Diabetes Ketoacidosis in Children

• If your diabetes is untreated or poorly controlled, blood glucose levels rise very high (hyperglycaemia).
• This occurs because you don't have enough insulin for your needs, the glucose in the blood is not being taken into the cells so your body makes its own fuel by burning up stored fat.
• When fat is used in this way, waste products called ketones are produced and these excreted in the urine.
• Small amounts of ketones are not harmful, and are normally produced when you start to bum up body fat...for example when you go on a weight reduction diet.

However, problems arise when Blood Sugar levels are high and excessive ketones are produced and these start to accumulate in the body.

If untreated this will result in a condition called 'ketoacidosis'. This condition is serious and urgent medical treatment is essential.

What causes this?

1. Illness and infection (e.g. flu, vomiting, diarrhoea, urine infections).
2. Missed or incorrect insulin dosage.
3. Poor injection technique.
4. Ineffective insulin due to faulty storage or expired date.

Watch for

1. The common signs and symptoms of hyperglycaemia, e.g. excessive urination and thirst, dry mouth and skin, tiredness.
2. Persistant high level of sugar in blood or urine.
3. Presence of ketones in the urine.
4. Nausea, vomiting and abdominal pain.
5. Sweet smell of acetone in the breath.
6. Respiration-deep and rapid.
7. Altered levels of consciousness.

To Prevent Ketoacidosis

If your are sick

1. Take your usual dose of insulin.
2. Test your Blood Sugar level and urine ketones at least 4 hourly (or more often if necessary).
3. Contact your Doctor with your results.
4. Give extra quick acting insulin according to your doctor's guidelines. If you cannot contact your Doctor, follow these guidelines:
   • (a) If your Blood Sugar Level (BSL) is less than 260mg/100ml, continue your normal insulin.
   • (b) If your Blood Sugar Level (BSL) is between 260 mg% to 360 mg% give 4 units of quick acting insulin (Hum insulin-r or Actrapid) every 4 hours, in addition to your usual dose.
   • (c) If your Blood Sugar Level (BSL) is above 360 mg! 100 ml, give 4 units of quick acting insulin (Hum Insulin-r or Actrapid) every 2 hours, in addition to your usual dose.
   • (d) Follow this procedure until your BSL is less than 250mg/100ml of Blood.
5. If you don't feel like eating, replace your normal carbohydrate portions with simple carbohydrate fluids, fruit juice etc. if your Blood Sugar Level (BSL) is persistently above 250mg/100ml, sip unsweetened fluids only.
6. Take extra clear sugar-free fluids. You need to have 200-500ml/hour (depending on your body size and degree of dehydration).
7. If your BSL is persistently high or if you are vomiting, you must contact your Doctor or go to Hospital.

Do not Delay!

Children with diabetes are no more likely to develop sore throats or virus illnesses than any other child providing their diabetes is well controlled. When diabetes is first diagnosed, poorly controlled, during an infection, stress, or other illness, the body's need for insulin increases. This causes the Blood Sugar level to rise very high (hyperglycaemia). With this lack of insulin the body cells can no longer use the glucose as the main source of energy' so the body makes its own fuel by burning up stored fats. When rut is used in this way, waste products called ketones are produced and these are excreted in the urine.

However, a problem arises when Blood Sugar levels are high and excessive ketones are produced and these start to accumulate in the body. Ifuntreated this will result in.

Ketoacidosis

This condition is serious and urgent medical treatment is essential.

Causes

1. Initial diagnosis.
2. Illness and infection (e.g. flu, vomiting, diarrhoea).
3. Missed or incorrect insulin dosage (including poor injection technique).
4. Long-term poor control and neglect.

Watch For

1. The common signs and symptoms of hyper glycaemia.
   • Excessive urination;
   • Thirst;
   • Tiredness;
   • Weight loss;
   • Signs of dehydration
     • dry mouth/skin;
     • sunken eyes.
2. Persistent high levels of Sugar in the blood or urine.
3. Presence of ketones in the urine.
4. Nausea, vomiting and abdominal pains, vomiting is always serious.
5. Sweet small of acetone on the breath.
6. Respirations and rapid.
7. Altered level of consciousness.

These symptoms may develop over hours or days.

Prevention Ketoacidosis in Children

To Prevent ketoacidosis

If you are sick

1. Never Omit Insulin - always take your usual dose.
2. Test Blood Sugar and Urine Ketones-Atleast every 2 hours and hourly is necessary.
3. Contact Your Doctor - give results of tests.
4. Extra Insulin - quick acting insulin may be needed according to your doctor's guidelines.
   If you cannot contat your doctor follow these guidelines:
   • If your Blood Sugar Level (BSL) is less than 200mg%, continue your nonnal insulin;
   • If your BSL is between 280-360mg per 100 rnl of Blood, give 2 units of quick acting insulin (Hum Insulin-r or Actrapid) every 4 hours, in addition to your usual dose;
   • If your BSL is above 360mg/l00ml of Blood, give 2 units of quick acting insulin every 2 hours in addition to your usual dose;
   • Follow this procedure until your BSL is less than 280 mg%.
5. Replace Normal Carbohydrate - If you don't feel like eating, replace with simple carbohydrate fluids, e.g. flat ordinary lemonade, fruit juice etc. (see your sick day card). If your BSL is persistently above 15mmolIL sip carbohydrate free (unsweetened) fluids (lemon juice mineral water).
6. Extra Fluids - You need to have extra carbohydrate free fluids every hour. (The amount depends on body size and degree of dehydration.)
7. High BSL or Vomiting - If BSL persistently high or you are vomiting you must contact your doctor or go to hospital.