Ketones when BG normal

My son, age 8 diagnosed in February, has recently started to lose a few pounds so we started checking his ketones periodically. His BG is usually always under 180 and typically under 150. We have noticed that even when his BG is under 120, he will have small ketones present in his urine and if his BG goes above about 150/160, his ketones are moderate or a little above moderate. Any ideas as to what might cause this? We have discussed this with his Endo team but they haven’t really been concerned or given us any explanation.

Mike @mm92599 although ketone [acidosis poisoning] is frequently associated with prolonged high body and blood glucose levels, there are other reasons.

You may have noticed when you’ve been around people dieting to loose weight, people who do NOT have diabetes, an aroma of acetone - the byproduct produced by the body when it breaks down fat accumulated in the body. That is the ketone you are detecting in your son.

Also, keep in mind that your son could experience some very high glucose levels, sustained for a day or a few, and not test positive for ketone in his urine.

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I’m definitely not a doctor but here are some ideas that have led to ketones with me and normal blood sugar. Is he eating low carb? I get ketones in my urine if I’m not eating a ton of carbs in the day. I’ve had small ones even with blood sugars in the 110-120 range. I also get them occasionally if I go long periods of them without eating (if I test right away in the morning, skip a meal, etc.) Dehydrated? Sometimes if you’re not drinking enough water you’ll see ketones on the strip too and as soon as you rehydrate they’ll be gone. I also get them if I work out extremely hard (body is burning fat). I think as diabetics were conditioned to think of ketones as bad, but the way it was explained to me (after going through literally fear of this too earlier this year) is that ketones automatically mean DKA. They don’t, and as scary as it is, keep an eye on them, but it doesn’t necessarily mean something bad. I get worried about ketones and true dka danger when I know my pump hasn’t been delivering insulin correctly (or if on mdi skipping an injection accidentally), I’m sick with something like a stomach bug that makes it more likely that I’m dehydrated, and when I see a higher reading 250+ that’s not responding to insulin. My endo basically told me to only check if I have 1-2 high readings in a row and that blood sugar is not responding to an insulin correction and increased fluids. Ketones are so frustrating because they happen to people without diabetes too, we just don’t talk about it in the same way because them having ketones like with the Keto diet, is something that’s not going to land them in dka versus almost every type one has a fear of it and some level because most of us have experienced dka before. Good luck with everything and definitely keep an eye on it, but hopefully increasing fluids helps!


Thank you for your response. I appreciate the insight.

Thank you for the response. My son does eat fairly low carb, but does have carbs with every meal and with snacks. He did go swimming yesterday afternoon for quite awhile and had some lows while swimming and didn’t eat many carbs. He also wasn’t drinking as much water as he should have so maybe this contributed to today’s ketones but we have also noticed them over the past few weeks. My main concern is with his weight loss. I don’t want him to lose too much weight since he isn’t a big kid to begin with.

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Totally get that too! I feel like after diagnosis (I’ve been diabetic for almost 17 years and was diagnosed at 11) it took awhile for me to gain weight, almost like my body adjusted to higher blood sugars for so long and by having insulin again it was like I had so much more energy that maybe I was more active. Theoretically, when his honeymoon period he’s in (assuming he is still in it) and he relies on more insulin he may put weight on. Definitely something to ask either his endo or pediatrician but I definitely remember being on the thinner side of averagefor awhile after diagnosis(1-2 years) and then once puberty hit, put quite a bit more on and was a super healthy weight in no time.

Mike @mm92599 , as Taylor @Tee25 said, proper hydration is essential for effective diabetes management - when we are high, when we are low and, all those hours in-between. Exactly what “proper hydration” may be is hard to say, as a rule I hydrate more [gatorade always during outside activities in Florida] than most people; if your son uses a CGM, he will find proper hydration allows for more accurate BGL results. Most especially if he tends to be slim like me. If it is any consolation for him, tell him that I gained back the 40 pounds I lost prior to my diagnosis.

Also, in my view, your son should not be afraid of eating carbohydrates, as long as the carbs provide good nutrition. Carbohydrates should be natural and in balance with other food groups and the effect of foods can be balanced with insulin. Most days I eat about 225 grams of carb, including three fruit. Your son is a growing boy, and should eat like one to insure good health later in life; the good eating habits he develops now will remain with him.

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