Ketones in urine

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My DS 9 had his urine dipped by the school nurse ( nighttime bed wetting clinic) and it flagged ketones in his urine so she asked us to do a first wee of the day sample and take to GP. They have dipped it and again said ketones++ and have sent to a lab for further testing.
Everything I've read and googled suggests diabetes, my DS has dyspraxia, sensory processing issues and is terrified of needles!! Will we need a blood test?!
And for any doctors / nurses or type 1 diabetic experts on here, can you please tell me if glucose would also need to be positive in his urine for it to indicate diabetes?
Glucose and everything else was negative in dip, was positive for ketones only. He has no symptoms.
Please help put my mind at rest, if not diabetes what could it be?

What does he eat?

Some people live very healthy lives on a keto diet so ketones in the blood in that scenario is actualy desired.

There is a big difference between ketosis and ketoacidosis - the former is fine, the latter is not. But unfortunately it does sound more likely to potentially be the latter and diabetes related - I say this as a 9 year old is not likely to be on a keto diet..

Yes he will need a blood test to check his HbA1c which will determine the average blood sugar level across the last two months or so.

My FIL has had Type1 diabetes since a child and is now in his late 70s. The british diabetic society also sometimes suggest a keto diet to people with type-2 diabetes as a way to avoid or reduce insulin injections but a keto diet is hard to stick to long-term so not often mentioned.

Hi my son is T1 diabetic. In my experience ketones in blood/urine are produced when high levels of glucose are present in blood. So if it's not shown glucose in urine then sounds like it may be not type one diabetes.

Having said that, if you have any worries of type one diabetes you need to treat it as an emergency and a simple finger prick blood test can determine sugar levels /ketone levels, either at out of hours gp/ A&E. Type one undiagnosed can be life threatening if left.

Ketones can be present in non diabetics, simply if they haven't eaten in a while, sickness bug or illness.

Hopefully you will get some answers soon.

Thank you both for your responses, his diet is good lots of fruit veg protein snd carbs, he also has sweets / choc and snacks. Drinks water and milk but never says he's thirty, I have to pursuance / remind him to drink especially with his water bottle at school.

It was first morning urine, could dehydration show as ketones?

Would diabetes usually show glucose in urine? As well as ketones? Would he have other symptoms?

First morning urine would show ketones as he wouldn't have eaten through the night, regardless of diabetes.

With Type one diabetes to get a high reading of ketones there would need to be glucose in the blood/urine to cause them, type ones can still get what's called starvation ketones if they haven't eaten (ie over night)
Hope that makes sense.

Main 4 type one symptoms are
Toilet
Thirsty
Thinner
Tired.