Don't know what to do?

[Duncan_Scott]

Hi Everyone,
Im still struggling to know what to do with my ketones.
My ketones this morning were 0.9 and my bloods were 6.8. I didn't have anything to eat but took 3 units of novo rapid as a correction dose ...2 hours later my ketones were 0.4.
I took 7 units of Lantus at 11.00 am (50% of my daily basal)...My bloods were steady at around 7.0...had some lunch and another 3 units of Novo Rapid and my bloods were good and sat around 6.4 most of the afternoon with just a slight drop nearer tea time. again another 3 units of Novo Rapid with my Tea and my bloods were sitting around 6.6-7.0...checked my ketones at 7.00 pm and they were 1.4 ... my bloods were around 6.2 ...took my other 7 units of Lantus to see if that would help reduce the ketones ..2 hours later they had gone up to 1.6.
Im not sure what to do, I do I take another shot of Novo Rapid or take on some carbs ...or both. Im trying really hard to keep my insulin low through diet and exercise but my weight just keeps going up 74 kg (bmi 23 in February to 82 kilos now)...does the weight gain keep on going or does it level off once my body has adjusted to the insulin?
The ketones, am I currently in nutritional ketosis if so at what point to I become concerned that it could trip into DKA.

Sorry for all the questions but I just don't know which way to go.

Kind Regards

Duncan

 

[Daibell]

Hi. Can you tell us what the meal content was? The fact that you have been gaining weight implies you are having more carbs than your body really needs and taking insulin to counteract that. On the other hand the high ketones does imply ketosis due to lack of carbs so I can't help explain things.

 

[KK123]

My ketones this morning were 0.9 and my bloods were 6.8. I didn't have anything to eat but took 3 units of novo rapid as a correction dose ...2 hours later my ketones were 0.4.

Hi there, I hesitate to 'advise' on anything medical and I appreciate you are type 2 so things may be different to why I may take a correction dose but may I ask why you are taking a correction dose of 3 units of novarapid when your glucose levels are 6.8? Are you on a keto diet or a low carb diet that is low enough to get you into nutritional ketosis?

Generally speaking (and there are exceptions as we are all individual), ketones can become a problem (DKA) if they are accompanied by high glucose levels. On a recent course, their mantra was 'if your ketones reach 3 then it's A&E' if your glucose is high too, ie around 13 or more. That said, those figures are average and you can't mess about with DKA. I embarked on a keto diet for a month and my ketone levels rose up to around 2, my glucose levels were low so it wasn't a problem, I knew it was nutritional ketosis.

If you are not on a low carb/keto diet then I don't know why you would be showing ketones, is that the issue?

 

[Jaylee]

Hi Everyone,
Im still struggling to know what to do with my ketones.
My ketones this morning were 0.9 and my bloods were 6.8. I didn't have anything to eat but took 3 units of novo rapid as a correction dose ...2 hours later my ketones were 0.4.
I took 7 units of Lantus at 11.00 am (50% of my daily basal)...My bloods were steady at around 7.0...had some lunch and another 3 units of Novo Rapid and my bloods were good and sat around 6.4 most of the afternoon with just a slight drop nearer tea time. again another 3 units of Novo Rapid with my Tea and my bloods were sitting around 6.6-7.0...checked my ketones at 7.00 pm and they were 1.4 ... my bloods were around 6.2 ...took my other 7 units of Lantus to see if that would help reduce the ketones ..2 hours later they had gone up to 1.6.
Im not sure what to do, I do I take another shot of Novo Rapid or take on some carbs ...or both. Im trying really hard to keep my insulin low through diet and exercise but my weight just keeps going up 74 kg (bmi 23 in February to 82 kilos now)...does the weight gain keep on going or does it level off once my body has adjusted to the insulin?
The ketones, am I currently in nutritional ketosis if so at what point to I become concerned that it could trip into DKA.

Sorry for all the questions but I just don't know which way to go.

Kind Regards

Duncan

Hi Duncan,

How long have you been using insulin.?
What have you been advised by your HCP to do regarding injection times for your Lantus?

 

[NicoleC1971]

Hi Everyone,
Im still struggling to know what to do with my ketones.
My ketones this morning were 0.9 and my bloods were 6.8. I didn't have anything to eat but took 3 units of novo rapid as a correction dose ...2 hours later my ketones were 0.4.
I took 7 units of Lantus at 11.00 am (50% of my daily basal)...My bloods were steady at around 7.0...had some lunch and another 3 units of Novo Rapid and my bloods were good and sat around 6.4 most of the afternoon with just a slight drop nearer tea time. again another 3 units of Novo Rapid with my Tea and my bloods were sitting around 6.6-7.0...checked my ketones at 7.00 pm and they were 1.4 ... my bloods were around 6.2 ...took my other 7 units of Lantus to see if that would help reduce the ketones ..2 hours later they had gone up to 1.6.
Im not sure what to do, I do I take another shot of Novo Rapid or take on some carbs ...or both. Im trying really hard to keep my insulin low through diet and exercise but my weight just keeps going up 74 kg (bmi 23 in February to 82 kilos now)...does the weight gain keep on going or does it level off once my body has adjusted to the insulin?
The ketones, am I currently in nutritional ketosis if so at what point to I become concerned that it could trip into DKA.

Sorry for all the questions but I just don't know which way to go.

Kind Regards

Duncan

Hi Everyone,
Im still struggling to know what to do with my ketones.
My ketones this morning were 0.9 and my bloods were 6.8. I didn't have anything to eat but took 3 units of novo rapid as a correction dose ...2 hours later my ketones were 0.4.
I took 7 units of Lantus at 11.00 am (50% of my daily basal)...My bloods were steady at around 7.0...had some lunch and another 3 units of Novo Rapid and my bloods were good and sat around 6.4 most of the afternoon with just a slight drop nearer tea time. again another 3 units of Novo Rapid with my Tea and my bloods were sitting around 6.6-7.0...checked my ketones at 7.00 pm and they were 1.4 ... my bloods were around 6.2 ...took my other 7 units of Lantus to see if that would help reduce the ketones ..2 hours later they had gone up to 1.6.
Im not sure what to do, I do I take another shot of Novo Rapid or take on some carbs ...or both. Im trying really hard to keep my insulin low through diet and exercise but my weight just keeps going up 74 kg (bmi 23 in February to 82 kilos now)...does the weight gain keep on going or does it level off once my body has adjusted to the insulin?
The ketones, am I currently in nutritional ketosis if so at what point to I become concerned that it could trip into DKA.

Sorry for all the questions but I just don't know which way to go.

Kind Regards

Duncan

TBH I cannot see anything wrong with your blood sugars or ketone levels.
Your ketones will go up when you are fasting or if not eating too many carbs. Either way as your insulin resistance reduces then you should need less insulin to deal with the same amount of carbs or protein. Are you eating low carb.keto to achieve nutrtional ketosis?
As a type 2 you are very unlikely to get ketoacidosis and you'd know because you would be very ill and the ketones would be over 5.
If you are in nutritional ketosis (above 0.6 I believe) then keep up the low carb diet and taper down the insulin gradually. Just because you're not eating carbs so much doesn't mean you won't need your baseline dose plus likely smaller boluses if not eating carbs. The liver keeps making glucose in addition to ketones and the body has to take time to adapt to being a fat burner rather than a sugar burner.
If you take more insulin this may encourage your body to store excess carbs as fat and it will certainly turn off the nutritional ketosis so I'd just take enough to keep sugars in the 4-7 range.
Lastly I think your focus should be on low carb and glucose level/waist size rather than ketones. I believe these vary a lot and more doesn't always mean better!

 

[Duncan_Scott]

Hi. Can you tell us what the meal content was? The fact that you have been gaining weight implies you are having more carbs than your body really needs and taking insulin to counteract that. On the other hand the high ketones does imply ketosis due to lack of carbs so I can't help explain things.

Hi Daibell, thanks for you response, I had homemade chicken curry (no rice or bread) followed by rhubarb and greek yoghurt, I estimated it to be around 25g of carb. I have a friend who is a nutritionist and she has tracked what I am eating for a few days and its around 80 g of carb per day and around 1200-1400 calories. I'm also walking around 10km per day. I have been diagnosed as type 2 for 14 years but having ended up in hospital with DKA last December the diabetic consultant treating me in the hospital thought I was more type 1 than Type 2 due to the way my body was reacting to treatment .....in part the DKA was brought on by sepsis and being put on Jardiance duo by a previous consultant. Thats why the rise in ketones has really got me spooked...I didn't know anything about them until the trip to the hospital. I'm going for a c-pep test on Monday to see if that can help determine if I'm type 1 or type 2.

 

[Duncan_Scott]

Hi there, I hesitate to 'advise' on anything medical and I appreciate you are type 2 so things may be different to why I may take a correction dose but may I ask why you are taking a correction dose of 3 units of novarapid when your glucose levels are 6.8? Are you on a keto diet or a low carb diet that is low enough to get you into nutritional ketosis?

Generally speaking (and there are exceptions as we are all individual), ketones can become a problem (DKA) if they are accompanied by high glucose levels. On a recent course, their mantra was 'if your ketones reach 3 then it's A&E' if your glucose is high too, ie around 13 or more. That said, those figures are average and you can't mess about with DKA. I embarked on a keto diet for a month and my ketone levels rose up to around 2, my glucose levels were low so it wasn't a problem, I knew it was nutritional ketosis.

If you are not on a low carb/keto diet then I don't know why you would be showing ketones, is that the issue?

Hi KK13,
Part of the problem is that after 14 years of being type 2 they are not sure and they think I am 'more' type 1 than 2. I'm on around 80g of carb per day and to be honest I feel like its just eating a healthy low diet rather which happens to be low carb rather than going keto. I feel really well in myself but my weight is going up and now that I am on insulin (i presume) and my ketones as well just very worried about DKA.

Thanks for you support its really appreciated.

Kind Regards


Duncan

 

[Duncan_Scott]

Hi Duncan,

How long have you been using insulin.?
What have you been advised by your HCP to do regarding injection times for your Lantus?

Hi Jaylee, I was on insulin about 5 years ( In Spain)ago but it was only Lantus once per day ...then the consultant put me on Victoza and stopped the Lantus. I'm now in Singapore and the consultant put me on Jardiance Duo along with the Victoza ...my numbers were great as was my weight but I got sepsis and this as well as the SGLT2's sent me into full blown DKA and I was in hospital for 9 days. The consultant at the hospital has put me back on insulin but this time i'm also trying to deal with novo rapid so i'm still trying to figure out what to do and what not to do with the stuff. With regards to the consultant he told me to take 10 units at night and that was it. I'm trying to find the best solution that works for me and split the dose I'm up to 14 units of Lantus and around 9/10 units of Novo Rapid per day . My bloods are really good during the night and pretty stable. I did contact the consultant a couple of months after I started on the insulin as my bloods were low but my ketones were high and he suggested having a small amount of carbs and inject a small amount of insulin to bring the ketones down.
It feels like I'm going around in circles to be honest, Im trying to get my bloods and insulin down as low as possible and this should help keep the weight off but when I do that by reducing carbs and exercising my ketones go up and the advice from the consultant seems to be to eat more carbs and inject more insulin (albeit in small doses) which will put the weight on which seems counter productive...in the meantime I'm really wary of DKA.

Kind Regards

Duncan

 

[Duncan_Scott]

Hi KK13,
Part of the problem is that after 14 years of being type 2 they are not sure and they think I am 'more' type 1 than 2. I'm on around 80g of carb per day and to be honest I feel like its just eating a healthy low diet rather which happens to be low carb rather than going keto. I feel really well in myself but my weight is going up and now that I am on insulin (i presume) and my ketones as well just very worried about DKA.

Thanks for you support its really appreciated.

Kind Regards


Duncan

Hi KK13, I should have said that with my ketones being raised not feeling I wanted to see if by just taking a little insulin without the food if this would reduce the ketone levels without the need for food as well . It seemed to work as they fell from 0.9 - 0.4. Alternatively, If I eat carbs then this would probably bring my Ketones down but would also raise my sugars and I would then have to take the insulin to counteract this and this would put my weight up further. ...I think? I'm so confused with it all .

Kind Regards


Duncan

 

[Jaylee]

Hi Jaylee, I was on insulin about 5 years ( In Spain)ago but it was only Lantus once per day ...then the consultant put me on Victoza and stopped the Lantus. I'm now in Singapore and the consultant put me on Jardiance Duo along with the Victoza ...my numbers were great as was my weight but I got sepsis and this as well as the SGLT2's sent me into full blown DKA and I was in hospital for 9 days. The consultant at the hospital has put me back on insulin but this time i'm also trying to deal with novo rapid so i'm still trying to figure out what to do and what not to do with the stuff. With regards to the consultant he told me to take 10 units at night and that was it. I'm trying to find the best solution that works for me and split the dose I'm up to 14 units of Lantus and around 9/10 units of Novo Rapid per day . My bloods are really good during the night and pretty stable. I did contact the consultant a couple of months after I started on the insulin as my bloods were low but my ketones were high and he suggested having a small amount of carbs and inject a small amount of insulin to bring the ketones down.
It feels like I'm going around in circles to be honest, Im trying to get my bloods and insulin down as low as possible and this should help keep the weight off but when I do that by reducing carbs and exercising my ketones go up and the advice from the consultant seems to be to eat more carbs and inject more insulin (albeit in small doses) which will put the weight on which seems counter productive...in the meantime I'm really wary of DKA.

Kind Regards

Duncan

OK?? Well you probably need to know what's happening with your basal (Lantus. I use the stuff myself.) before messing with what's going on with your Novorapid. (I use that too..)
This may help you find out with the Lantus which is a long acting background insulin. https://www.mysugr.com/en/blog/basal-rate-testing/

Personally, the numbers you are reporting. If it was me, I wouldn't be concerned regarding DKA.

What are you eating regarding diet? You mentioned moving to Singapore? Any drastic changes there??
With Novorapid & meals. Insulin timing is essential prior to eating with the insulin working profile.

Do you use a CGM or sensor? Or ever considered one? These can spot trends you may have missed with a meter?
(Though I wouldn't advocate letting the meter gather dust if using insulin.)

You realy should liaise with a decent endo about all of this..

 

[Fenn]

Hi, in my very uneducated opinion, the only thing you should be worrying about is your weight, I don’t even know why you are testing your keytones? You could try lowering your carbs to lose weight. I should too but I’m weak of mind and will lol, best of luck with everything.


Ps I would love your numbers