The presence of too little insulin and high blood glucose levels, means that the body cannot use that glucose to produce energy. Instead the body will use up fats as an alternative source of energy. When fat is used as energy, by-products called ketones are produced. These ketones can build up over time and can make the blood very acidic. The ketones can be detected by blood or urine testing and you may also notice a smell on your child’s breath (like acetone or pear drops).
Ketones may also be produced when blood glucose levels are low as a sign of low food intake. These ketones are sometimes called ‘starvation ketones’.
Ketones can make you feel very unwell. It is very important that your child does not have ketones for long periods of time. A build up of ketones associated with high blood glucose can go on to cause diabetic ketoacidosis (DKA).
If your child is vomiting with high blood glucose levels and ketones you must seek urgent help.
Diabetic ketoacidosis (DKA)
Diabetic Ketoacidosis (DKA) is a very serious complication of diabetes, which will quickly result in your child being admitted to hospital. If action is taken at an early stage then DKA can usually be avoided. For this reason it is important you contact your diabetes team as early as possible if your child becomes unwell.
What is Diabetic ketoacidosis (DKA)?
What causes DKA?
The underlying problem causing DKA is not enough insulin. The following factors may contribute:
- Undiagnosed diabetes
- Not enough insulin to meet the increased need during periods of illness.
- Inaccurate or missed insulin doses.
- Poor overall control of diabetes – HbA1c above 75 mmol/mol (equivalent to an average blood glucose of 12mmol/l or more).
An HbA1c above 75mmol/mol makes DKA more likely.
How to recognise DKA
High blood glucose levels - DKA is often (but not always) accompanied by high blood glucose levels.
Ketones in the blood - check for ketones if blood glucose levels are 14mmol/l or above, or if your child is unwell for any reason
Frequently passing urine
Thirst
Feeling tired and lethargic
Blurry vision
Abdominal pain, nausea, vomiting
Breathing changes (deep sighing breaths)
Smell of ketones on breath (smells like pear drops)
Collapse/unconsciousness.
Ketones in the blood - check for ketones if blood glucose levels are 14mmol/l or above, or if your child is unwell for any reason
Frequently passing urine
Thirst
Feeling tired and lethargic
Blurry vision
Abdominal pain, nausea, vomiting
Breathing changes (deep sighing breaths)
Smell of ketones on breath (smells like pear drops)
Collapse/unconsciousness.
How to prevent DKA
The best way to avoid DKA is to keep blood glucose levels within the target range and to take action early if your child becomes unwell.
If you child is feeling unwell, complaining of a sore tummy or is vomiting:
If you child is feeling unwell, complaining of a sore tummy or is vomiting:
- Check blood glucose regularly - at least every 2 hours
- Follow the sick day rules to work out if extra insulin is needed
- Avoid dehydration with plenty of sugar free fluids given "little and often"
- Add in sugary drinks if not able to eat carbohydrate
- Phone for help if you are worried or if blood ketones are above 1.5mmol/l
- Think about reasons why your child has become unwell and if it needs treatment (e.g. antibiotics) - speak to your GP for advice
- Never stop insulin
Remember...
- Never stop insulin
- If unwell, follow sick day rules
- If you are worried, call for help.
