1. Learning Objectives for Ketone Testing Participants will be able to understand: What ketones are Why ketones are monitored When ketones should be monitored When to contact the parent/guardian or healthcare provider Participants will be able to demonstrate: How to perform ketone testing KBN 2014

2. What are Ketones? Acids that result when the body does not have enough insulin and uses fats for energy May occur when insulin is not given, during illness or extreme bodily stress or dehydration Can cause abdominal pain, nausea and vomiting, much like flu symptoms Without sufficient insulin, ketones continue to build up in the blood and result in diabetic ketoacidosis (DKA) KBN 2014

3. Why Test for Ketones? O DKA is a critical emergency situation O Early detection and treatment of ketones prevents DKA and hospitalizations O Untreated, progression to DKA may lead to severe dehydration, coma, permanent brain damage or death O DKA is the number one reason for hospitalizing children with diabetes KBN 2014

4. When Should Ketones Be Checked? The DMMP should specify, generally: O When blood sugar remains elevated O During acute illness, infection or fever O Whenever symptoms of DKA are present -nausea-rapid breathing -vomiting or diarrhea-abdominal pain -fruity breath odor-fatigue or lethargy -thirst and frequent urination KBN 2014

5. How Quickly Does DKA Progress? O An isolated high blood sugar reading, in the absence of other symptoms is not cause for alarm O DKA usually develops over hours or even days O DKA can progress much more quickly for students who use insulin pumps, or those who have an illness or infection O Happens most often when symptoms of DKA are mistaken for flu and high blood sugar and ketones are unchecked and untreated KBN 2014

6. How to Test Urine Ketones 1. Gather supplies 2. Student urinates in clean cup (a little dab will do) 3. Put on gloves, if performed by someone other than the student 4. Dip the ketone test strip in the cup containing urine. Shake excess urine off the strip 5. Wait the instructed amount of time, usually 15-60 seconds, each brand varies 6. Read results at designated time 7. Record results, take action per DMMP KBN 2014

7. Testing for urine ketones Dip test strip in urine, remember to always wear gloves when handling urine or blood Time exactly as instructions state Read color change and document KBN 2014

8. Test Results: Color Code KBN 2014

9. Treatment for Ketones O DMMP specifies treatment for ketones for the individual student Generally: -free to use the restroom as needed -sugar-free liquids, i.e. water -insulin administered as per consultation with school nurse and DMMP -limit physical activity -if vomiting or lethargic, -nurse/school employee should call parent/guardian KBN 2014

10. GO TO THE AMERICAN DIABETES ASSOCIATION SAFE AT SCHOOLS VIDEO CHAPTER 11 KETONES on the internet at YOU TUBE: http://www.youtube.com/watch?v=TXYMMguSDxs&feature=sh are&list=EC3DE9DDE8EB2A2E56