Ketones

[ThePenguinPimp]

I've beenm t1 diabetic for 30 years now and I have brittle diabetes and I get ketones if my blood sugar rises just a little.

My question is.. why do I need to test for ketones if my blood sugar is above the recommended 13? If I'm aiming to get my blood sugar down anyway so why do I need to know the ketones reading (other than to depress and panic myself further)?

 

[Mbaker]

High blood sugars and high Ketones can lead to Ketoacidosis, which i'm afraid could be any of the following: unconsciousness, hospital, possibly death.

 

[KK123]

Hi Penguin, it's not always possible to get your glucose levels down quickly enough to prevent DKA if you are well on the way. Even when you are in hospital on a drip, it can take a while, and DKA is rapid. As Mbaker said of the potential outcome, it is far too serious a risk to ignore and if you think you might be getting it (ie, by high levels and high ketones) then panic is what you should be doing. Do you have advice on what to do from your own DN/GP?, ie, if YOUR levels reach this because of your particularly brittle diabetes, then do this, etc? x

 

[ThePenguinPimp]

I know the symptoms of DKA though have not had it since being on the pump and I've had a few times where I've thought that if my blood sugar dont start showing signs of dropping soon then I'm going to take myself to hospital but have never actually needed to go..I'm not concerned about DKA I'm just curious as to why we are told to test for them like what good does it do? There isn't a reading which says you've got DKA.

It seems to me that DKA is more reliably diagnosed by symptoms and the only time it would be useful is if you have a normalish blood sugar but are having DKA symptoms (it is possible to go into DKA without high blood sugar apparently). Noone has ever told me what to do with the ketone value just to check for it lol.

 

[Antje77]

Noone has ever told me what to do with the ketone value just to check for it lol.

I'd ask your HCP at which ketone lever they want you to show up in A+E.

 

[KK123]

I know the symptoms of DKA though have not had it since being on the pump and I've had a few times where I've thought that if my blood sugar dont start showing signs of dropping soon then I'm going to take myself to hospital but have never actually needed to go..I'm not concerned about DKA I'm just curious as to why we are told to test for them like what good does it do? There isn't a reading which says you've got DKA.

It seems to me that DKA is more reliably diagnosed by symptoms and the only time it would be useful is if you have a normalish blood sugar but are having DKA symptoms (it is possible to go into DKA without high blood sugar apparently). Noone has ever told me what to do with the ketone value just to check for it lol.

Hi Penguin, sorry, I don't agree. I was rushed from my Drs surgery with a high glucose reading and high ketones and I felt absolutely normal. At the hospital they kept asking me how I was feeling because I was showing none of the outward symptoms yet all the blood results and tests were showing signs of DKA. I ended up on a drip for 24 hours. I think the presence of ketones is one of the main symptoms of DKA, in other words it's one of the things that help them to diagnose whether you have it or not or are at imminent risk of getting it. If for example, the ketone tests showed normal (low) ketones then they know that (probably) the high glucose level is down to something else. The presence of both together may not necessarily mean DKA but it raises the probability. By the way, life threatening DKA is shown by your bodily functions shutting down, who wants to get to that point before testing for ketones? They told me that high glucose with the presence of high ketones is a massive risk factor, then they test the bloods, including kidney and liver functions and a host of other things which shows them the stress your entire body is under...all whilst you may be feeling fab. The sooner they then treat you for it, the better chance of survival.

 

[ThePenguinPimp]

Hi Penguin....

I do get what you're saying.. I think perhaps because I ALWAYS have ketones (I think due to swinging blood sugars over many years) this complicates things further.. A couple of years ago I was taken to hospital after not having eaten or drank anything for 6 days (bad episode of gastroparesis) and my ketones were high (I can't remember what it was but they thought from the ketones I should've been in DKA) but blood tests at hospital showed that despite the fact my kidneys were shutting down I was not actually in DKA (probably due to pump).. I'm going to ask my diabetes team next time I see them if there is a rule for this and will update the thread but testing for ketones everytime I'm above 13 still seems like a pointless exercise unless theres something else going on as well..

 

[KK123]

I do get what you're saying.. I think perhaps because I ALWAYS have ketones (I think due to swinging blood sugars over many years) this complicates things further.. A couple of years ago I was taken to hospital after not having eaten or drank anything for 6 days (bad episode of gastroparesis) and my ketones were high (I can't remember what it was but they thought from the ketones I should've been in DKA) but blood tests at hospital showed that despite the fact my kidneys were shutting down I was not actually in DKA (probably due to pump).. I'm going to ask my diabetes team next time I see them if there is a rule for this and will update the thread but testing for ketones everytime I'm above 13 still seems like a pointless exercise unless theres something else going on as well..

Hi Penguin, you are clearly fully aware of the ketone issue and YOUR diabetes, you know what's 'normal' for you after so long, I would be interested to know what your team says, please come back to us. x