Ketone Testing

by Leighann on 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 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.


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.


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).


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.

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.

Precision Xtra Blood Ketone Meter

(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


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?

Read more posts about blood ketone testing.

{ 17 comments… read them below or add one }

1 Joanne March 4, 2010 at 8:00 am

We use this meter with Elise, and although yes, the strips are expensive, it has been worth it for us. When your child is in diapers, getting a urine sample is no easy task. We used to have to put cotton balls in her diaper, but that was no guarantee that they wouldn’t move and be completely dry when it came time to test.

And then of course there is the issue of the poopy diaper… Let’s just leave it at that.

We’ll use this meter until Elise is potty trained, and then probably move back to the cheaper urine strips. But we will always keep it around, just in case.


2 Leighann March 4, 2010 at 1:06 pm

I can’t imagine trying to get a urine sample from a child who isn’t potty trained.

We’re still using the strips at home, but I think it will work for us at school.


3 Tracy March 4, 2010 at 8:27 am

We use this meter as well. We had the same issue with pee strips as Joanne, Zane was in diapers when dx. It was too much of a pain to get the pee on the cotton balls. We love this meter and only use it if we really think it is necessary. The strips are quite expensive, but totally worth it. I like having an actual number to see instead of comparing colors too!

Good luck with yours!


4 Leighann March 4, 2010 at 1:06 pm

Yes, my husband and I never seem to agree which color it is! The actual number is great to see.


5 Shamae March 4, 2010 at 10:39 am

Well we have a ketone blood tester but rarely do we actually have the strips. Our insurance doesn’t cover them at all. So when we do stumble upon or are given free trial strips, it is heaven! Usually we do the pee strips. But if the pee strips say large, I like to check the actual number with the ketone tester. Also, if she is running high during the nights it’s easier to use the blood tester than to wake up a 6 year old and try to get her to pee. She is still a kid and needs that precious sleep. We used to have her pee in a cup but finally decided it was just simpler and easier on everyone to just have her pee directly on the stick. Made ketone testing in our home much, much simpler! It doesn’t need much urine on it and works great!

So we do both. I think all insurance companies need to carry these. It is just more accurate in dealing with your children’s health. There was a time people checked their sugar levels by peeing on a stick too…but we’ve evolved from that. Time to evolve with ketone testing too.


6 Leighann March 4, 2010 at 1:09 pm

That’s a good idea to use the urine strips and then double check with the meter if they are large.

Our nurse suggested teaching her to pee directly onto the strip instead of into a cup to make it a little more easy for us.


7 Tracy Shannon March 4, 2010 at 11:41 am

we have the same meter as well, but our local pharmacy is unable to get the strips for it (we live in Ontario, Canada). We use the pee strips as best as we can. Emily usually doesn’t have a problem with peeing for it (4.5yrs old). But it’s a great machine!


8 Leighann March 4, 2010 at 1:08 pm

I can’t remember who (maybe it was Shamae) said that you could order the strips online a little more cheaply than at the pharmacy.


9 Pam March 4, 2010 at 4:28 pm

Hi Leighann!
When my daughter was dx last year, the hospital gave us the Precision Xtra meter. We rarely use the urine strips. The blood ketone strips came in handy when she came down with a nasty stomach bug about 6 weeks after diagnosis. We were testing her ketones every hour, and ended up in the hospital when they got too high (I think it registered about 2.5 on the meter). There would’ve been no way to test her urine, since after about 6 hours of throwing up (which continued for the next 4 days) there wasn’t any liquid in her body (thus the high ketones!). The ironic thing was that the ER wasn’t familiar with the meter, and when I told them an exact number for her ketones the doc on call wasn’t sure what that meant! Ever since then, I try to keep a good supply of ketone test strips on hand in the event of another stomach flu. Even though my insurance does cover them, they are more expensive, and not always in stock. So I, too, have found that they’re cheaper and more readily available if I order them through my prescription by mail service.


10 tmana March 5, 2010 at 1:14 am

An earlier version of this meter was given to The Other Half years ago by his medical insurance company when he was diagnosed as having “borderline diabetes”. (No, they did not give ketone strips.) IIRC the original manufacturer was Medisense (who also made Glucerna). The original manufacturer for Freestyle meters was Therasense (I’ve been using Freestyle products that long). Therasense and Medisense were both acquired by Abbott a few years ago. Even back then, it was hard to find the ketone strips and they were extremely expensive. The Precision Extra downloads via a cable that ends in a specialized “strip”, not unlike the glucose and ketone calibration strips.


11 Ayden's Mom March 5, 2010 at 10:15 am

Hi Leighann,

We also use this meter and we have had a tremendous amount of success with it. Even last week when Ayden woke up with a fever of 104 at three in the morning, we jsut did a quick finger poke to see his ketones were on the rise and he needed hydration on top of the tylenol and cold cloth. By the next morning his levels were in check his ketnoes were negative and we were able to manage everything before it got out of control.

Our daycare also tests Ayden three times a day and they don’t have any issues with giving him a quick ketone test whenever his levels are slightly higher, just to be sure. It has revealed a lot of patterns for us, that we can use to keep him in better health.


12 KristinD March 6, 2010 at 4:01 pm

we use these strips as well, and love was the reason we decided to try them..peeing in the nurse’s office was embarrassing for my daughter..our insurance covers them 100%! very grateful for that!..other than having to carry another meter, it’s so much easier. Hopefully more companies will make them, and make them to use in regular meters as well.


13 Reyna August 31, 2010 at 4:18 pm



14 Jaylene September 6, 2010 at 8:08 am

We use the Precision Extra to check my daughter, now 8 for ketones. We found out about it from a friend of a CWD. It is AWESOME and I would never go back to urine ketone sticks! It is more accurate, since it tells what your ketones are now not hours ago as in urine ketones. It is also easier especially when my daughter has been sick. I can’t imagine having to try and get urine from a sick child. Luckily we had our friend tell us about this meter. Thank goodness!!!! Our lives have been much easier. It is one on diabetes cares best kept secrets. Our doctors and nurses never mentioned it to us, we had to ask for it. I recommend it to all CWD I meet. LOVE IT!!!


15 Reyna September 26, 2010 at 5:04 pm

I heart.heart.heart this post Leighann. It is one of my many missions…to let people know about a different way of testing ketones. I am shocked that parents (especially parents of young children) are not made aware of it by their physicians.

Nice job!


16 Melissa May 24, 2011 at 9:24 am

I just found this post. I am in Australia and use the equivalent meter for my daughter. The NDSS (the Australian Scheme for Diabetes) subsides a lot of diabets related costs but Blood ketone strips aren’t on the list. Our price last year was $20/box but now ~$10/box still not cheap but better. My baby was diagnosed at 9 months and I haven’t used urine strips (wringing wee out of cotton balls didn’t appeal and non real time results put me off) but one illness we went through 4 boxes of blood ketone strips. But I successfully mananged high ketones (3.4) at home and avoided hospital.
Besides the cost the other problem is availablity. I have tried more than 6 pharmacies to get a box.


17 Dana March 4, 2012 at 2:46 pm

It has been two years since you posted this and yet there is still the same issue. They are still expensive, hard to find, and barely covered (if at all) by the insurance companies. We are super blessed to be allotted a box a month. But with my little guy being so high and then so low all the time (he is only 21 months) we go through them super fast especially when he is sick. 10 sticks just don’t go very far! It makes me sad that the company hasn’t done more to make this more efficient for diabetic families. Especially for those of us who have babies who can’t pee on the stick.


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