Understanding Ketone Testing and Sick Day Rules
Caring for a child with Type 1 Diabetes (T1D) involves more than just managing blood sugars- it also requires being prepared for times when your child is unwell. Whether your child is a baby, toddler, child or teenager, knowing how to test for ketones and understanding sick day rules is critical to prevent serious complications like diabetic ketoacidosis (DKA).
Here’s what every parent should know:
What Are Ketones and Why Are They Important?
Ketones are chemicals made by the liver when there’s not enough insulin in the body to turn glucose into energy. Instead, the body breaks down fat for fuel, producing ketones as a byproduct. While this is a natural response, high levels of ketones can be dangerous for people with T1D and may lead to DKA, a potentially life-threatening condition that needs immediate medical attention.
When Should You Test for Ketones?
You should check your child’s ketone levels if they:
Have persistent high blood glucose levels (typically above 13.9 mmol?L or 250 mg/dL)
Are feeling unwell (with symptoms like nausea, vomiting or abdominal pain)
Have a fever or infection
Have symptoms of DKA (e.g., rapid breathing, fruity-smelling breath, extreme tiredness)
Even if blood sugar seems normal, ketones can still rise during illness or periods of stress, especially in younger children and toddlers.
How to Test for Ketones
There are two main ways to check for ketones:
Urine Ketone Strips: These are dipped into a urine sample and change colour to indicate ketone levels. They are easy to use, especially for young children who many not tolerate finger pricks well.
Blood Ketone Meters: These work similarly to a blood glucose meter and provide real time ketone level. Blood ketone testing is often more accurate and can detect ketones earlier.
Ask your diabetes team which method they recommend for your child, and ensure you have the supplies on hand, especially during illness.
Sick Day Rules: What Every Parent Needs to Know
Being prepared for sick days can help prevent DKA and keep your child safe. Every diabetes clinic or hospital may have its own guidelines, but general sick day rules often include:
Never stop insulin: Even if your child isn’t eating or is vomiting, they still need insulin. Your diabetes team can guide you on adjusting doses.
Check blood glucose and ketones frequently: Usually every 2-4 hours.
Keep your child hydrated: Encourage frequent sips of water, electrolyte solutions or sugar free fluids. If blood sugars are low, offer sugary drinks like juice or oral rehydration solutions.
Monitor for signs of DKA: These include vomiting, deep or rapid breathing, drowsiness, confusion or fruity-smelling breath
Adjust insulin as advised: You may need to give extra fast-acting insulin based on ketone and glucose levels- this is often referred to as “correction doses.”
Know Your Clinic’s Sick Day Protocol
Every child is different, and so is every diabetes care team. Make sure you:
Have a written copy of your hospital or clinic’s sick day rules
Know your clinic’s emergency contact numbers
Understand when to seek medical help- for example, if ketones remain high despite insulin, your child can’t keep fluids down, or they’re showing signs of DKA
Don’t hesitate to reach out to your care team with concerns. It’s always better to ask early than wait too long.
Final Tips for Parents/ Carers
Keep a “sick day kit” with ketone strips, blood ketone meter (if you use one), fast-acting insulin, syringes or pens, fluids and snacks
Educate everyone involved in your child’s care (relatives, teachers, babysitters) about sick day management
Review sick day rules with your diabetes team at least annually or whenever there’s a change in your child’s treatment plan.
Understanding ketone testing and being prepared with sick day rules is a vital part of managing Type 1 Diabetes in children of all ages and teenagers. The earlier you act when your child is unwell, the better the outcomes. Stay informed, stay prepared and never hesitate to contact your diabetes care team when in doubt.
