What happens if you put water on ketone stip?

aprilmoss · Sep 25, 2018

Water on a ketostrip will not result in a positive indication as it contains no ketones.

An otherwise well diabetic should not have even trace ketones.

Ketostrips aren't usually used in regular diabetic care. If the blood glucose is within range, it's unlikely he's producing ketones. My son is a diabetic and while we had ketostrips in our medicine cabinet at home, he never took them to school (and I don't have any as a nurse).

If you have keto-diastix (ones that read ketones and glucose), you may be able to tell as there should be a very slight change on the glucose scale.

They were kind of handy back in the Atkins diet days...

Avill, BSN, RN · Sep 25, 2018

Thank you for your reply! They are used regularly when their blood sugar is above 300 (which unfortunately is often). I'm trying to get this boys to realize how important it is to control their BS at home but I can only do so much at school

grammy1 · Sep 25, 2018

Our orders usually say to check ketones if BG >250 X2, or >350 X1. We have them go in a cup, open the restroom door and I stick the ketone strip in. Student then discards the urine. I got burned by one student and have always dipped myself since then.

Avill, BSN, RN · Sep 25, 2018

That is exactly my fear. This is the first year I have had a diabetic this challenging. He isn't straight out disrespectful, but he doesn't take care of himself and I honestly don't trust him. It just seemed odd to me that his blood sugar would be in the 400's and have NO ketones, not even trace.

How did you catch them lying or what not?

grammy1 · Sep 25, 2018

He was in school with BG between 400-600 all day. His doctor knew how challenging this kid was and specifically sent a letter that he should stay in school even at 600. He would gorge on candy then come in and check his BG to be sent home.

So, he was high all day but negative ketones-documented every time. Ended up in the hospital in DKA that night. My saving grace was that he also told mom he was negative when she had him check at home. I guess the constant vomiting was her first clue.

I still keep in touch with a friend of his (they're in their 20s now), and he hasn't changed one bit. Ends up in the hospital multiple times a year and it's all self induced. :no:

Avill, BSN, RN · Sep 25, 2018

So sad. That makes sense though. I did ask him if he has ever been in DKA, he said only when he was first diagnosed. I also went back to look at his past BS and he has had a few "trace" results so maybe he isn't lying. I'll just keep an eye on him.

KelRN215, BSN, RN · Sep 25, 2018

My diabetic 5 year old has a blood ketone meter. Blood ketones are more reliable per his Endocrine team. That's actually the standard for this clinic. They teach to check urine ketones as a back-up if the blood ketone meter isn't working for some reason.

KelRN215, BSN, RN · Sep 25, 2018

He was in school with BG between 400-600 all day. His doctor knew how challenging this kid was and specifically sent a letter that he should stay in school even at 600. He would gorge on candy then come in and check his BG to be sent home.
So, he was high all day but negative ketones-documented every time. Ended up in the hospital in DKA that night. My saving grace was that he also told mom he was negative when she had him check at home. I guess the constant vomiting was her first clue.
I still keep in touch with a friend of his (they're in their 20s now), and he hasn't changed one bit. Ends up in the hospital multiple times a year and it's all self induced.

We had a kid like this in our program. He was in state custody. He turned 18 a few months ago and basically said screw everyone and everything who's trying to help me. We found out he'd passed away when our medical director got a call from the medical examiner.

ruby_jane, BSN, RN · Sep 26, 2018

We have them go in a cup, open the restroom door and I stick the ketone strip in. Student then discards the urine. I got burned by one student and have always dipped myself since then.

That's what I did when I wasn't sure if a kid was being honest. What do the orders say? Is the kid completely independent? Or "with assistance?" If something's ringing your bells then maybe a chat with the provider is in order?

ruby_jane, BSN, RN · Sep 26, 2018

How did you catch them lying or what not?

You'll know. Believe me. Also remember...you can't care more than this kid (or family) does.

Google "Motivational interviewing." I guarantee you there's something that student will find valuable and perhaps you can come up with a plan where they can do what they need to do in order to achieve whateveritis. My challenging diabetic wanted to go outside for lunch. If the kid got to three days a week with BSG between 75-249, the kid got to go out. It worked in the short term.

aprilmoss · Sep 26, 2018

OK, if he's at 400-600, then he's probably also spilling some in his urine. Using the dual-glucose/keto sticks may be the answer for you.

A student who is regularly at 400 is in deep trouble. I'd be talkign to the parents/doctor about a more agressive plan. While checking ketones will get an early DKA caught, the student is doing DANGEROUS AND IRREPARABLE harm with such high BGs. My son kind of went off the deep end when he headed off for college and wasn't under our observation anymore. He's had kidney, vision, and other serious problems including an amputation. GET THIS KID HELP.