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OBJECTIVE -This study was designed to test the accuracy of capillary ketonemia for diagnosis of ketosis after interruption of insulin infusion. RESEARCH DESIGN AND METHODS-A total of 18 patients with type 1 diabetes treated by external pump were studied during pump stop for 5 h. Plasma and capillary ketonemia and ketonuria were determined every hour from 7:00 A.M. (time 0 min ϭ T0) to 12:00 P.M. (time 300 min ϭ T300). Plasma ␤-hydroxybutyrate (␤-OHB) levels were measured by an enzymatic end point spectrophotometric method, and capillary ␤-OHB levels were measured by an electrochemical method (MediSense Optium meter). Ketonuria was measured by a semiquantitative test (Ketodiastix). Positive ketosis was defined by a value of Ն0.5 mmol/l for ketonemia and Ն4 mmol/l (moderate) for ketonuria. RESULTS-After stopping the pump, concentrations of ␤-OHB in both plasma and capillary blood increased significantly at time 60 min (T60) compared with T0 (P Ͻ 0.001), reaching maximum levels at T300 (1.30 Ϯ 0.49 and 1.23 Ϯ 0.78 mmol/l, respectively). Plasma and capillary ␤-OHB values were highly correlated (r ϭ 0.94, P Ͻ 0.0001). For diagnosis of ketosis, capillary ketonemia has a higher sensitivity and negative predictive value (80.4 and 82.5%, respectively) than ketonuria (63 and 71.8%, respectively). For plasma glucose levels Ն250 mg/dl, plasma and capillary ketonemia were found to be more frequently positive (85 and 78%, respectively) than ketonuria (59%) (P ϭ 0.017). The time delay to diagnosis of ketosis was significantly higher for ketonuria than for plasma ketonemia (212 Ϯ 67 vs. 140 Ϯ 54 min, P ϭ 0.0023), whereas no difference was noted between plasma and capillary ketonemia.CONCLUSIONS -The frequency of screening for ketosis and the efficiency of detection of ketosis definitely may be improved by the use of capillary blood ketone determination in clinical practice. Diabetes Care 26:1137-1141, 2003T he Diabetes Control and Complications Trial (DCCT) has demonstrated that intensive diabetes management, multiple daily injections (MDI) in two-thirds of cases, and continuous subcutaneous insulin infusion (CSII) in one-third of cases could reduce the risk of development and progression of long-term complications of type 1 diabetes (1). CSII provides the most physiological pattern of insulin delivery currently available (2). However, it is now clearly established that CSII is associated with a substantial increase in risk of diabetic ketoacidosis (DKA) compared with MDI (3,4). In a meta-analysis of 14 studies, odds ratios (95% CI) were 7.20 (2.95-17.58) for exclusive use of insulin pumps compared with 1.13 (0.15-8.35) for MDI (4). Technical problems with CSII (pump failure, catheter occlusion, skin infection) may reduce insulin delivery or insulin absorption and cause DKA (5). Currently, the use of short-acting insulin analogs in external pumps is becoming more widespread because some studies have shown that the use of such analogs provides better glycemic control and stability than regular insulin (6 -8). Considering the pha...

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