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Diabetes at the RCH

Ketones and diabetic ketoacidosis

  • Ketones

    Ketones are produced when the body breaks down fat for energy when there is insufficient insulin for cells to access glucose. Ketones occur most commonly when there is not enough insulin in the body. They are acidic and are dangerous if they build up in the blood as they cause a life threatening condition called Diabetic Ketoacidosis DKA.

    Small amounts of ketones are normal ( 0.0 – 0.6mmol)

    Diabetic ketoacdosis (DKA)

    Diabetic Ketoacidosis (DKA) is a life threatening condition that occurs when there is insufficient insulin and blood ketones are abnormally high. High ketones are often associated with very high BGLs as well. The high ketones cause imbalances in body fluid and salt levels, leading to dehydration and build-up of acids in the blood. Vomiting and increasing drowsiness result. DKA requires urgent medical assistance.

    What causes DKA? 

    • Missing insulin injections.
    • Illness.
    • Previously undiagnosed type 1 diabetes.

    Signs and symptoms of DKA? 

    DKA can develop rapidly and requires urgent medical assistance. Signs and symptoms may include

    • High blood glucose levels with ketones present.
    • Tummy pain.
    • Vomiting.
    • Dehydration.
    • Rapid, shallow breathing.
    • Acetone smell on the breath.
    • Confusion.
    • Drowsiness which may lead to coma.

    How do I check for ketones? 

    Ketones can detected in the blood and in the urine

    ketone strips

    Urine ketones are positive if a colour change occurs (+, ++ or +++). If positive urine ketones check blood ketones.

    When do I need to check for ketones? 

    • When the blood glucose level is greater than or equal to 15 mmol/L.
    • Whenever your child is unwell, no matter what the blood glucose is.

    Ketones do not need to be checked more frequently than every four hours if they are less than 1.0mmol/L or 0.6 mmol/L with insulin pump therapy. 

    For injections action is required if ketones are 1.0mmol/l or higher 

    If using an insulin pump: action is needed if ketones are 0.6 mmol/L or higher 

    Seek urgent medical attention or call an ambulance by dialing 000 if: 

    • You have had 3 vomits or diarrhoea or continued stomach pains, especially if these pains are associated with high BGLs.

    • If at any stage, ketones are 3.0 mmol/L or higher, you should give an 'urgent dose' of rapid acting insulin as explained above and present to hospital for urgent medical assessment. This situation has a high risk of diabetic ketoacidosis (DKA) which is a medical emergency.  Remember signs of DKA include; vomiting, stomach pain, rapid breathing, drowsiness.

    • After following the above advice, ketone levels are increasing or remain 1.0 mmol/L or higher. 

    The Royal Children's Hospital (RCH) Sick day service phone number 9345 5522 ask for the 'Diabetes sick day call' 7am – 9pm Monday – Friday (for patients of the RCH).

    Page updated November 2024