Diabetic Home Care and Monitoring (cont.)
Robert Ferry Jr., MD
Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Diabetic home care management facts
- What is diabetes?
- What is the treatment for diabetes?
- Exercise therapy
- Diet therapy (diabetic diet)
- Drug therapy
- How is diabetic treatment monitored at home?
- Blood glucose reagent strips
- Blood glucose meters
- Urine glucose tests
- Tests for urinary ketones
- What additional monitoring does the doctor do?
- Blood glucose
- Continuous glucose sensors (CGMS)
- Hemoglobin A1C testing
- Find a local Endocrinologist in your town
Tests for urinary ketones
Ketone testing is an important part of monitoring in type 1 diabetes. It is a tool that is often also used in pregnancies that are complicated by diabetes.
Ketones are formed when one fasts (for example, sleeping overnight) or when there is a profound lack of insulin. When the body produces an insufficient amount of insulin, the cells are unable to remove glucose from the blood, and the level of glucose in the blood rises. The cells respond to what appears to be a lack of glucose by stimulating the body to produce larger amounts of glucose. Rising blood glucose level causes more urination and dehydration. In addition, ketones are produced by the liver due to low insulin levels. The presence of ketones signals a condition in diabetics called ketoacidosis. Ketoacidosis signifies that the cells are not getting enough insulin.
Severe diabetic ketoacidosis is a medical emergency, since it can result in loss of consciousness and even death. There is a correlation between high blood glucose levels, dehydration, and ketones. The higher the glucose level, the more likely that ketones will be made. Therefore, patients with diabetes with blood glucose levels over 240 mg/dL should test promptly for urinary ketones. Patients with type 1 diabetes should test for ketones during any acute illness and during severe stress. Also, urinary ketones should be checked if any symptoms of ketoacidosis occur (such as nausea, vomiting, abdominal pain).
Ketones can normally be found in the urine. For example, after an overnight fast, ketones can be seen in up to 30% of people without diabetes. However, these levels of ketone production are usually below the threshold of measurement by the ketone test strips. The strips can also give false positive results when patients are on drugs such as captopril (Capoten). False-negative readings may be seen if the test strips are old, exposed to air, or if the urine is very acidic (such as after drinking a lot of orange juice, which is also high in vitamin C).
These tests are based on the color change that occurs when ketones react with sodium nitroprusside or similar compounds. The tests are performed in a manner similar to that of urinary glucose testing. Different tests detect the three types of ketones (acetoacetic acid, acetone, and ß-hydroxybutyric acid). For example, Acetest only detects acetoacetic acid and acetone, but not ß-hydroxybutyric acid. Ketostix detects only acetoacetic acid, which can produce false-negative results if only acetone and ß-hydroxybutyric acid are present in the urine. Ketone tests are supplied as strips or tablets.
The American Diabetes Association advises that ketone testing materials be available in the office setting and that physicians should prefer using blood ketone measurements over urine ketone measurements if possible. Home testing for blood ketones is also available, though not often used due to higher cost of the test strips.
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