Kids First, Diabetes Second Book: Ketone Testing

by Leighann on December 14, 2015

Kids First Diabetes Second

(See advertiser disclosure below.)

Since illness is already circulating through the schools, I figured it was a good time to talk about ketone testing. If there is one thing that is frustrating about diabetes, it’s checking for ketones, especially in younger kids. Finding out about blood ketone meters was life changing and I couldn’t believe no one had told us about them sooner!

Here is an excerpt from my book Kids First, Diabetes Second about checking for ketones.

CHAPTER FOUR: Diabetes 101

Ketone Testing (The Best-Kept Secret)

When we were in the hospital after diagnosis, we had to check Q’s urine for ketones every time she went to the bathroom until we had two ketone tests in a row that came back negative. In the hospital, she could pee into a “hat” inserted onto the toilet. When we came home and needed to check for ketones on sick days or when her blood sugar was above 300, we had her pee into the little plastic potty she had used to potty train. We would then dip the urine ketone strip in and read it.

There are several problems with urine ketone strips. First, I have an axiom that I like to say loudly: You can lead a child with diabetes to ketone strips, but you can’t make her pee. Seriously, I don’t know many young children who can urinate on command. And think of children still in diapers! I have heard of parents who put cotton balls in their child’s diaper to try to soak up enough urine to test. I was called into school many days when Q’s blood sugar was high and the nurse wasn’t in the building long enough to wait for her to urinate.

In addition, there is much room for interpretation as to what color shows up on the stick. Do you see those shades of pink and maroon on the side of the ketone test strips bottle? It’s not always easy to discern if ketones are negative, trace, moderate, or large based on the color. One of the biggest negatives I see to using urine ketone strips is that they lag behind by about two hours. Ketones in the urine have actually been filtered by the kidneys; therefore, a urine ketone test gives you a picture of what was going on in your child’s body about two hours prior. The stick could show that your child is negative for ketones when, in fact, they could be building up.

I think one of the best-kept secrets in diabetes management of younger children is the blood ketone meter. Unfortunately, I didn’t find out about it until the middle of Q’s kindergarten year. I now sing its praises and highly recommend using a blood ketone meter over urine ketone test strips.

The process of using a blood ketone meter is similar to checking blood sugar. You lance the finger and apply blood to a special test strip. In a few seconds, the meter gives you an actual number, so there is no guessing whether it is negative, trace, moderate, or large. Where the urine test lags behind by two hours, the blood ketone test gives real-time results. It lets you know if there are ketones floating around your child’s system right now, allowing you to quickly treat. And the best part is that any caregiver who can check blood sugar can also check blood ketones. It is also easy to check children for ketones in the night without waking them.

The downsides to blood ketone strips are that they are expensive and that they expire relatively soon, usually within one to two years of purchase. Urine ketone strips are cheap. Blood ketone strips cost about $5 each before insurance coverage, and some policies don’t cover them. Our co-pay for blood ketone strips brings their cost well below the $5 per strip, and, for us, the convenience makes the price worth it. If your insurance company says that they do not cover blood ketone strips, you can ask your doctor to write a letter of medical necessity indicating that it is a more accurate and accessible way for you to assess your child’s blood ketone level. Additionally, you can ask your insurance company for an override.

Update not in the book: Our insurance company began covering blood ketone strips as part of our durable medical equipment (DME) coverage at a very decent copay. We order them from the same supplier that gets us our continuous glucose monitor supplies.

Kids First Diabetes Second Book

Learn More

If you’d like to learn more about the book, you can read more on the Kids First, Diabetes Second book page. It’s available widely in print and as an eBook from book sellers such as Barnes & Noble,, and IndieBound. And if you do read it and find it to be a valuable resource, I would greatly appreciate if you could write a review on any of the online retail sites. Thanks!

Disclosure: This post contains affiliate links to booksellers.

Please remember that I never give medical advice. Ask your endocrinologist or pediatrician for advice about your own child. Make your own informed decisions for your own child.

Advertiser Disclosure: Nova Biomedical, a maker of blood ketone meters and strips, has been a long time advertiser on D-Mom Blog. They did not ask me to write about ketone strips and I am not being directly compensated for this post. Advertisements are not endorsements. There are two blood ketone meters currently on the market.

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