Ketones in the morning.

[Gemmablower]

So my daughter fasts for 12 hours at night and I have noticed that when her basal is flat at night just a couple mmol drop then her ketones can be low at the beginning of the night but reach 0.7-0.9 in the morning even with a bed glucose reading of 8mmol and waking on 6mmol.
When I increase her basal by half unit they diminish to 0.4 but in turn the higher basal creates a huge drop at night meaning going to bed on 11mmol means a waking glucose of 4mmol so the result is having to send my daughters sugars up to compensate for extra basal.
My questions is what level of ketones is ok in the morning after fasting for 12 hours? I would prefer to send her to bed in range but more ketones are being produced so it worries me?
What level of starvation ketones would you expect after 12 hours of fasting? X

 

[novorapidboi26]

significant ketones that would need attention is anything over 1.5mmol/l.........

now I say significant, but this is me talking about a sick day scenario as opposed to fasting ketones......

but its still a good guide......

the levels you have posted are normal I would say.......

 

[teacher123]

Those ketone levels are completely fine.

The danger is when glucose levels are high (13 mmol/l +) and ketones are high and rising. It indicates a lack of insulin in the body so action needs to be taken immediately otherwise diabetic ketoacidosis will ensue. If you want more clarification, I'll tag @LucySW who knows more about this topic than me

 

[tim2000s]

Because she fasts, she is using fat as fuel - it's a form of nutritional ketosis, where the body starts to burn fat and produces ketones as a by product. As her blood glucose level is normal and flat, there is nothing wrong here. Please leave her basal alone and stop trying to get rid of the ketones.

They are highly unlikely to be a sign of Diabetic Keteoacidosis in this case and it is perfectly normal.

 

[Gemmablower]

Thanks for your thoughts.
@tim2000s ketones where not the only reason for trying an increased basal. Her post meal spikes were sometimes high teens and thought she may now need more basal day and night as not suffered with such big meal spikes before and as her growth spurts and honeymoon period is meaning a lot of gradual alterations the last 2months it's pretty tough keeping up with it.
I may have been wrong and the i:c ratio may have needed adjusting instead but I can only learn by trying and sometimes I get it wrong.

 

[tim2000s]

What basal is she on @Gemmablower?

It may be possible to split her basal into overnight and daytime to allow more flexibility.

 

[Gemmablower]

Shes on lantus and has it in the morning. I have considered this a few times but she is 3 and the extra injection wouldn't go down to well right now but something to def consider for the future. X

 

[Diamattic]

I wouldn't worry about ketones unless she has high blood sugars.. Ketones are normal in fasting situations such as hers.

I wouldn't increase basal to deal with post meal spikes, i would first be sure she is counting carbs correctly, and injecting at least 15 minutes prior to eating AND is eating low carb meals (as well as being in the 4-6mmol/L range pre meal)

 

[Gemmablower]

My daughter woke with 1.6ketones this morning. The reason I keep an eye on them so much recently is at bedtime if for some reason she had gone high her ketones quickly build to 0.8 so I correct in the night and keep an eye on ketones aswell as glucose and has made me paranoid she's not getting enough insulin during the night to develop ketones when high at bedtime so quickly.
Lantus is injected in the morning.

So she does fast for a very long time her last meal is at 4.30pm and has a small snack at bedtime of 5g at 7.30 and eats at 8am. Last night I tested at 11pm and she had 0.4 ketones and was 7mmol which was fine she woke on 6.5mmol but with big starvation ketones of 1.6. I'm really worried it's a lack of insulin?
wouldn't you feel terrible with level of ketones? If I'm wrong please can someone explain why her body does this when fasting? And how are the ketones made exactly? I have read about this a lot but hoping someone might have some more in depth info?

 

[RuthW]

Tim explained it, Gemma. When you burn fat, you produce ketones. Once you have burned all the carbs you last ate, you burn body fat. But ketones are only dangerous when blood sugars are also high. In fact you shouldn't even test for ketones when blood sugars are NOT high. What's happening is good, not bad. And no, you don't feel bad with ketones at that level.

Yes, I don't know why professionals can't tell you. But you might consider that they are telling you but you are not able to take it all in at once. Like TIm told you above and you didn't take it in.

Stop testing her ketones when her bloods are normal. Stop worrying and tinkering when her blood are normal. Don't over correct.

Also for a child, twenty minutes before a meal might be too long. If she's slim, and obviously she's smaller than an adult, she will be more sensitive to insulin so they onset time is likely to be quicker. But generally, yes, you have learned some useful things here.

Have you read Think Like A Pancreas? I find having a book about this stuff to hand is often more useful than either consultations or forums, precisely because the info in a book is more organized than on a forum, and you have more time to consider it than you do I a brief meeting with a specialist.

 

[Gemmablower]

I know the procedure for ketones but diagnosis can make you worry when I'm seeing them.
I'm very thorough with my daughter and her safety comes first so do not do anything before I discuss it with my team first and I'm not tinkering with anything right now just simply trying to understand it.
I re read what tim wrote which was useful I suppose I was just after any more on this like the name of the process so I can look it up, I take everything on board my nurse tells me with great detail but she honestly could not tell me why and I like all the information to make informed decisions as it's so important to me. it's all about just making me feel comfortable.
I have a good book type 1 diabetes in children and adolescent which is helpful and will def get that book thank you x

 

[tim2000s]

I know the procedure for ketones but diagnosis can make you worry when I'm seeing them.
I'm very thorough with my daughter and her safety comes first so do not do anything before I discuss it with my team first and I'm not tinkering with anything right now just simply trying to understand it.
I re read what tim wrote which was useful I suppose I was just after any more on this like the name of the process so I can look it up, I take everything on board my nurse tells me with great detail but she honestly could not tell me why and I like all the information to make informed decisions as it's so important to me. it's all about just making me feel comfortable.
I have a good book type 1 diabetes in children and adolescent which is helpful and will def get that book thank you x

The process we are talking about is "Nutritional Ketosis" - it is the state that LCHFers aim to get into and stay in wherby you burn fat as a fuel rather than Carbs. Ketones are a natural by-product of this process as they are a waste product of the fat metabolism.

In a state of ketosis, typically, someone will have a blood ketone measure of 2-4 mmol/l. This is quite normal and safe. The graph below shows this:

This page may also help you understand it a little better:

http://ketodietapp.com/Blog/post/2013/11/30/Ketosis-Measuring-Ketones

I personally have experienced Ketone levels at this level quite comfortably. It is nothing like DKA, which I have experienced once in my life, and I will keep it that way.

 

[Gemmablower]

Thank you Tim that's just the sort of thing I was looking for x

 

[tim2000s]

@Gemmablower It's also worth looking at the Lean Gains blog - it's really a diet and bodybuilding blog, but what your daughter does is similar in terms of eating pattern, i.e. Intermittent Fasting. You might also find this paper interesting.

 

[RuthW]

You know, Gemma, I have had Type 1 since I was 5. That's forty-eight years. Things were pretty primitive back then. My mother wouldn't recognize a ketone if it dropped on her from a great height. All we had were urine tests, which told us roughly what our blood sugars were about six hours before. And you know what? I am perfectly healthy. Remember she's a child, not a collection of symptoms to obsess about. Get her up and welcome the day with her every day. Be glad that all is well. Really, I think you need to let this morning ketones thing go.

 

[Gemmablower]

And thanks Tim all the information has put me at ease and I understand a lot more and don't need to worry about them.