Hyperglycemia and Ketone Testing

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Hyperglycemia and Ketone Testing
Last Updated: Mon Nov 17 07:17:58 2008
Children with Diabetes

Background

Hyperglycemia means high blood sugar. For people with type 1 diabetes, hyperglycemia caused by insufficient insulin can lead to diabetic ketoacidosis, a very serious situation that requires emergency medical treatment. Hyperglycemia can also be caused by eating too much food, which requires treatment to lower blood sugar levels but which does not lead to DKA. The only way to determine between the two situations is through ketone testing.
Causes of Hyperglycemia

* Eating too much food relative to the amount of insulin injected
* Missing an insulin injection
* Blockage in insulin pump tubing
* Disconnected insulin pump infusion set
* Illness or stress

Symptoms of Hyperglycemia

* Frequent urination
* Frequent thirst
* Blurry vision
* Dry mouth
* Fatigue

Testing for Ketones

There are two ways to test for ketones: urine testing and blood testing. Just as blood glucose testing proved to be superior to urine glucose testing, so too is blood ketone testing proving to be better than urine ketone testing. Ketones appear first in the blood, then in the urine after being filtered by the kidneys. Thus the body has been producing ketones for a while before you can detect them in the urine. Children with Diabetes Highly Recommends blood ketone testing over urine ketone testing.

Since ketones in the blood can be detected well before ketones in the urine, there is the possibility to treat sooner than you would if you waited for urine testing to show a positive result. Blood ketone testing can be easier for parents who have very young children with diabetes who do not always have the ability to urinate on command. Also, being able to test with a finger stick eliminates the need to find a bathroom to test if you're away from home or when kids are at school.

Two recent studies (February 2006) demonstrate clear medical benefit from blood ketone testing. The first study (Diabetic Medicine 23 (3), 278-284) showed a significant reduction in hospitalizations during sick days (38 vs. 75 per 100 patient days) for people who used blood ketone testing compared with urine ketones testing. Staying out of the hospital is a very powerful argument for using blood ketone testing. The second study (Diabetes Technol Ther. 2006 Feb;8(1):67-75) showed that, for patients using insulin pumps, blood ketone testing could identify interruptions in insulin flow faster and more accurately than even blood glucose monitoring and could thus help pumpers prevent DKA better than if they didn't use blood ketone testing.

Whether you choose blood or urine ketone testing, it's important to keep a fresh stock of test strips on hand at all times. You don't want to find yourself or your child sick and then discover that you have nothing to check ketones.

At this time, however, blood ketone testing is more expensive than urine ketone testing. A Precision Xtra meter costs about $65 in the United States (though it is often on sale at drug stores), and the ketone test strips cost about $30 for eight, or about $3.75 per test. In contrast, urine test strips can cost as little as 16 cents per strip (vial of 100 Ketostix) to as much as 40 cents per strip (package of 20 foil wrapped Ketostix). While sometimes insurance in the US will cover the cost of the blood ketone test strips, they still cost more than urine test strips. Regardless of this additional cost, the clinical benefits described in recent studies still argue for using blood ketone testing.
Blood Ketone Testing

The Precision Xtra blood glucose meter can also be used to test for blood ketones. As of November 2006, this is the only meter than can test for blood ketones. Because of the importance of identifying ketones as soon as possible, everyone with type 1 diabetes might want consider a Precision XTRA for blood ketone testing, regardless of which blood glucose meter they use. For children and teens, particularly at school, testing for blood ketones rather than urine ketones might be more convenient, easier to use, and therefore more like to actually be used.

© Children with Diabetes, Inc.

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