Too Many with Type 1 Don’t Test for Ketones

One-third of people affected by Type 1 diabetes lack any means to test for DKA at home.



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Recently, we featured the story of a father who was coming to terms with his grown son’s death from diabetic ketoacidosis (DKA). The father, Joe Purden, regrets that he didn’t learn more about the dangers of DKA when his son was first diagnosed. He and his wife worried more about hypoglycemia than DKA, and they didn’t realize how quickly DKA could prove fatal.

A new study suggests that many people with diabetes might be underestimating DKA, as well. The University of Florida Health study found that 32 percent of Type 1 households lack any means to test for ketones, and some 20 percent of respondents have never tested for ketones. For the study, researchers analyzed questionnaire data from some 2,995 people with Type 1 diabetes or who care for people with Type 1 diabetes through the T1D Exchange.

According to a Healio report, the study found that ketone testing became less frequent as people with Type 1 aged. Just over half (53 percent) of people who cared for children with Type 1 who were six or younger reported regularly testing for ketones when blood sugar levels reached 300 mg/dL or higher. That percentage shrinks as the age of respondents went up, with just 7 percent to 11 percent of those aged 26 and up saying they regularly test for ketones then.

Many participants said they didn’t check for ketones even when showing possible symptoms of DKA. Some 38 percent of respondents said they didn’t check for ketones during a bout of nausea and 45 percent of respondents didn’t test during a fever. That’s troubling because DKA can easily be mistaken for cold and flu symptoms.

A CDC report found that there were 2,417 reported cases of death from what it characterized as “hyperglycemic crisis” in 2009. However, the report also states that only 40 percent of death certificates for people with diabetes lists diabetes as the cause of death, and that it’s impossible to know how many DKA deaths go underreported.

Certified diabetes educator Gary Scheiner warns about the dangers of DKA in his book, Think Like A Pancreas: A Practical Guide to Managing Diabetes With Insulin. In an edited excerpt, he described it this way:

Diabetic Ketoacidosis (DKA) is a condition in which the blood becomes highly acidic as a result of dehydration and excessive ketone (acid) production. When bodily fluids become acidic, some of the body’s systems stop functioning properly. It is a serious condition that will make you violently ill and it can kill you.

The primary cause of DKA is a lack of working insulin in the body. Most of the body’s cells burn primarily sugar (glucose) for energy. Many cells also burn fat, but in much smaller amounts. Glucose happens to be a very “clean” form of energy—there are virtually no waste products left over when you burn it up. Fat, on the other hand, is a “dirty” source of energy. When fat is burned, there are waste products produced. These waste products are called “ketones.” Ketones are acid molecules that can pollute the bloodstream and affect the body’s delicate pH balance if produced in large quantities.

People with Type 1 do a burdensome amount of testing, and pay a high price for testing supplies for blood sugar readings. While it may seem difficult to add one more step or one more set of supplies to your testing routine, ketone testing can unquestionably save lives, and we encourage you to be careful and vigilant.

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Craig Idlebrook is managing editor for Insulin Nation and Type 2 Nation. He's written about health policy, environmental health, community health, and maternal health for over 25 publications. You can reach him at cidlebrook@epscomm.com.