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Ketosis Home Management in Pediatric Type 1 Diabetes in Germany: Mismatch Between Subjective Self-Ratings and

Simone Eisenhofer1,2, Martina Patrizia Neininger1,2,3, Astrid Bertsche3,4

  • 1Drug Safety Center, Leipzig University Hospital, Leipzig University, Brüderstrasse 32, 04103 Leipzig, Germany.

Children (Basel, Switzerland)
|May 27, 2026
PubMed

Insights

Families managing type 1 diabetes (T1D) at home often overestimate their skills in preventing diabetic ketoacidosis (DKA), despite significant errors in practical ketosis management. This highlights a critical gap in education and support for T1D sick-day care.

Area of Science:

  • Pediatric Endocrinology
  • Diabetes Management
  • Patient Education

Background:

  • Effective sick-day management is crucial for preventing diabetic ketoacidosis (DKA) in children and adolescents with type 1 diabetes (T1D).
  • Home management of ketosis is a key component of T1D sick-day care for families.
  • Understanding family competence in ketosis management is essential for improving DKA prevention strategies.

Purpose of the Study:

  • To assess the competence of adolescents and caregivers in home ketosis management for type 1 diabetes.
  • To evaluate subjective self-ratings versus objective skills in preventing DKA during sick days.
  • To determine the availability of essential supplies for ketosis monitoring and management.

Main Methods:

  • Interviews with adolescents with T1D and caregivers of younger children.
  • Subjective self-assessment of competence in ketosis home management.
  • Objective assessment via clinical scenarios, practical skill demonstrations (urine dipstick testing, insulin administration), and household supply inventory.

Main Results:

  • High subjective self-ratings of competence contrasted with objective findings of frequent errors in urine dipstick testing (100% adolescents, 98% caregivers) and insulin administration (98% for both groups).
  • Median reported management steps were low (4/10 for adolescents, 5/10 for caregivers), with 33% of adolescents and 11% of caregivers never testing ketone levels.
  • Urine dipsticks were available in only 43% of households, while insulin cartridges were available in 78%.

Conclusions:

  • A significant discrepancy exists between perceived and actual competence in home ketosis management for type 1 diabetes.
  • Practical skills in urine testing and insulin administration are often flawed, increasing DKA risk.
  • Limited availability of testing supplies and educational gaps necessitate improved support for T1D sick-day management.
Abstract

Keywords:
diabetes mellitusdiabetic ketoacidosis (DKA)diabetic ketosisinsulin administrationketone testingsick-day managementtype 1 diabetes (T1D)urine dipsticks

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