Hyperglycaemia and Ketoacidosis

Hyperglycaemia means high blood glucose levels which can lead to ketoacidosis if no action is taken.

What is ketoacidosis?

If there is not enough insulin to convert the blood glucose into energy, the body starts searching for other sources of energy, usually from the body fat.  The body burns the fat as fuel and it begins to release chemicals called 'ketones' into the blood, which then appear in the urine.

Ketones act as poisons in the body and if they build up to a high level this can be dangerous.

Ketoacidosis may develop due to illness or major stress or simply not having enough insulin.

Ketoacidosis can taken from a few hours to several days to develop but it can be life threatening, so recognising and treating it in the early stages is essential.

Signs that your child may be developing ketoacidosis

Raised blood glucose levels

Ketones in the urine or blood

Nausea and/or vomiting

Tiredness

Weight loss

Increased thirst

Passing urine frequently

Dehydration

Breath smells of pear drops

Deep sighing breaths (this would require urgent medical attention)

Treatment

• Increase the frequency of blood glucose testing if the levels start to rise into double figures, i.e. above 10mmol/L.

• Check the urine for ketones using Ketostix, or check the blood for ketones using the Medisense Optium meter.  Remember that Ketostix go out of date 6 months after opening.  Always make sure you have Ketostix for holidays and bank holidays.

• Check for ketones during periods of stress or illness or if the blood glucose levels begin to rise over a period of time, i.e. 2-3 days.

• If test is negative but blood glucose levels are high, increase insulin as advised i.e. 1-2 units working on daytime blood glucose first, leave 2 days and increase again.

• A trace or a small amount of ketones may be present if your child has not been eating (e.g. because of a sore throat).  Encourage him/her to drink plenty of sugar-free fluids and replace food with sugary fluids.

• If there is a moderate or large amount of ketones in the blood or urine, more insulin is needed immediately.  Please ring one of the diabetes team if you are unsure about how much extra insulin to give.  Encourage your child to drink sugar free fluids to help the body get rid of the ketones.

• Check blood glucose every hour and ketones every 3 hours.

• Never stop the insulin.  The usual dose may need to be increased or extra fast-acting insulin may need to be given.  Please make sure that you have a bottle of fast-acting insulin (e.g. Humulin S, Actrapid, NovoRapid or Humalog Lispro).  Extra fast-acting insulin may also be required at lunchtime and/or bedtime if ketones are still present.  Remember to replace your fast-acting insulin six weeks after first using if kept out of the fridge or if the expiry date has passed, if it is kept in the fridge.

• If your child is ill, ask your GP to see him/her.  If she/he is not eating, replace carbohydrate foods with sugary liquids as advised on the illness leaflet.  Other non-sugary drinks should also be offered to help the body to get rid of the ketones.

• Vomiting, stomach ache and headaches can occur if ketones are present in the urine.  This can lead to the child becoming confused, very pale, with dull and glazed eyes and becoming drowsy.  It may be that there will not be sufficient blood in the fingers to get a true reading of blood glucose levels.  If there is a large amount of ketones in the blood or urine and the symptoms described are present, bring your child immediately to hospital or ring for an ambulance.  Please inform the ward that you are coming if you have time, or we will do so if we have spoken to you.

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