Sick days and ketones 2011

Sick Days and Ketones: The final lesson

Jean-Ann Holt

Often referred to as “The Ketone Queen”

Sick days and Ketones

When to testWhen to bolusWhen to injectWhen to use Temp rateWhen to ring for help

Case study 1

George,age 4 is unwell. Temp 38.6 BSL 21?any obvious cause of illness?Pamol for tempCheck for ketones 0.2Check line/site/last bolus/basal patternGive bolus on pump. 2.1unitsAfter 2 hours, check BSL. Now 20.2Check for ketones still 0.3Give another bolus (pump will estimate IOB) 0.7unitsUse +temp rate 30% for 3 hoursAfter 2 hours check BSL. Now 10.1 leave Temp basal on.

Important points :

Always use increased temp rates when BSl staying high.Always check for ketones when sick or BSL over 13.0 check blood ketones

Use increased temp rate to maintain normal BSLsChange site if no obvious cause and BSL rising in spite of corrections

Case study 2

Anita is 7, woke at 4am vomiting. BSL 17.6. ketones 2.1worked out correction and X1.5 and give by injection.checked site/line/last bolus/last site change. no obvious cause used increased temp rate +30% for 3 hoursGave small sips of water or other fluidcalled 6310790 #1 to speak to consultant on call.Advised to continue to check BSL & blood ketones 2 hourly and re-correct after 2 hours (calculate IOB).At 10am after a further Injection at 7am. BSL is 15.2, ketones 1.6. spoke with doctor. Advised re further injection correction and increase to temp basal to 150%.No further vomiting. Taking fluids (mainly water)Ketones and BSL came down over day but needed 150% basal for 14 hours.Used 8 blood ketone strips and needed to go for more!!

When to test

When your child/young person is sickmore testing is essential.

Check for blood ketones if BSL is >13Check site, line, cartridge.

No ketones and all OK, do correction.

Recheck the BSL after 2-3 hours.

When to test cont.

After 2 hrs BSL is OK --- great!

After 2 hrs BSL is still >13 recheck ketones

No ketones----do correction PLUS TBR +20-30%

This is essential to maintain normal BSL.

Ketones + --- do injection. Correction x 1.5 PLUS TBR

When to test cont.

After 2 hrs BSL is OKKeep the TBR running to maintain normal BSLRecheck in 2 hours

If BSL still >13, recheck for ketones.If positive Ring for adviceDo a site change.Will most likely need to give another injectionWork out the Active Insulin on Board (40% left after 2hrs.)and subtract the IOB, give injection.INCREASE the TBR to 40-60%

Conclusion

Pumping is flexibleWhen there is no long acting, ketones will be made rapidly.Ketones should ALWAYS be treated with extra insulin.NEVER exercise when ketones are presentMaintain hydrationSeek medical advice when ketones are persisitant.

KETONES

Are the BAD GUYS!!!