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Child Health Guideline Identifier

Diabetes - managing hyperglycaemia and ketone testing in hospitalised patients with diabetes mellitus

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Background

Hyperglycaemia is defined as blood glucose levels above 15mmol/L

Causes of hyperglycaemia

Possible causes of hypoglycaemia are:

  • Additional carbohydrate food intake
  • Inadequate insulin dose
  • Measuring the blood glucose level too soon after a meal (generally a 2 hour window is required after eating before retesting a blood glucose level)
  • Temporary increase during or after vigorous exercise in response to adrenaline
  • Emotion such as excitement or stress
  • Infection or other illness
  • Glucose on the fingers (for example food or sweet drinks on unwashed hands) giving a falsely high reading
  • Insulin pump users -infusion set or pump fault

Clinical presentation

 The symptoms of severe hyperglycaemia can include

  • thirst
  • polyuria and polydipsia
  • excessive tiredness
  • feeling unwell

Management of hyperglycaemia

The aim of managing hyperglycaemia within the inpatient setting is to:

  1. Restore euglycaemia (4-7mmol/L)
  2. Avoid the development of ketones and possible ketoacidosis

Treatment of hyperglycaemia

The endocrine registrar (or paediatric registrar after hours) should be notified immediately if the blood glucose level is > 20 mmol/L.

Test for ketones if the blood glucose level is > 15 mmol/L. Ketones in diabetes indicate that there is too little insulin in the body.

Ketones are chemicals in the blood which come from the breakdown of fat. The body makes ketones as an alternative source to glucose in some situations. When there are ketones in the blood they will also be found in the urine.

The endocrine registrar (or paediatric registrar after hours) should be notified immediately if ketone testing results (see table below) are positive .

Blood ketone testing

Measuring for ketones in the blood using the Freestyle Optium Neo™ gives an earlier and more accurate picture of ketones in the body than urine ketone testing. Blood ketone testing reports the amount of ketones (beta-hydroxybutyrate) in the blood as a number.

Blood ketone reading (mmol/L) (beta-hydroxybutyrate)
Less than 0.6 Negative/trace
0.6 - 1.5 Small to moderate ketones
Above 1.5 Moderate to large ketones

Urine ketone testing

Testing for ketones in the urine is done using Keto-Diabur-Test 5000 (Ketostix™) urine test strips. Always check the expiry date and the date the bottle was opened. Urine can be passed directly onto the strip or by dipping the strip in a clean container of urine. Clean cotton wool can be used to capture urine in babies or toddlers wearing nappies.

The result must be read at exactly 15 seconds by comparing the colour of the strip to the chart on the side of the bottle.

Negative No colour change
Trace Just a slight colour change (slightly pink)
Small, + 1 mmol/L (darker pink)
Moderate ++ 5 mmol/L (purple)
Large +++ 15 mmol/L - dark purple colour

Information for Families

Blood Glucose Testing Online Teaching Module

Sick Day Management Online Teaching Module

References

  1. ISPAD Clinical Practice Consensus Guidelines 2014 Compendium. - Hypoglycemia: Assessment and management of hypoglycemia in children and adolescents with diabetes. Ly, T.T., Maahs, D.M., Rewers, A., Dunger, D., Oduwole, A., & Jones, T.W. Pediatric Diabetes 2014: 15 (Suppl. 20): 180-192.
  2. National Evidence-Based Clinical Care Guidelines for Type 1 Diabetes in Children, Adolescents and Adults Craig, ME, Twigg, SM, Donaghue, KC, Cheung, NW, Cameron, FJ, Conn, J, Jenkins, AJ, Silink, M, for the Australian Type 1 Diabetes Guidelines Expert Advisory Group. Australian Government Department of Health And Ageing, Canberra 2011.

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Document Control

  • Date last published: 08 June 2017
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Endocrinology
  • Author(s): Rosalie Hornung, Fran Mouat, Craig Jefferies
  • Owner: Paediatric Diabetes Service
  • Editor: Greg Williams
  • Review frequency: 2 years

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