title: Ketone production in children with type 1 diabetes, ages 4-14 years, with and without nocturnal insulin pump suspension.
abstract: OBJECTIVE
  To compare the frequency of elevated morning blood ketone levels according to age in 4-14 year olds with type 1 diabetes following overnight use of an automated low glucose insulin suspension system, or following control nights when the system was not used.
  
  
  METHODS
  For 28 children ages 4-9 years and 54 youth ages 10-14 years, elevation of morning blood ketone levels was assessed using the Precision Xtra Ketone meter following 1155 and 2345 nights, respectively. Repeated measures logistic regression models were used to compare age groups for blood ketone level elevation following control nights (system not activated) and following intervention nights with and without insulin suspension.
  
  
  RESULTS
  Elevated morning blood ketones (≥0.6 mmol/L) were present following 10% of 580 control nights in the 4-9 year olds compared with 2% of 1162 control nights in 10-14 year olds (P < 0.001). Likewise, the frequency was greater following intervention nights in the younger age group (13% of 575 nights vs 2% of 1183 nights, P < 0.001). A longer duration of pump suspension resulted in a higher percentage of mornings with elevated blood ketones in the younger age group (P = 0.002), but not in the older age group (P = 0.63). The presence of elevated morning ketone levels did not progress to ketoacidosis in any subject.
  
  
  CONCLUSIONS
  Elevated morning blood ketones are more common in younger children with type 1 diabetes with or without nocturnal insulin suspension. Care providers need to be aware of the differences in ketogenesis in younger age children relative to various clinical situations.
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: R Paul
authors.initials: RP
authors.lastname: Wadwa
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: H Peter
authors.initials: HP
authors.lastname: Chase
authors.affiliation: Jaeb Center for Health Research, Tampa, Florida, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Raghinaru
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, California, USA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Buckingham
authors.affiliation: Division of Endocrinology & Metabolism, St. Joseph's Health Care, London, ON, Canada.
authors.forename: Irene
authors.initials: I
authors.lastname: Hramiak
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Maahs
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Laurel
authors.initials: L
authors.lastname: Messer
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, California, USA.
authors.forename: Trang
authors.initials: T
authors.lastname: Ly
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, California, USA.
authors.forename: Tandy
authors.initials: T
authors.lastname: Aye
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, California, USA.
authors.forename: Paula
authors.initials: P
authors.lastname: Clinton
authors.affiliation: Jaeb Center for Health Research, Tampa, Florida, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Kollman
authors.affiliation: Jaeb Center for Health Research, Tampa, Florida, USA.
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
authors.affiliation: Jaeb Center for Health Research, Tampa, Florida, USA.
authors.forename: John
authors.initials: J
authors.lastname: Lum
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D007659:Ketones / Q000097:blood*; D008297:Male
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D007659:Ketones
keywords: insulin pump; ketosis; pediatric; type 1 diabetes