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From Atlanta, Georgia, USA:

Our three year old son has been waking up with small to medium ketones every morning for the past 5 days. He is a bit sluggish in the A.M. because of the ketones, but drinks plenty of water and will eat some food and so they are flushed out by mid morning. His overall numbers have all been in target range (100 - 200).

We check him for ketones when he is sick or has a reading over 240 or has a normal or higher reading and is acting sluggish. This is what we are confused about. For the past two days we have been checking ketones all day, whenever he goes potty, and we put cotton balls in his diaper at night to check for them also. His readings, from Tuesday morning to Wednesday morning are as follows:


  • 2:30 A.M. -- 93 no ketones (he also did not have them at his 11:00 check on Monday night)
  • 7:30 A.M. -- 160 (moderate ketones)
  • 11:00 A.M. -- 180 (no ketones), several checks throughout Tuesday with no ketones
  • 4:00 P.M. -- 200 (no ketones), several checks after dinner with no ketones
  • 9:00 P.M. -- 121 (no ketones)
  • 11:30 P.M. -- 109 (no ketones)


  • 3:30 A.M. 99 (no ketones)
  • this morning, Wednesday morning, he was 153 with small ketones

His readings from the days before are very similar.

It is important to note that this trend has just started happening and has not happened before to our knowledge as we have always tested in the A.M. when he is sluggish, sick, or over 240. In fact when he is sick he usually doesn't have them at all.

I was told that ketones take about six hours to form, and they could be the result of not enough insulin, or a rebound. I am not considering the increase in blood sugar from 3:30 to 7 am a big rebound because he usually does this anyways, and has rarely had ketones even when the increase was to 250. His doctor cannot figure this out and says that it is ok as long as they are being flushed out. I agree with this, we just don't want him to feel yucky in the A.M. Do you all have any insight as to why this is happening? They seem to be forming after 3:30 A.M. Could it also be that he is a bit off of his meal plan and not eating as much(we have heard that people who diet and lose weight can develop ketones although he has not lost any weight.

His dosage is 1.5 H/3 N in the am, 1.5 R at supper, and 1 minus N at 9 P.M. He has his P.M. snack at 7:00 and it consists of egg beaters mixed with ice cream and milk with a bit of vanilla. (Very good, by the way.)


In a young child slight ketonuria in the morning can be normal (with or without diabetes). Your son's control sounds fairly good but I would be inclined to think that his sugars are dipping between 3:30 and 7:00 A.M. Perhaps a trial of a slight reduction in evening insulin would be worthwhile even if he runs slightly higher for a few days.


Original posting 25 Mar 97


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Last Updated: Tuesday April 06, 2010 15:08:54
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