Quality statement 5: Blood ketone monitoring in type 1 diabetes

Quality statement

Children and young people with type 1 diabetes are offered blood ketone testing strips and a blood ketone meter.

Rationale

Insufficient insulin can lead to increased ketone levels which, if untreated, can lead to progressive dehydration and diabetic ketoacidosis (DKA). The risk of DKA is increased if a child or young person with type 1 diabetes has an illness such as flu or a urinary tract infection, or has missed some insulin doses. NICE's guideline on diabetes in children and young people suggests that blood ketone testing is more cost effective than urine ketone testing for preventing hospital admission during intercurrent illness. It is important not to use out‑of‑date testing strips because the result might not be accurate. Education on how to prevent, detect and manage increased ketone levels is also vital.

Quality measures

Structure

Evidence of local arrangements to ensure that children and young people with type 1 diabetes are offered blood ketone testing strips and a blood ketone meter.

Data source: Local data collection.

Process

Proportion of children and young people with type 1 diabetes who receive blood ketone testing strips and a blood ketone meter.

Numerator – the number in the denominator who receive blood ketone testing strips and a blood ketone meter.

Denominator – the number of children and young people with type 1 diabetes.

Data source: Local data collection.

Outcome

a) DKA.

Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.

b) Hospital admission rates.

Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.

c) Mortality.

Data source: Local data collection and 2013–14 National Paediatric Diabetes Audit.

d) Satisfaction of children and young people with type 1 diabetes and their family members or carers (as appropriate) with blood ketone testing strips and blood ketone meters.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (primary and secondary care providers) ensure that systems are in place to offer children and young people with type 1 diabetes blood ketone testing strips and a blood ketone meter.

Healthcare professionals (such as GPs and consultants) offer children and young people with type 1 diabetes blood ketone testing strips and a blood ketone meter, and advise them and their parents or carers on how to prevent, detect and manage increased ketone levels.

Commissioners (clinical commissioning groups) commission services that offer children and young people with type 1 diabetes blood ketone testing strips and a blood ketone meter.

What the quality statement means for children and young people and their parents and carers

Children and young people with type 1 diabetes are offered blood ketone testing strips and a blood ketone meter to measure ketones in their blood. When people need more insulin (because they are ill or have missed some insulin doses) their body makes ketones, and too many ketones can make people very ill – this is called diabetic ketoacidosis, or DKA for short.

Source guidance

Equality and diversity considerations

Particular care should be taken when communicating with children and young people with type 1 diabetes and their family members or carers (as appropriate) if they have, for example:

  • physical, cognitive or sensory disabilities

  • difficulties speaking or reading English.