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Question:

From Warren, Michigan, USA:

My four year old son has had type 1 diabetes since he was 11 months old, and he has been on an insulin pump for six months. I checked my son's blood glucose at 12:45 am and it was 187 mg/dl [10.4 mmol/L]. I checked it again at 7:20 am while he was still asleep and it was 238 mg/dl [13.2 mmol/L], and when he got up at 8:00 am, it was 239 mg/dl [13.3 mmol/L]. He did not want to eat right away, and he also did not urinate right away. He wanted to eat at 9:50 am so I checked his blood glucose (260 mg/dl [14.4 mmol/L], so I corrected for it, and he ate. He did not urinate until 10:30 am, and he hadn't used the bathroom since previous evening. I checked his urine with a strip, and it showed moderate ketones, even though his blood glucose hadn't been extremely high. I had him drink some water, and he was able to urinate some more at 11:00 am which showed no ketones. Now I am wondering if my urine strip was bad or if there is some relationship between the amount of ketones and the time between using the bathroom? Would you have a small amount of ketones if you had urinated earlier or would it still have showed a moderate amount? Is there is any correlation between the amount of ketones and the concentration of the urine?

Answer:

As I understand your son's story, there was a period from sometime in the evening until around 10 a.m. the next morning during which your son did not urinate. At the same time, his blood sugars were high enough so that the body was producing ketones as part of the process of creating energy from fat rather than from glucose. The fact that he was not urinating also suggests that he had little if any fluid intake over this same period. When you eventually checked his urine for ketones these had been not only filtered by the kidney throughout the night, but since the amount of water filtered over this period must also have been small, the combination of a concentrated urine and a long collection period would have increased the apparent concentration of ketones.

In the morning when you both gave him extra insulin and water, not only was the urine more dilute but the production of ketones was suspended by the insulin, hence a negative urine ketone test. I think you need to talk to your son's doctor about this and at the same time to review the nighttime insulin pump settings because the ketosis and the blood sugar levels suggest that there was insufficient insulin over the period in question. Incidentally, you might look at Hyperglycemia and Ketone Testing. Testing blood ketones (though more costly) gives a more precise picture of the relation between blood sugar and ketones. There is of course, no relationship between the urinary ketone concentration and the length of the interval between urination.

DOB

DTQ-20030830223032
Original posting 4 Sep 2003
Posted to Other

  
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Last Updated: Tuesday April 06, 2010 15:09:50
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