Keytones

[tracymcd]

Have a quick question how often should keytones be checked my dad is just out of hospital on Tuesday with ketoneacidocis and was given a new meter with glucose test strips and keytone ones but there is only 10 keytone ones and he wasn’t told how often to check them should it be every day or once a week as every day seems a lot as he would run out in a week

 

[Deleted member 527103]

I was told to check my ketones only when I have prolonged high blood sugars.
Typically DKA occurs with high blood sugars so it is very rare to get high ketones with lower blood sugars unless your dad is starving himself or eating very low carb diet.
Therefore, there is little point testing if your dad’s blood sugars are ok

 

[EllieM]

Is your dad a newly diagnosed T1 @tracymcd ? My understanding is that DKA is caused by lack of insulin (with high bgs) so it's pretty common for new T1s to be diagnosed via DKA. Once diagnosed it's much harder to go into DKA (unless skipping insulin) specially if you are using a cgm or flash reader so you will spot a sustained high bg.

Having said that, there are a few meds that can cause DKA at lower bgs (usually T2 drugs). Is your dad on any diabetic medication other than insulin?

 

[ElenaP]

Have a quick question how often should keytones be checked my dad is just out of hospital on Tuesday with ketoneacidocis and was given a new meter with glucose test strips and keytone ones but there is only 10 keytone ones and he wasn’t told how often to check them should it be every day or once a week as every day seems a lot as he would run out in a week

I have been thinking about your dad since your post a week ago. I am relieved that he had hospital treatment.

Ketones may not need checking for several weeks. Ketones develop when a person has high blood glucose readings for many hours. Therefore, the ten ketone test strips are enough for now. Just ask his GP to put them on his prescription, and then you will have some extra ones ready at home. You will also need a prescription for test strips for the new blood glucose meter.

The hospital diabetes nurses should have given your dad a written piece of paper containing ‘Sick Day Rules’. (I have one permanently on my kitchen wall.) What the ‘Sick Day Rules’ say is that if Blood Glucose levels stay higher than 14.0 mmol/L for several hours, despite extra insulin as a correction bolus, then you need to check for ketones. The ‘rules’ go on to say to have more insulin and re-check in 1-2 hrs. The ketone sticks could be either the ones that you dip in urine or ones that are put into a reader to check ketones in blood. The urine ones are easier to understand because those give a colour coding for the severity of the ketones. Prolonged high ketones need help from 111 or 999.

You said in a previous post that your dad has been type 1 diabetic for about two years. Therefore, he will be testing his blood glucose before each meal and two hours after a meal. I hope that he has been taught carb-counting so that he can work our how much insulin to inject before each meal. If he hasn’t been on a carbohydrate-counting course yet, then he needs to ask for one. It is better to attend in person, but I have heard that some people need to do this on-line. The diabetes nurses should have also told him to inject more insulin as a ‘correction bolus’, if his two-hours after a meal readings are more than 14 mmol/L.

I hope that your dad will have six-monthly appointments with the hospital diabetes nurses and at least once a year with a diabetes consultant. It is the consultant who will be able to prescribe a FreeStyle Libre blood glucose monitors for him to wear on his arm.

Ketones are dangerous, but now that your dad has ketone sticks, and more information, you do not need to worry too much. As an example, I only need to test for ketones whenever I have some sort of infection that keeps my blood glucose readings too high. For instance, five weeks ago I had Covid (for the third time) and 111 sent paramedics.