Confused...having a hypo with high ketones!!!

[Geordie lass]

This morning I checked my BS levels (fasting) as usual and they were 2.7...I also have a blood ketones monitor that I test every other morning just to make sure that my ketone levels are normal. Now, this morning during my hypo I thought I would test my ketone levels and they were reading at 3.1!!!! Of course, I was very shocked as I am in hypo mode and not feeling particularly unwell, just the usual hypo symptoms, which I have now treated. I am so confused as I associate high ketone levels with having high BS levels. Can anyone explain to me how this has happened. In my 10 years of having T1 I have never had high ketone levels like this before. Should I be worried? What do I need to do? Thanks for your help. M x

 

[mrburden]

Hi,
Ketones are a by-product created when there is not enough glucose to fuel the body's needs, so the body burns it's fat reserves to create energy.
Generally, this can happen when there is either:
not enough insulin in the body to convert the glucose into energy (with high BG readings)
or, as in your case:
when there is not enough glucose for the insulin to convert to energy (with low BG readings).
Both of these conditions have the effect of preventing glucose being used as fuel for the body and, as a result, both can give rise to higher ketone levels.

 

[Spiker]

I'm at a loss to explain that I admit but I am not totally convinced by mrburden's explanation either unless you are low carbing? . If not your low BG state is (since you are T1) most likely a high insulin state and a high insulin state clears ketones and suppresses ketosis.

If however you are low carbing then mrburden is completely correct, and also in that case your 0.3 ketone reading is nothing to worry about.

Any chance you messed the ketone reading up as you were hypo? Maybe used a glucose strip rather than a ketone strip if it's a Glucomen LX meter?

 

[Geordie lass]

Thanks for your replies. The ketones did come down eventually. I am low carbing so I think this is probably the answer. I don't take enough insulin at the moment to have high insulin in my system, although I have reduced my basal rates as I am having too many hypos at the moment!

Spiker - not sure where you got the ketone reading of 0.3 - this was never mentioned in my post. It was 3.1 that I posted. Also, no chance of mixing up the ketone meter reading and I only have ketones strips for that particular meter as my blood glucose meter is different and links straight up to my pump.

Thanks for your replies.

 

[Spiker]

Spiker - not sure where you got the ketone reading of 0.3 - this was never mentioned in my post. It was 3.1 that I posted. Also, no chance of mixing up the ketone meter reading and I only have ketones strips for that particular meter as my blood glucose meter is different and links straight up to my pump.

Ah sorry I mentally converted your 3.1 mmol/L to 0.3 g/L. It doesn't help that there are 4 different scales for measuring ketones!

Glad you got to the bottom of it.

 

[mrburden]

Spiker,
When glucose cannot be absorbed by the body, the liver starts to turn stored fats into energy. The fact that glucose cannot be absorbed is down to an insulin/glucose imbalance, which can either be too much insulin with no glucose, (which causes hypoglycemia) or too much glucose for the insulin levels in the blood (which causes hyperglycemia). Both events can create ketones in the blood/urine as is explained on this webpage:

http://www.diabetes.org/living-with-diabetes/complications/ketoacidosis-dka.html
What Causes DKA?
Here are three basic reasons for moderate or large amounts of ketones:

• Not enough insulin
  Maybe you did not inject enough insulin. Or your body could need more insulin than usual because of illness.
• Not enough food
  When you're sick, you often don't feel like eating, sometimes resulting in high ketone levels. High levels may also occur when you miss a meal.
• Insulin reaction (low blood glucose)
  If testing shows high ketone levels in the morning, you may have had an insulin reaction while asleep.

- See more at: http://www.diabetes.org/living-with...ns/ketoacidosis-dka.html#sthash.HsnpfXgT.dpuf

 

[Randburg]

Hi Spiker and mrburden.
I'm interested in this subject and did open a tread, but really did not get an answer.
If I am a type 2 and if I go very low carb ie as close as I can to zero, and keep this up for a week, will I pass ketones ?
I have purchased some urine strips that test a lot of things including Ketones and I have been a week on Zero ( a dash of cream in my coffee is probably my only carbs)
Only a faint trace of Ketones, but nothing exciting after 6 days
I think by this time I must be burning Fat as my weight is dropping a little each day.
My Blood Glucose is remaining in the 5 to 6 mark most of the day, the lowest was 3.9 before lunch on 1 day
Very interested to hear your comments as my knowledge on Ketones is limited.
Will I ever show Ketones as I still produce natural insulin as a type 2 or am I wasting my time looking for them ?

 

[mrburden]

Hi Randburg,
It is possible but far less likely that you will show ketones as a tablet controlled T2. But quite often T2 diabetics will eventually progress to need insulin at a later stage. When or if that happens then the chances of showing ketones will be the same as anyone on insulin, as the balance of glucose to insulin in the body can go wrong if you are injecting rather than your body producing normally.
That said, if you are a T2 and you suffer a bout of sickness or diarrhea, there is a chance that your body will produce ketones.
his page has some useful info on the signs and symptoms to look out for:
http://www.diabetes.org.uk/Guide-to-diabetes/Complications/Diabetic_Ketoacidosis/

 

[Randburg]

Thanks

 

[LittleGreyCat]

Just to note that ketones and ketoacidosis are not synonymous.

People who switch to very low carb diets will have ketones in the blood because that is linked with using fat instead of glycogen as a fuel.
That is a good thing.
In this case you test for ketones to see if you have switched to fat burning as your main fuel.

Ketoacidosis is due to very high levels of ketones, and is a bad thing.

 

[Randburg]

Just to note that ketones and ketoacidosis are not synonymous.

People who switch to very low carb diets will have ketones in the blood because that is linked with using fat instead of glycogen as a fuel.
That is a good thing.
In this case you test for ketones to see if you have switched to fat burning as your main fuel.

Ketoacidosis is due to very high levels of ketones, and is a bad thing.

Thanks,
This is what I am trying to do, but a week into virtually no Carbs and I am only picking up a trace of Ketones in urine.( loosing weight though)
Do you know how long it takes to start the process of Fat burning process ?

 

[Spiker]

@mrburden I think that info you posted is accurate, but not precisely relevant to the OP and other questions. For the OP, that level of ketosis (3.1) is just normal for low carbing. We don't need to suspect a hyperglycaemic or hypoglycemic state when a low carber shows moderate ketones.

 

[Spiker]

@Randburg one possible explanation is that you have been in ketosis prior to testing. Some people only test positive for ketones during the initial adaptation and stop showing ketones in the urine after they are ketoadapted. It might help if you can get a blood ketone meter.

Another explanation could be if you are having very large amounts of protein, and this is being converted to glucose, preventing ketosis. I'm not sure how likely this is because gluconeogenesis normally happens at the same time as ketosis, and is inhibited when you are not in ketosis.

Is there any possibility there are hidden carbs in your food? Sugar alcohols?

 

[Geordie lass]

@mrburden I think that info you posted is accurate, but not precisely relevant to the OP and other questions. For the OP, that level of ketosis (3.1) is just normal for low carbing. We don't need to suspect a hyperglycaemic or hypoglycemic state when a low carber shows moderate ketones.

Thanks spiker. I had my diabetic check at the hospital today and mentioned this to them. I also had a 2.7 blood ketone reading this morning. I was advised that because I am eating such low carbs, that ketones is quite normal and nothing to worry about as my blood sugar levels are too low for DKA status.

Thanks everyone for your input. It is an interesting subject. I certainly have learnt something new about ketones!

 

[Type1Jim]

Hi there. Found this about ketones if it is of any use
http://glucomen.co.uk/_assets/1_dka_diabetic_ketoacidosis.pdf

 

[LittleGreyCat]

Thanks,
This is what I am trying to do, but a week into virtually no Carbs and I am only picking up a trace of Ketones in urine.( loosing weight though)
Do you know how long it takes to start the process of Fat burning process ?

If you have traces of ketones in your urine then as far as I know you are in ketosis.

You can be in ketosis and not show traces in your urine, if your body is burning all the blood ketones as fuel.
It is only the surplus unwanted ketones which are excreted in the urine.
Hence the advice to test your blood for ketones.

 

[Randburg]

Hi
Thanks to all for the advice, I have really learnt a lot as I tend to do each time I Log in to the forums.
The Ketone signs in my urine are getting a bit better, a definite purple colour now and I'm down just on 3 Kg in 10 days .
That's almost the weight I wanted to loose, 2 to go, so all is good
I'm investigating the Blood Ketone tester idea