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Diabetic ketoacidosis (DKA) is a rare but serious condition. It can happen if your child’s diabetes is not managed properly. Left untreated, DKA can cause your child to go into a coma. In some cases, it can even cause death. But you can take action to keep your child from having DKA.
The body’s cells need glucose to burn for energy. If glucose is not getting into the cells, the body has to burn fat instead. But burning fat produces a waste product called ketones. Ketones can build up dangerously in the blood and urine. Your child’s body can’t handle large amounts of ketones.
When large amounts of ketones build up in the blood, it can cause diabetic ketoacidosis. This means that the chemical balance of the blood is upset. DKA may be more common in children with type 1 diabetes than in children with type 2. The following are the most common causes of DKA:
A lack of needed insulin in your child’s blood (this can happen if your child misses his or her insulin shots)
Illness (flu, cold, or infection)
An insulin pump that is broken or not working properly
Insulin that has expired or has not been stored properly
Often, symptoms of DKA can look like the flu. Contact your child’s healthcare provider or seek emergency care right away if you notice any of these symptoms:
Ketones present in urine or blood (see “How to Check for Ketones” below)
Very dark urine or no urine in 6 hours
Rapid, deep breathing
Thirst or very dry mouth
Drowsiness or trouble concentrating
Always check for ketones when your child has any of the above symptoms, or has:
Blood sugar above 240.
Diarrhea or vomiting.
Fever of 100.4°F (38°C) oral or 101.4°F (38.5°C) rectal or higher, or as directed by your child’s healthcare provider
Ask your child’s healthcare provider to show you how to check for ketones at home. Ketone testing is most often done with urine test strips. For a baby or toddler, you can put a cotton ball in your child’s diaper to absorb urine. Then, put the moist cotton ball onto a test strip to check for ketones. For older children, follow the directions on the test strip package. Some blood glucose meters may also be used to check for ketones in your child’s blood. Ask your child’s healthcare provider for more information. If ketones are present in the blood or urine, call your child’s healthcare provider right away.
DKA can be prevented. The best way to do this is to give your child insulin as directed. Be sure to follow your child’s treatment plan as given to you by the healthcare provider. When your child’s blood sugar is high, treat him or her right away. Remember that your child’s blood sugar can be harder to manage when he or she is sick. To be safe, check your child’s blood sugar every 4 hours when he or she is sick. Ask the healthcare provider for sick-day guidelines. This includes learning to adjust your child’s insulin dose safely. And always keep a “sick-day” box available. This box should include:
Can of soup
Flavored gelatin, such as Jell-O, with and without sugar (these can be kept in the refrigerator)
Frozen juice bars with and without sugar (these should be kept separately in the freezer)
Suppository medication to stop nausea and vomiting, if needed
Be sure to check the expiration dates of everything in the sick-day box once a month. Replace items as needed.
Vomiting or diarrhea
Blood sugar of 240 or higher that does not lower after your child receives insulin
Blood sugar under 70
Ketones present in blood or urine
For more information about diabetes, visit these websites:
American Diabetes Association www.diabetes.org
Children with Diabetes www.childrenwithdiabetes.com
Juvenile Diabetes Research Foundation www.jdrf.org
American Association of Diabetes Educators www.aadenet.org
American Association of Clinical Endocrinologists www.aace.com
National Diabetes Information Clearinghouse www.diabetes.niddk.nih.gov
NOTE: This sheet does not give all the information you need to care for your child with diabetes. Ask your child’s healthcare provider for more information.