Having Trouble Understanding Ketones.

[Duncan_Scott]

Hi Everyone,
Having been diagnosed 14 years ago with Type 2, I had until fairly recently, a pretty good control of it. My diabetic consultant put me on Jardiance Duo and I reduced my carbs, not a crazy amount but to about 80 g per day.
To cut a long story short I ended up in in hospital for 9 days with one of the issues being DKA (brought on by Sepsis.).
During this time the hospital diabetic consultant thought I was more type 1 than type 2 due to the way my body was responding to treatment. The result is that he has put me on Lantus (10 units) and Novo Rapid... plus metformin and 1.2 units of Victoza (I had used this before).
So here we are, I feel great, The lantus is now up to 14 units split (7X2) plus the metformin and the Victoza. I am on about 80g carbs per day and i'm consuming around 1200-1400 calories per day and I'm walking around 10k per day. But, my weight has gone up from 75kg to 82 kg! and my ketones are never below 0.4!. I had no idea about ketones until my episode in hospital and now I am really scared. The other day I woke up they were 1.2 and within 2 hours they had gone to 2.3. Yet my fasting bloods are usually around 6.0-7.0.

This morning I woke up at 4.00am and my Ketones were 1.0, I went to the bathroom and went back to sleep. Two hours later I woke up again and my Ketones were 0.4! My bloods were 6.2 and had been steady (libre).

My bloods are generally around 6.0-7.9 with the odd high... if I make a mistake they go to around 10.5/11. I don't understand how my bloods can be so good and yet my ketones are rising ...I feel like I'm doing all of the right things. I'm trying to find out what I can do with the ketones.

I am going for Cpep test next week to see if it can determine more accurately if I am type 1 or type 2. In the meantime,
Do I increase the insulin, the carbs or both? If I increase the insulin , this will put my weight up and it just seems like a self fulfilling prophecy of a worsening cycle.

If I cut the insulin and carbs back my weight might go down but indicators are that my ketones will rise.
Does anyone have any knowledge of this area or do they know of a good consultant who can help. Having been really comfortable with my diabetes management and accepting it as its who I am ..now i'm so scared of another DKA episode.

Thanks

D x

 

[Goonergal]

Hi @Duncan_Scott

Certainly sounds like you’re having a rough time and I hope the diagnosis of type 1 / type 2 is soon resolved as no doubt that will help to make things clearer and easier to manage.

I’m not in a position to give specific advice but it sounds as though you’re managing well and your ketones are not at a dangerous level. It is the combination of high blood glucose and ketones that can lead to DKA. I’ve taken a screenshot of the NHS advice from this website: https://www.nhs.uk/conditions/diabetic-ketoacidosis/ and hope it will be helpful while you wait for your appointment next week. However, if you have doubts at any time, I’d advise calling 111.

 

[EllieM]

There is a big difference between nutritional ketosis and diabetic ketoacidosis
Nutritional ketosis vs diabetic ketoacidosis (DKA) - Diabetes

Basically, you are likely to have low levels of ketones on a low carb diet. It's perfectly healthy and normal. The high levels caused by ketoacidosis are a completely different beast.

 

[Antje77]

I'd have a talk with your HCP about the Jardiance. SGLT2 inhibitors have some association with DKA without high blood glucose.

 

[Duncan_Scott]

There is a big difference between nutritional ketosis and diabetic ketoacidosis
Nutritional ketosis vs diabetic ketoacidosis (DKA) - Diabetes

Basically, you are likely to have low levels of ketones on a low carb diet. It's perfectly healthy and normal. The high levels caused by ketoacidosis are a completely different beast.

Hi Ellie, that is the bit i'm not sure about, as a diabetic at what point to does it move from nutritional ketosis to diabetic Ketoacidosis. I feel really well in myself on the low carb its just the tipping point that concerns me.

Thanks for your help.

Kind Regards


Duncan

 

[Duncan_Scott]

I'd have a talk with your HCP about the Jardiance. SGLT2 inhibitors have some association with DKA without high blood glucose.

Hi Anje77, Yeah I think looking at what happened to me suggests that for me the SGLT2's are not for me unfortunately (the result i was getting were incredible. It suggests that I might be leaning toward T1 hopefully the C pep test will give us a better steer.

Thanks for coming back to me.

Kind Regards


Duncan

 

[Duncan_Scott]

Hi @Duncan_Scott

Certainly sounds like you’re having a rough time and I hope the diagnosis of type 1 / type 2 is soon resolved as no doubt that will help to make things clearer and easier to manage.

I’m not in a position to give specific advice but it sounds as though you’re managing well and your ketones are not at a dangerous level. It is the combination of high blood glucose and ketones that can lead to DKA. I’ve taken a screenshot of the NHS advice from this website: https://www.nhs.uk/conditions/diabetic-ketoacidosis/ and hope it will be helpful while you wait for your appointment next week. However, if you have doubts at any time, I’d advise calling 111.

View attachment 49805

Hi Goonergal,
Thank you ever so much for the information, I think i'm generally ok with my ketones being slightly raised ...its the rate that they can climb and the levels that they climb to that scares me ...that and not fully understanding the triggers. I guess I'm like so many on these forums ...we are all trying to find our own coping mechanism it is absolutely brilliant that people such as yourself and others on these forums take the time to share their experiences and knowledge to others like myself who can struggle from time to time.

Thank you all.

Kind Regards


Duncan

 

[Daibell]

Hi and welcome. As others have said don't worry too much about the ketones as long as you BS is not high. I would not advise increasing the carbs as they are the main cause of BS rise and weight gain. I'm surprised you are on Victoza yet suspected of possibly being T1. If you have excess weight being T1 is unlikely but possible. The C-Peptide test should help resolve this. Carbs at 80gm/day is very good so I'm surprised by the weight gain but we are all different!