For those that have children in elementary school, does your school nurse test for ketones in urine at school for numbers over 300 ? We don’t usually check for them at home that much. When we are high we give extra insulin to get blood sugar down. Of course if we are pretty sick, I might, but most days we don’t.
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Our son is now in 7th grade but he was T1D in ES. In ES, I was in charge of his school management, according to the accommodations.
My son had a para with him during the day but anything like a Ketone check would be something the nurse and I would discuss via our shared chat. I would send messages to the para/nurse and they would execute against my requests.
In our case, as long as Liam wasn’t over 300 for long, we only treated with insulin, made sure he stayed hydrated and waited for BGs to drop. If they didn’t drop for an hour or two, then we’d begin doing Ketone checks (we used blood ketone test strips though). But we never needed to do this in all of his ES.
The DMMP should specify when ketones are checked and what actions should follow. School nurses and trained staff should follow that individualized plan in addition to the specific accommodations you negotiate with the school staff as part of your 504 plan.
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for my daughter age 2-5 checked ketones once a month and never had a bad reading. ES age 5-10 only checked when sick, never in school, always checked at home. I guess if the plan specifies a ketone check then the nurse will do it - I would edit plan if you think its unnecessary. Ed
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When my son was in middle school we did not include ketone checks in his plan. But he was older (11).
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Sorry, reply to wrong person…
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I don’t think pee sticks, either ketone or carbs, have any value in regular treatment of diabetes. I do use blood test strips (both ketones and carbs). The ketone values require very careful interpretation. I will always show elevated ketones above 250mg/dL but I can also show them throughout the BG range.
I suggest an endo appointment and a discussion about how to interpret ketone levels. You could request blood ketone test equipment but, while inaccurate and unreliable pee strips are readily available where I live, using a blood ketone test strip (which is reliable and accurate) is beyond the ken.
The rules have changed with the transition from MDI to pumps. Ketones were boring with MDI; an opportunity for criticism but not constructive comment. With pumps there is a real need to accurately assess a high ketone in the presence of any BG. High ketones with low BG are easy 
The pump ain’t working. High ketone with high BG is a lot more challenging; I know through personal experience, I use BG test strips for carbs and ketones along with a pump (I don’t trust the CGM when things seem weird) and I know it is very difficult to work out if the pump has failed or not.
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It probably depends on the school and your child’s diabetes care plan. I’d check with the school nurse and diabetes team about when they recommend testing for ketones. Every school seems to handle it a little differently.
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I was in charge of school nurses in 8 schools for diabetes issues only. I do not recall a single time that we did a ketone check unless it was instructed by a parent or with a doctor’s order,
Ketone checks were joint decisions. Unless we saw sustained BS in excess of 300 which by that time were were in touch with the parent asking them for directions
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