Type 2 review..advice on ketones

[T2#Me]

Hi all. My first post, although I have been lurking for some time learning so much from you all, so thank you. Diagnosed 3 years ago with a scary hba1c of 80. GP started me on metformin straight away along with the usual 'eatwell' nutritional advice and I've very much been up and down with my hba1c since, while I've battled some difficult mental health issues. A few months ago I finally took responsibility for my own health and embraced low carb high fat and intermittent fasting after reading of everyone's success on this forum. Its taken a while to beat my carb craving and find a new way of eating but as of my last blood test 10 days ago my hba1c is now 43. Saw a different GP to normal who gave me a gold star and asked how. I said I've really cut down on carbs, more exercise and test, test, test. I asked if any chance of testing materials on prescription (rather than drugs) and she promised to look into it. They're keeping a close eye on my progress and I have another DN review this week which I have been told is to assess me and make a decision about the testing materials. By the way I've cut out my evening metformin so am only on 500mg a day (without GP's knowledge I might add) as I'm fed up with the stomach issues. And anyway, I don't feel I need it now. My question today is about the DN review. The nurse is nice enough but has always been of the 'type 2 is progressive' way of thinking. Never discussed low carb with her so don't know her view on it. I am obviously very keen to get testing materials on prescription and appreciate how lucky I will be if this is the case. I've purchased some urine testers for ketones and they reveal the darkest colour, showing I am in ketosis. I know that the DN has always checked for ketones in my urine at a review and I have not even known what this meant until recently. I'm looking for tips on how to handle the review as according to my research ketones are only dangerous if accompanied by high readings. Is this correct? My readings are now usually around 5 or 6 so obviously I have things under control. Has anyone else on low carb had ketones detected at a review and was it an issue? I'm still so new to understanding it all so any advice very welcome. thanks

Well done and good luck ... thanks for this thread as I was just about to ask about ketones myself ... cheers.

 

[PatsyB]

I was told by the Nurse when I asked her about keytones not to worry about them as I was type 2 and they affected type 1 who do you believe lol

 

[brassyblonde900]

I was told by the Nurse when I asked her about keytones not to worry about them as I was type 2 and they affected type 1 who do you believe lol

Your nurse is correct to some degree. Ketones are not a source of concern for most type2s to some degree.
Ketones are safe. They are produced by the body when glycogen is low, as an alternative source of energy amongst other benefits.
However there is another condition called Ketoacidosis which is a serious life threatening medical condition.
Most times people confuse the two.
You might want to take a look at this article, which goes into more detail, regarding the difference between the two.
https://www.healthline.com/health/ketosis-vs-ketoacidosis

 

[Oldvatr]

I believe nice guidelines suggest strips are issued only when an integral part of control. Not sure of the exact wording. Maybe get a printout of it to take with you. Try and emphasise that the testing is precisely what has given you that control.

Also emphasise that the alternative to not testing would be more drugs, they pay either way and your health isn’t better with strips. No guarantees but I’d say using their guidelines against them is your best hope.

Somehow I got mine prescribed, at least for now, by my, discrete low carb advocate, dn just by asking for them and demonstrating I was motivated to use the results not just log them. You’ve already done that.

Yes I too have succeded in getting a scrip. I am a driver so need to have extra checks for DVLA. I am also on a medication that can cause hypo's (Metformin is not one recognised as being hypogenic, so on its own will not help get strips) The turning point for me was as has been said above I was able to prove that I was being proactive with the results by reducing my bgl and BP meds in response to them. I also used the strips to improve my efficiency of what meds I was on by proving that for me at least, timing of the doses wrt mealtimes was important and significant. These adjustments are proven to save the practice on my meds and support needs, so my GP was able to interpret the NICE guidelines in my favour.

 

[Oldvatr]

I was told by the Nurse when I asked her about keytones not to worry about them as I was type 2 and they affected type 1 who do you believe lol

Whilst it is true that T2D tends to be less susceptible to DKA, it is not unheard of. If a T2D has very severe Insulin Resistance, then they may still be producing insulin themslves, but not enough to get their bgl levels down. As T2D progresses (which unfortunately happens to many but not all T2) then there comes the time when external insulin is required, and then there is a similar risk of DKA as T1D.

There are some medications especially the SGLT-2 family, which can cause DKA even on relatively low bgl levels in some.



Some diseases such as pancreatitis can also affect the supply of insulin, and again some medications are associated with raising the chance of pancreatitis. However, the OP is probably not in these categories so need not worry.
Edit to add some relevant info
https://www.nursingtimes.net/home/b...e-linked-to-pancreatic-cancer/5059874.article

 

[PatsyB]

so me being on Insulin has the risk of keytones, thank you for that information

 

[HSSS]

Out of interest I know pee sticks can read falsely negative for ketones after a while but is there any reason to doubt positive readings after 4 months? Sometimes fairly strong sometimes more subtle. Does this mean I’m not using the ketones I’m obviously producing? Or I’m still producing more than I need?

 

[Oldvatr]

so me being on Insulin has the risk of keytones, thank you for that information

You have a greater risk than me that's sure. Please make sure you are aware of the symptoms of DKA.

I am lucky in that I was running with bgl off scale on my meter (>32mmol/l) without worrying about ketones since I knew I was still producing my own insulin, and that in time my levels were dropping. It was not a recommended state thats for sure, but I did not get DKA and since then I have learnt to control my bgl muxh better such that my GP has registered me as Normal.

Ketones are only a problem when higher than normal. Nutritional ketones can register up to about 5 mmol/l without being any problem, and it is when they get to 10 or above that the blue lights should start flashing since that is an abnormal level not usually caused just by diet or exercise.

 

[paulus1]

lease dont assume type 2s are safe from DKA its simply not true. on dignosis i was 24.2 bg and 4.2 ketones. my blood gases were becoming acidotic i was lucky a longer delay i would has the consultant said be dead. yet not always i had a bad spell with bg over 27 i think a bug affected me. ketones 0.1 which is normal