Assessment and monitoring of metabolic control

Monitoring of urinary ketones

• It is good clinical practice to advise urinary ketone measurement during episodes of uncontrolled hyperglycemia, insulin deficiency, intercurrent illness (‘sick days’) and impending ketoacidosis
  [Some centers advise regular ketone testing before breakfast as an indicator of antecedent insulin deficiency (the dawn phenomenon)]

Equipment

• Tablets or urine testing strips for ketone testing are available that detect increased levels of urinary acetoacetate (present in lower concentrations than b-OH butyrate)
  [New blood ketone strips measuring -OH butyrate in electronic monitoring devices are on clinical trial]

Guideline for ketone testing

• Illness with fever and/or vomiting
• If BG rises above 15 mmol/l in an unwell child
• Episodes of drowsiness
• Abdominal pains or rapid breathing
• Before breakfast to detect overnight insulin deficiency