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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

    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 

    If your child has ketones present and you are unsure what to do, call the RCH switchboard on 9345 5522 and ask switchboard to put you through to the “diabetes sick day service”