faking ketone test??

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Specializes in 12 years as a school nurse.

Hi all, I have a new student with poorly controlled diabetes type1. For the first month here, he did not have any ketone strips to bring to school. I have finally got his mom to send a non-expired bottle to keep in the office. When his blood sugar is above 240, he is supposed to test for ketones, so he takes a strip into the bathroom and brings it back out to compare to the bottle. I'm wondering if he is actually using urine though, or maybe toilet water?! Once he had a trace of ketones at 280, but another day at 538 he was negative for ketones! What gives? Should I be making him use a urine cup and dipping it myself? I know as school nurses we're always on the lookout for those kids that fake being sick, but to fake being fine?, crazy to me!

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Specializes in school nursing, ortho, trauma.

are they just ketone strips? most of my kids have the ones that test for glucose too so i'll see that they have a little glucose in their urine too.

if that's not an option then when you give him a cup have him bring it back out. If it's crystal clear, then it may be eau de latrine. Or you can do what we do when drug testing and pour dye into the water before hand and advise not to flush until after the test. (actually we'd turn off the water, but that seems extreme in your case)

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Specializes in School Nurse.

I give my student a cup, and then have him meet me at the RR door with the urine. I dip the strip and do the comparison chart.

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Specializes in 12 years as a school nurse.
I give my student a cup, and then have him meet me at the RR door with the urine. I dip the strip and do the comparison chart.

ok, I can do that, but I'm only here one day a week, so I'll ask the secretary how she feels about handling pee!

Has anyone else suspected kids faking ketone testing?

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Until I get to know them, I make them bring the cup to the door. Once I feel they're trustworthy (and for some, that is never), I let them dip it themselves. I will say though, I've had some in the 500's or who read "HI" and have negative or just trace of ketones, and those are ones I dipped myself. If they're that high, there's usually no problem getting a second specimen from them if needed. :yes:

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Specializes in LTC.

I'm not a school nurse, but I am a T1D, I've been high enough to not register on the meter and still tested negative for ketones. I generally have only seen ketones if my pump site fails or I'm vomiting for an entire day. Still, I'd have it tested in office, because, again, I'm a T1D and we can seriously be a sneaky bunch if we don't want to deal with being sick right that moment.

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Specializes in 12 years as a school nurse.

yes, these strips only test for ketones. The first day the secretary give him a cup to use, he refused, said "no I don't do it that way"

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Specializes in school nurse.

It would be better if they can get insurance to pay for ketone blood strips. Some glucometers measure both if you switch out the strips. Blood shows ketones faster than urine anyway.

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Specializes in School nursing.
I'm not a school nurse, but I am a T1D, I've been high enough to not register on the meter and still tested negative for ketones. I generally have only seen ketones if my pump site fails or I'm vomiting for an entire day. Still, I'd have it tested in office, because, again, I'm a T1D and we can seriously be a sneaky bunch if we don't want to deal with being sick right that moment.

I appreciate your honesty in that last sentence, because I see that with a couple of my HS students with T1D.

But honestly, I have only seen ANY of my T1D student test above trace amounts twice, and I've seen glucose levels above 500. One of those times the student was also actively vomiting and borderline DKA. The other time, the student feeling just fine, had BG in the 300s, ketones of 0.6 (per meter). Student had a correction plan in place, so I followed it and the student returned to her normal.

I have urine ketone strips as back-up, but nothing beats a ketone meter. However, those are specific for each kid as I do not have a back-up ketone meter, just a back glucometer. For the strips, I have the kid bring me the sample and I dip it myself.

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Specializes in Pediatrics Retired.
ok, I can do that, but I'm only here one day a week, so I'll ask the secretary how she feels about handling pee!

Has anyone else suspected kids faking ketone testing?

I do the dipping and reading too. I have the kid leave the cup of urine on the back of the toilet; pour the urine in and toss the cup when I'm done.

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Kids these days...but really, I agree with some responses here that closer proximity or monitoring (without actually watching the void) could solve the problem.

Also, remember metabolic states will not be the same all of the time. Depending on nutrition, insulin coverage, and activity a blood sugar of over 500 may just be a hyperosmolar state with NO ketones.

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Specializes in ICU, LTACH, Internal Medicine.

Not a school nurse but....

In EITHER type of diabetes ketosis (or, rather, ketoacidosis) is NOT directly connected with hyperglycemia. Ketoacidosis is the result of lipolysis and fatty acids being used as an energy source instead of glucose. Fat is our body's next before the last source of energy, the last being structural proteins (this is why it is so difficult to lose any "fat weight"). Before this happens, all glycogen's storage (liver, muscle) and all easily available proteins must be used; if the patient gets at least some insulin (which is the most potent anabolic hormone in the body, directly opposing lipolysis and using glycogen for energy needs), ketogenesis will not happen, doesn't matter how high is blood glucose. Ketosis happens as a result of absolute deficiency of insulin, and takes a good number of hours to develop, if not days.

Hope it helps.

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