isn’t like a “starvation” or dehydration issue. Maybe a diet higher in protein? Just wondering if anyone here may have any thoughts? I am trying to be supportive and helpful and am hoping I am not creating more stress for her by thoughts I am offering. I told her to check for ketones again this evening with using cotton balls in his diaper and to let his doctor know if they are still positive. She is going to take him in for fasting bloodwork in the morning before school. He does have symptoms or excessvie thirst and urination at times, not sure if this is more of a diabetes insipidus thing? Any thoughts?

My oldest boy just turned 5 (Type 1) and I also have a younger boy who is about to turn 3. Jackson (who will turn 3 in about 2 weeks) was treated for Neuroblastoma (a pediatric cancer) when he was 9 months old (chemo and surgeries).

He has been well since then, but recently started showing a few signs of Type 1. Frequently thirsty, very wet diapers. We check his bg fairly frequently, and is usually in range).

Recently he had a mild stomach bug, threw up 2 times in one day, and was fine the rest of the day. He ate and drank normally after this, but on a hunch, my wife checked his ketones much later in the day, and they showed as Large. We freaked out and I rushed home to help test his bg (as he doesn’t like doing it). We did and he was 110 or so. We talked to the docs and it was determined that the small duration of vomiting was enough to elevate the ketones.

Has your friend’s child had any illness lately?


She did get to go over everything with his doctor later that evening and she seems to think it may be that he just isn’t eating enough or tends to eat a higher protein diet. His metabolism is not functioning well so he might not be absorbing enough. They are still waiting to hear back about his fasting bloodwork. But her doctor encouraged her to feed him plenty of whatever he will eat. Today she said the ketones were trace. I hope the bloodwork continues to come back normal for him. They have enough challenges each day. Thank you for the reply.