oh we have those. They expired in 2018. I tried to give them away and no takers. 
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I find it hilarious that this comes with an âI love ketoâ sticker. I also feel $75 is a really high price! I got a free Precision Xtra meter just by contacting an Abbott rep and telling them I was buying some of their strips and needed a meter.
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I find that crazy considering that ketone meters werenât exactly new when your kids were diagnosed. Why are they still recommending and providing urine strips?!?! Crazy. When I was diagnosed, urine strips were all there were, so we used those when I was sick but not really any other time (I also wasnât pumping back then). When I started pumping in 2007 the urine strips were recommended for me to use whenever I was above 17 mmol/L, even though Iâm fairly sure that ketone meters were a thing by that point. I learned about the Precision Xtra in 2009 or so have used ketone meters ever since.
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You two just introduced me to Ketone metersâŚgoing on 4 years into Liamâs diagnosis. XD
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Before I invest in one, could you give me a run down on how theyâre helpful?
So, as I understand itâŚwe would just need to have a conversation with the Endo about what ranges should mean what, for our situation, and then, based on the test from the meter, whatever the range is, you would have a good guess of exactly how much extra insulin is needed? At present, we just go with the âbolus the crap out of him and donât stop until BGâs start coming down, then hang on tight and watch out for the resulting potential crashâ methodology.
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There are also charts in some books that go over this information. But, for young kids, Iâd definitely discuss it with your doctor. Ask about âsick dayâ rules. Sick days donât necessarily mean you have to be sick, they can mean youâre having any situation that results in ketones. This is where your doctor may talk not only about hydration but about some of the other things discussed in this thread, such as the need to eat carbohydrates (even if this may mean pushing blood glucose up higher temporarily), how much extra insulin to add to a correction, and so on.
When I was a kid, my mom (or dad) and I went to classes every year where things like sick days and ketones were discussed. So there may be some types of classes you could attend with other families. Or maybe a one-on-one session with a CDE to customize things more to your specific situation.
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Well, so you can either have a conversation with your endos about ketones and what actions to take in certain scenarios for sure. Also, for us, if you have ketones, you can call the on-call attending endos and they will give advice on how to bolus at any time day or night, whereas if you just have an ordinary sticky high they donât call you back.
But we just got a sheet of paper in a binder with a different decision tree depending on the level of ketones on the blood strips. Kind of like a coding chart or a flow-chartâŚbut with instructions involving ketones. Like 0.8 or above, take 10 to 15% more, increase temp basal to X. That kind of thing. And when we call, they often suggest things like have X grams of carbs but bolus X*Y more than you usually do.
My guess is that if you ask your endo folks, they might have free samples of those meters. And you can request that they write you scripts for them with a letter of medical necessity; I think they default to sending you the useless urine ketone strips but you can def. request different ones. We donât pay for them, they are just auto refilled at some set frequency. I think we only get something like 50 every 3 to 6 months and thatâs more than plenty.
I feel like doing this is kind of a newb thing? I havenât asked my Endo for advice on anything for years. I usually just research, educate myself, then take action. So I probably wouldnât call the Endo at this point in our journey. But seeing if the Endo has any recommendations for Liam and definitely seeing if they have any free meters / writing script for strips is something weâll definitely do.
Thanks!
The chart on this page is close to the one I was given years ago. Oddly I canât find any equally simple American chart online, though Iâm sure they exist. Of course you can tweak the percentage increases, though in my experience each episode of (illness-induced) ketones responds a little differently.
The Freestyle ketone test strip doesnât work in the PDM (at least not the Canadian one). Before Omnipod I used the Precision Xtra meter @TiaG mentioned, because it tests both BG and ketones and I prefer to have just one meter.
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@Beacher this is great!
Whatâs weird is that when I call my endo they also prescribe a higher temp basal for ketones, in addition to an injection of rapid-acting, once the site has been changed out. Thatâs why weâve called our endo advice line whenever ketones are elevated (itâs happened a handful of times), because the temp basals arenât listed in our notebook or easy to find online from a clearly reliable source.
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My problem with these schemes is that they assume sickness. Thatâs another reason why I never check ketones. Iâve never been given any advice on checking ketones in other circumstances.
@Boerenkool, is the problem that they donât encompass pump failures then? Or do you conceive of some other situation when youâd have ketones that arenât encompassed in the ketone guidelines?
Thank you JEN for your response. It made me realize that I wasnât conveying what I wanted to. I certainly recognize there are now ketone meters. My statement about comparing a strip to the outside of a bottle was a comparison of what most of us were doing 40+ years ago with BS and ketones (precise and accurate control was really a fantasy), along with a commentary on the current technology for ketone meters.
A glucose meter can give you 500 values between normal and too high for the meter to read. A ketone meter can give you only 64 values between normal and too high for the meter to read (1.6 to 8.0). I wonât get into the complex math of precision, accuracy, and standard deviation, but I believe the FDA allows a 20% error on these meters. 20% variance in a 64 value range is vastly different than a 20% variance in a 500 value range. I would feel like ketone testing was much more worthwhile if I had more specific values with a ketone meter. I donât have enough confidence in the difference between a 1.6 and a 1.9 to significantly alter a treatment plan.
I will also admit to some personal bias here. I carry and store and hoard enough diabetic crap. I remember when Glucometer was a brand name and the meter, case, associated supplies were as big and heavy as a small child. I am pretty unwilling to revert back to carrying anything more that I donât consider a necessity.
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Well, I donât know what the guidelines should encompass, but the impression I get from reading this thread is that you can get ketones in other situations than sickness. So then Iâm wondering, e.g. am I at risk of developing ketones when I spend x hours above y mmol/l? Or does a BG higher than z mmol/l regardless of duration mean I risk getting ketones?
When I read the comments about ketones and children and carbs here, I feel like a lot of people werenât given a good basic education on ketones other than âthey are bad.â I think the basic understanding is a very important part of the decision to test or not test for ketones.
I think we are often bombarded with the idea that diabetes is exclusively related to insulin production (I am going to specifically reference Type 1 here â Type 2 has too many variations and my knowledge too lacking to talk about it). When treating highs and lows, itâs often prudent to remember that we loose beta islets and alpha islets on the pancreas. Beta cells produce insulin and alpha cells glucagon.
A normal body is constantly increasing one and decreasing the other to regulate energy. As diabetics, obviously we no longer produce our own insulin, but we also no longer produce glucagon to release our bodies stored sugar (Glycogen). Itâs one of the obvious reasons weight loss is difficult - we are always maxed out on stored sugar, and any extra calories are converted to fat. Likewise, itâs one of the reasons non diabetics will sometimes engage in fad diets injecting extra insulin, or glucagon, so their body releases their stored sugar and then breaks down fat to sustain their body.
As diabetics, when we need extra energy because our blood sugar is low, we stuff food (carbs) into our body. If we donât stuff those carbs in, and we have no glucagon to release stored sugar, to get energy our body breaks down fat, and through fat break down, creates ketones.
Ketosis is certainly complex, and there are a host of alternative energy processes, alternative pathways, and multiple systems and hormones involved. However, ketosis in its simplest terms is ânegative energy balance.â Even though BS may be high, cells canât use the sugar energy without insulin, the body is using extra energy to get rid of excess BS, and the body has to burn fat to get energy and sustain itself. Add to that high activity and growth spurts of children, itâs obvious that children can experience ketones with BS levels that are much lower than adults and even normal BS. As I understand it, extreme athletes can also regularly suffer high ketone levels with normal BS values.
I can certainly say that I have in occasion experienced the symptoms typically associated with ketosis after a day of strenuous activity, yet still having a normal or low BS level. While I can also certainly say I donât fit into either category of extreme athlete or child, if I did, I may be more inclined to regularly check ketones
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We have had high ketones (almost 3.0!) with a blood sugar of 100 all night long!
Basically, my sonâs pump was not delivering insulin all night. But because we were at altitude and skiing all day, somehow his muscles were pulling in some of the excess sugar produced, despite that lack of insulin.
Still, some organs canât draw any glucose from the blood (like kidneys), so his body was still âstarvingâ for energy and churning out ketones to fuel his higher metabolic needs for those organs.
In that scenario, we checked for ketones purely because his pump was still in the âchange reservoirâ menu when he woke up. If we hadnât, who knows how dangerous the scenario could have been.
Anyways, I agree, ketones are nuanced.
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My clinic has said I can use the same guidelines when Iâm high and showing ketones because of pump/site failure.
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Do you then always check for ketones when youâre high? And what BG do you take as cutoff value?
No, I donât automatically check when high â Iâve only used two strips from my current box, which expired in 2017.
Short-term, isolated highs I just tackle with extra insulin. In the absence of DKA symptoms, it doesnât matter to me what my ketone level is. If theyâre there, presumably theyâll be gone soon and arenât posing any danger.
If an extreme high (above 17/300, where I havenât been forever) were prolonged, however, even if I felt fine I might check, and then switch from everyday âcorrection factorâ corrections to ketone âsick dayâ corrections. (Now, with a CGM, Iâd probably just take a guess at a larger dose and keep an eye on the Dex.)
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For us, we check for ketones any time our son is over 300 for more than an hour or two, weâve given him a ton of insulin and he isnât coming down, and thereâs not a reasonable explanation like he missed a bolus for a bagel or something at school.
We at least hit 300 though at least once a week; we donât check with every one, just the sticky ones. Probably more like once a month or once every month and a half. We also check ketones ay time he has a fever or if he has a stomach upset, or if his pump site looks damaged or his pump somehow seems like it wasnât delivering insulin. About one out of every five times we check, we see ketones in the moderate range â and a few times this has corresponded with symptoms that are worrisome like nausea. So that means in the three years heâs been diagnosed he maybe has had ketones perhaps 5 or 6 times and weâve maybe used a total of 50 ketone blood strips.
Since the ketone meter was free with insurance and the ketone strips are paid for by insurance, and since he already has to carry around a little âsuitcaseâ with diabetes supplies itâs a pretty minimal downside for us.
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