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Now that we’ve been using blood ketone strips for over a year, I can say they are one of the best kept secrets of managing diabetes for a young child. Look for an update later this summer on our experience with them. And even though I have more to say on the subject, this post is one of the most frequently read posts on D-Mom Blog and I wanted to highlight it for those who haven’t read it yet.
Ketone Testing
originally posted March 4, 2010
One of the widest known axioms of raising a young child with diabetes is:
You can lead a diabetic child to ketone strips, but you can’t make her pee.
There is nothing more frustrating that having a number above 300 turn up on the blood glucose meter and not be able to check your child for ketones.
When does this happen to us?
Bedtime
Bedtime routine includes the usual bath, PJ’s, teeth brushing, and going potty. And of course our daughter’s routine includes a bedtime snack and finger check. But the order sometimes varies.
It’s inevitable that on nights when her blood sugar is too high that she has already gone potty and just can’t make herself go again.
School
At five, my daughter is not quite adept at peeing in a cup. At home we have her pee into the training potty to easily dip the urine ketone strip. And she obviously doesn’t require as high a level of privacy at home with her family as she does at school.
So what happens when her blood sugar is above 300 at school?
The male vice principal can’t help her. The nurse is time pressed and must get to the next school right away. And I want Q to get recess if at all possible–the running around will help bring down high blood sugars.
So I get a call each time and am asked what I would like to do.
Should the female nurse help her try to quickly pee in a cup and miss her recess?
Or do I want to leave work and drive over and help.
Usually I just drop what I’m doing and get to school. Luckily this isn’t a regular occurrence.
Solution
I recently heard about a blood glucose meter that doubles as a blood ketone meter. I have to say that when I tried to research it online the information was a little spotty.
I called our nurse and she said that it is a good alternative because:
- Anyone who can use a blood glucose meter can use it.
- It doesn’t require the privacy or coordination of peeing in a cup.
- It gives real time results unlike urine ketone tests that are delayed by about two hours.
The drawbacks:
- It’s yet another device to carry.
- Blood ketone test strips are extremely expensive.
How expensive? Blood glucose test strips are about $1 each (before insurance) and blood ketone test strips are about $5 per strip (before insurance).
Wow.
Lucky for us the nurse said she could send us a meter and a couple of boxes of test strips to try out. If we like it they will write a prescription and we can ask our carrier about insurance coverage.
The meter is the Abbott Precision Xtra Blood Ketone Meter.
We participate in the free Abbott Freestyle Promise Program, which gives a deep discount on test strips. I called to see if blood ketone strips are also covered by this program, but sadly they are not.
Our insurance covers the blood ketone strips as a Tier 2 prescription. Though I have heard that other carriers provide absolutely no coverage and a box is about $50 for 10 strips.
Our verdict is that we will keep this blood ketone meter at school for the convenience of being able to test her right away and take action if needed. But we will continue using urine ketone strips at home. It would be nice to have a second meter for use at home for sick days when real time results are more critical.
Interpreting Results
I am used to the color coding on the urine ketone strips and know how to interpret them. But the blood ketone meter gives results as a number. Though they give three ranges with corresponding colors (think green light, yellow light, and red light), I didn’t know exactly how that would be applied to our DKA Prevention Decision Tree.
(Image: Abbott Diabetes Care)
The actions we take according to the DKA Prevention Decision Tree vary based on the presence of ketones.
I called the nurse to help me interpret the ranges:
- Below 0.6 = normal
- 0.6 to 1.5 = trace to small ketones
- Above 1.5 = moderate to large ketones
Integration
What I want to know is why companies can’t integrate this technology into all meters. We use the Freestyle meter as our backup (we used the Freestyle Lite while doing MDI). This is also made by Abbott. And our OmniPod insulin pump uses Freestyle test strips. Why can’t the OmniPod also check for ketones?
Wouldn’t that make life so much easier? Less devices. More functionality.
How do you check for ketones in your younger children?
For more information about Precision Xtra (Abbott):
- Customer Care: 1-800-527-3339
- Lifetime free meter upgrades
- Insurance helpline: 1-866-246-2683
- Precision Friends for Life Program: 1-866-633-4736 or MediSense.com
- Precision Xtra User’s Guide (ART06986 Rev. B 8/05)
Read more posts about blood ketone testing and the Abbott Precision Xtra Blood Ketone Meter.
{ 6 comments… read them below or add one }
I so want/need one of these for Zane. I am checking now to see if our insurance will cover any of it, I so hope so!!! Thanks for the repost, I needed it!
Ask your endo’s nurse or CDE if they have a meter and some samples that they can give you for free. (Ours mailed it to us since we are so far away.) If your insurance doesn’t cover them, ask if you can get an override with the reasoning that you have a child and it’s difficult to test urine for ketones.
Good luck!
Hi, we’ve been using the optium xceed glucose and ketone tester since our daughter was diagnosed last September and we are very happy with it . They are from Abbott medical. I can’t say what cost they are because as diabetes is a chronic disease the government covers all D related costs (we live in Ireland) .
Great to hear that the strips are covered for you!
In the US it’s up to the individual insurance company as to what they will cover and at what tier. Some people are paying $5 out of pocket per strip! We have it covered at Tier 2 and it costs me about $45 for 50 strips.
I love the ketone meters. They make it so much easier, and the strips come individually packaged which is great because we don’t use them much. I work at an endo office and we get the meters and give them away, so if you want one, I’d ask your endo for one. There is also a new one out made by NovaMax.
On a somewhat funny note about ketone strips: My 17 year old is color-blind. I’ve always wondered why when he runs high, he never has ketones. When my daughter runs high, she gets small ketones. Last month when I asked Josh to check for ketones, he said he didn’t see the point because there is no difference in the colors that the strips turn, so they all meant the same thing. It finally dawned on me that he can’t see the difference in the colors that represent small, med, large etc on the vial. SO he has always told me the ketones were negative when they probably weren’t because he can’t see the colors! At DM camp he said he just told the nurse each morning it was negative!
SO, another reason for a ketone meter if you have a color blind child!
I just had a conversation with an adult PWD who is color blind. He’s looking into whether or not his insurance will cover the strips. I said if being color blind isn’t enough reason for a “medical necessity” override, then I don’t know what is!
That’s so funny (or not so funny!) about your son saying he’s always negative for ketones. I wouldn’t have thought to question him about that.