Ketones - To Check or Not to Check


we check ketones a lot, haha! Any time there’s a high that seems a bit sticky, I get paranoid.

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Always The Truth With Diabetes?

lol. I think the last time I checked Ketones was 2 years ago? I guess I just don’t see the benefit? Okay, I check ketones and they’re high, then what? Drink lots of water and get the sugars down. The exact same thing I’m always doing when he’s high anyway. I guess I just don’t see the added benefit of doing the ketone check since it isn’t going to change what I do much as a result of the ketone test results.


The last time I checked ketones is years ago, I don’t remember when. I don’t see the benefit either. Besides that, ketone strips aren’t covered by insurance and they would expire before I’d use them.


The only thing a ketone check would do would verify, to me, is that poison is getting into Liam’s system, and this would serve as another way I can “kick myself”…I already do that enough where his diabetes is concerned.


@ Borenkool, you may have heard of diabetic ketoacidosis (DKA) mentioned in TV commercials. It is a very serious condition. Measuring ketones will help determine if you are entering a DKA stage with very high blood sugar. Read more about it here:



It’s really a totally different ballgame when there’s ketones. The poison of super high blood sugar is of course not great, but DKA means an automatic stay in the ICU. And it means the amount of insulin you need to give will be different, and you may need to do things like change out sites, discard insulin, etc…
Plus, knowing how easily your child develops ketones can help you predict and potentially avoid dangerous situations in the future.


One of Mitch’s friends (in his mid-30s) was recently diagnosed with DKA after an Omnipod failed. He got a kinked cannula and just didn’t react quickly to change out the pod soon enough. There were no alerts or alarms letting him know it failed. Within maybe 5 to 6 hours of having high blood sugar he was in DKA. And he wound up in the ICU. He’s super on top of stuff, low A1C, tight control, etc., otherwise.


I guess what I’m saying is how is any of this beneficial in the immediate moment? For instance, here are the steps I take when Liam gets high. 1) I ensure he drinks plenty of water. 2). I bolus repeatidly until the BG’s start coming down. 3) IF BG’s don’t start coming down within an hour, I change the POD in case there is an issue there and, if necessary, give MDI shots to ENSURE he’s got insulin in his system in the event of a POD problem.

I always check BG’s during the highs, but I still don’t understand why checking Ketones matter because how is it going to change my actions? I’m not going to call 911 when Liam has high BG’s / ketones as Mayo Clinic recommends…it’s just silliness for a child who goes high frequently.

Now…IF his BG’s went high and stayed high more than a couple hours (I’m talking over 250), and nothing I’ve done is helping, and he’s refusing to come back down then sure I would probably check Ketones and make a call to the Endo, but that’s never happened for us. His highs always come back down after a bit of time following the steps outlined above.

Just can’t imagine how checking ketones is helpful information to me. Since DKA can happen at different thresholds for different people and since different people develop ketones with lower or higher BG’s, how does knowing he has some ketones helpful in any immediate decision-making that I am involved in to bring his BG’s down.

I know the symptoms of DKA so I’m always watching for that anyway, but if he’s being super insulin resistant, there’s an occlusion or anything else where insulin isn’t making it into his cells as it should, checking ketones isn’t going to help any of that. Taking immediate actions of giving MDI shots if necessary, changing PODs, checking BG’s regularly and ensuring he drinks regularly are the HELPFUL steps in my mind.

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This would never happen for us. If he’s high more than a couple hours, I’m very aggressive in changing PODs, giving MDI shots, etc., No reason to ever be that high for 5 to 6 hours unless you are sleeping and don’t notice. We’ve been high (over 200) sometimes for most of the night, but not DKA high.


I’m not “opposed” to using Ketone strips…I just fail to see the benefit to any immediate action that we are taking when the BG’s are high and there are ketones present.


Well in the immediate term it means YOU NEED WAY MORE INSULIN THAN YOU THINK YOU DO.
Also it means you need to immediately do steps like changing out the pods, changing out the insulin, an relying on injections sooner than you would ordinarily do. You have less time to work with than you think you do, so to speak. And also why let him be higher longer than necessary, which is what happens when the body needs to clear ketones.

For instance, with a flu – if you checked ketones and found they were moderate, you would immediately increase his insulin dose much more than you would just based on the number alone. You need X insulin to lower the blood sugar number and Y number JUST to clear the ketones. And the X doesn’t start to work until Y has done its job, so to speak.

Also, since ketones can also develop with stomach bug and with starvation/fasting, so in the instance that someone is starting to feel nauseated, you should always check ketones and then if they have ketones and can’t keep food down you basically need to go to the ER immediately. I mean, it just changes your decision tree substantially.

there’s a reason why Samson’s pump says, anytime he’s over 250 “check ketones, inject insulin manually.” It’s because most of the time DKA is not an issue, but this step can reduce the risk of it happening in the few cases where it is.

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Also Liam is going to be in school next year. There’s no way to change out his pod every time he’s over 250 for more than 2 hours. This step can tell you whether you have more time to bring down the blood sugar, or whether someone needs to go to school to go do a changeout (which our nurse said schools don’t typically do).


But I don’t need to “see ketones” to act on this. If his BG’s are high, I want him back down…ketones or not. I want him as low as possible as often as possible. Ketones or not, I’m always working to get BG’s back down as soon as possible and I’m always taking the recommended steps whether there are ketones or not.

Also, whether you have ketones or not, more insulin is required by most people the higher your BG goes…so I always give more the higher Liam goes regardless of ketones or not.

I can see how it may prevent that one DKA episode that may happen in 1 out of million high BGs you may have in your life…but I just don’t see using 1 million ketone strips to avoid that one instance when really the steps I will take after each strip (including the one where he may go DKA) are going to be exactly the same…except the additional step I may have to take if DKA is to call an ambulance.

I’m really not trying to be difficult…I just don’t see the benefit. I really don’t. I take all actions AS IF THERE ARE KETONES ALWAYS…


but it’s like I’m saying. You sometimes need 50% more insulin than the high BG will suggest if someone has ketones. If you have a sticky high of 350 and there are moderate to large ketones, you will need way more insulin than you would if it’s the same exact number, for the same exact duration, without ketones. So you’re baking in a high for longer.

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This doesn’t happen that often for us, so it’s possible that IF this happens for 2 hours that we can/will go change out POD and take actions, again, assuming there are ketones and assuming these steps need to be taken just to be safe.


I guess maybe I’ve just never ran into this situation.

Everytime Liam goes high, we take immediate action and don’t stop taking actions until he’s back within range. Ketone strips I suppose could tell me that I need to give more insulin, but I’m already super aggressive when he’s very high anyway (this includes giving a LOT more insulin via pump and/or change POD and/or give MDI shots and/or ensuring he drinks plenty of water and doesn’t run around too much.)


I’m going out on a limb here – and it’s possible it’s not true for Liam since he seemed to be honeymooning for so much longer. But you probably have had ketones before and didn’t realize that’s part of why it took so long, and so much more insulin, for a high to come down. And at the least it would have saved an hour or two of high blood sugar and feeling really miserable.

Blood ketone strips are like a handful of dollars a strip and you use them maybe two or three times a month. To me, it’s just a no brainer. It’s the exact same steps as taking your blood sugar, just with a different meter. And it provides peace of mind and a guidebook for what to do next.


I don’t know if I agree with this. Why? Because Ketone strips don’t come with built in algorithms that dictate “how much extra” insulin you should give your child based on the level of ketones in their system. They only tell you you have ketones (small to big). I always treat Liam as if he has ketones when he’s high and am already aggressive with Insulin. If you ONLY treat high BGs aggressively when there are ketones then I can understand using them. But if you, as is our case, ALWAYS treat high BG’s as if there are ketones in the system then the protocol are the same. Super aggressive, change outs, MDIs, etc.,

For the most part, our highs come back down relatively quickly (within 2 hours). The only time we’ve ever had prolonged highs (between 200 and 250 for 6 - 8 hours) was during the night when ketone strips wouldn’t have helped because I slept through the alerts and didn’t bolus or test at all.

I guess it provides peace of mind if you assume he ordinarily does NOT have ketones. To me, high BG = ketones so I always treat aggressively and work to get the BGs back down ASAP.


We’ve been high (over 200) sometimes for most of the night, but not DKA high.

Samson has developed ketones when he was hovering at 180 for four or five hours overnight before. In fact, he’s developed HIGH ketones with a blood sugar of 100 all night! Samson seems to develop them really easily, but the point is, you can’t just assume you’re “safe” if blood sugar isn’t quite at 250.


True, I hope I never find out the “DKA level” that Liam is. But as I said the only prolonged times we’ve had are just those times where he was either SICK (and we were already doubling or tripling his insulin requirements) or if we slept through high alerts and he was over 200. But ketone strips wouldn’t have helped us during those times we slept through the alerts. What would have helped would have been waking up and bolusing him. lol