According to the old poem, “Roses are red, violets are blue. Sugar is sweet and so are you.”
While it’s nice to be sweet metaphorically, too much actual sweetness is not healthy for your child with diabetes. If excess sugar builds up in your child’s blood, she can develop a condition called diabetic ketosis (also called DKA, ketoacidosis, hyperglycemia or acidosis). This occurs when insulin levels are low and glucose builds up in the blood instead of moving into the tissue, where it’s normally used for fuel.
Without glucose available for energy, the body starts relying on a type of fat called ketones. Ketones are acidic, and if the body can’t adequately neutralize the acid, the blood pH starts to drop. This is a dangerous state leading to DKA.
It’s important to check for ketones and to know what to do if your child has them. The way you respond to a diabetic emergency can mean the difference between a good night’s sleep and anxious hours spent in the emergency department.
DKA develops gradually over several hours or days and is caused by:
- Not taking insulin as prescribed
- Illnesses (such as colds, flu or infections) that cause an increased need for insulin
- Emotional stress that leads to an additional need for insulin or that causes your child to neglect taking their insulin
- Exercising with very high glucose levels
Warning Signs of Ketosis
- High blood sugar levels
- Ketones in the urine
- Frequent urination
- Excessive thirst
- Fatigue and sleepiness
- Upset stomach
- Stomach pain
- Nausea and vomiting
- Difficulty breathing
- Breath that smells fruity
- Dry, hot and flushed (reddish) skin
Check for urine ketones if:
- Blood glucose is over 250 mg/dl for 2 tests in a row
- Your child is ill and blood glucose is over 250 mg/dl
- Your child plans to exercise and blood glucose is over 250 mg/dl
When elevated blood glucose occurs and ketones are present, your child needs additional insulin and fluids. Consult your sick day plan to help you calculate the additional insulin needed for ketones.
If ketones are present:
- Call your child’s doctor. Be prepared to describe the symptoms, give results of blood and sugar ketone tests, and offer what your child ate or drank during the past 12 hours.
- Follow the doctor’s instructions, which will involve using insulin and sugar to reverse ketosis.
- Perform urine ketone tests every 2 hours, as directed. Keep a record of test results.
- Follow your child’s sick day plan. If you don’t have one, ask your health care provider or educator to develop one for you.
- Give your child plenty of water and sugar-free fluids. These dilute the blood of ketones and prevent dehydration.
- Do not let your child exercise if their blood glucose is over 250mg/dl and ketones are present.
What to do if your child has signs of ketosis
- Write a list of foods and fluids that your child consumes.
- Offer fluids. Every hour, give your child 4 ounces of fluids to help prevent her from getting dehydrated – especially if she is vomiting and/or has diarrhea. Offer her salty foods like bouillon soup and crackers, as well as potassium-rich foods like bananas.
- Make an appointment with your child’s primary care physician to care for fever, sore throat, earache and other problems.
For a sweet life, keep your child free of sugar overload – and watch those ketones.
For additional information about diabetes, visit Akron Children’s Center for Diabetes and Endocrinology.