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.

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.

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.

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