faking ketone test??

[nursekoll]

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!

[JenTheSchoolRN, BSN, RN]

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.

It does. In the case of my student, it was no insulin dosing for entire long weekend. The parent was away and student had a long history of being non-compliant (I hate that word, but appropriate here). Parent was scared and I'd like say the kiddo was, but I'm not sure about that with a continuing A1C of over 10. Parent, doctor, and I continue to try new things/tactics.

[sammiesmom]

Bahaha at my husband's employment, they do drug testing with an employee of the same sex in the restroom with them! They are doing this because they came out to the place of employment as opposed to being in their own facility. They do a random drug testing for business insurance purposes, I think?? It didn't go well for my husband and refuses to pee in front of another guy so he had to go to the testing office.

[Farawyn]

Bahaha at my husband's employment, they do drug testing with an employee of the same sex in the restroom with them! They are doing this because they came out to the place of employment as opposed to being in their own facility. They do a random drug testing for business insurance purposes, I think?? It didn't go well for my husband and refuses to pee in front of another guy so he had to go to the testing office.

Yea, well, this is school nursing, so...

And ketones, not drug testing.

[cmefford]

I have a young man (4th grade)that I believed was dipping his strips in the toilet and then returning it to me to check. I now have a urinal in my bathroom that he used and then I dip it myself so I can be sure that we are getting an accurate reading. The sad part of this...not only is he non-compliant, his mom does nothing to make him compliant, I fight with her as much as I do with him.

[nursekoll, BSN, RN]

I have a young man (4th grade)that I believed was dipping his strips in the toilet and then returning it to me to check. I now have a urinal in my bathroom that he used and then I dip it myself so I can be sure that we are getting an accurate reading. The sad part of this...not only is he non-compliant, his mom does nothing to make him compliant, I fight with her as much as I do with him.

Yes, the family/parents can be difficult to get through to as well. A family history of diabetes can be detrimental, as they are so stubborn that they know what they are doing, and "oh 300 is not that bad, I'm not concerned, Grandma was way worse." Well, I AM!! This kid thinks he will get a pancreas transplant and be cured. I'm just wondering what irreversible damage is being done to his body in the meantime. . .