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Am I going to far?

  • Thread starter Thread starter Anonymous
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You have me worried now about the possible reaction from my Practice if my urine est shows ketones. They are so efficient that in wo visits they manged not to accept the urine sample I took to them each ime so I possibly got away with it,

As none of the drs ever speak o a diabetes patient except at the Annual Review and hen refer all questions back to their specialist diabetes nurse who only pretends to know anything this is a matter of concern.

I already spend a good part of my time in the hospital. Is it worth "carbing up " before the blood test? What will they do if they find ketones?
 
wiflib said:
High ketones are bad for any diabetic injecting insulin, not just T2's (in the presence of high BS).
I know it's old hat but I'd like to use IDD or NIDD again. Insulin dependent diabetes or non-insulin dependent diabetes.

Opinions please.

wiflib
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I'm in favour of this. Seem to spend half my time clarifying the difference between IDD and NIDD. It sometimes seems although we have more differences between us than we do it common.
 
Unbeliever said:
You have me worried now about the possible reaction from my Practice if my urine est shows ketones. They are so efficient that in wo visits they manged not to accept the urine sample I took to them each ime so I possibly got away with it
Click to expand...

This is a good point, and one which I fell foul of when I was first diagnosed, when my Doc spotted small ketone levels at my follow up appointment.

That afternoon I got a phone call from the Hospital telling me to come in as soon as possible and be prepared to be admitted (which was a bit of a shock as I was looking after the kids that day). When I arrived the (wonderful) Diabetic Nurses scrutinsed my BG tests (self funded) and after about 30 minutes convinced themselves that the ketones were as a result of my diet, and not because I was an undiagnosed T1 diabetic. They told me to "eat more" carbs and sent me on my way.

I think that there is much misunderstanding in the Medical community about the difference between ketosis and ketoacidosis, although in my case they were simply being cautious, for which I thank them.
 
My Ketones are at larger levels when it's very late at night,between 11pm and 2am-Does anyone know a reason for this? :eh:
 
Unbeliever said:
Is it worth "carbing up " before the blood test? What will they do if they find ketones?
Click to expand...

Understand your thinking, but can it be right to do something you don't think is right for your health (carbing up) just to stop some apparently badly-informed medical staff drawing the wrong conclusion?
Perhaps instead you could prepare a well-argued reason for WHY you would have ketones and why it's ok - in simple terms they can understand of course! Something like
"Obviously, as you'll be aware, it would be alarming if I had high levels of Ketones showing with high BG levels. However, as my BG levels are extremely good (brief show of BG testing results) the ketones I'm displaying are merely reflecting the fact that I'm eating a lower level of carbs and burning body fat as a result; so, as I'm sure you'd agree, nothing to be concerned about." Back-up printed off internet quotes about ketones to be on hand!
Alternatively, just tell them "my body, so shove it!" :lol:
 
Paul1976 said:
My Ketones are at larger levels when it's very late at night,between 11pm and 2am-Does anyone know a reason for this? :eh:
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What level of ketones? What is your BG?

Ketones vary throughout the day. They are supposed to peak around midnight for most people (I think).
 
Hey LLC :lol:

Somewhere you said yesterday that people like me live in the "twilight zone" (50 - 100g) and that wasn't a good idea?

Care to elaborate a bit as I think that applies to loads of us.
 
Hi Stephen.I get +/-(pink) during the day and ++(Burgundy) at night and my Bg's are around 21mmol or about then.I then drink loads of water to try and flush them out during the night.was thinking of trying the strips instead for my xceed blood monitor for a more accurate picture but I imagine they won't be cheap!
 
Paul1976 said:
Hi Stephen.I get +/-(pink) during the day and ++(Burgundy) at night and my Bg's are around 21mmol or about then.I then drink loads of water to try and flush them out during the night.was thinking of trying the strips instead for my xceed blood monitor for a more accurate picture but I imagine they won't be cheap!
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Paul, you really need to get in touch with your diabetes team as these levels are rather worrying.
 
noblehead said:
Paul1976 said:
Hi Stephen.I get +/-(pink) during the day and ++(Burgundy) at night and my Bg's are around 21mmol or about then.I then drink loads of water to try and flush them out during the night.was thinking of trying the strips instead for my xceed blood monitor for a more accurate picture but I imagine they won't be cheap!
Click to expand...

Paul, you really need to get in touch with your diabetes team as these levels are rather worrying.
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I agree.
 
I'm going to speak to the team on friday when they're teaching me to inject with the pen.
A while back-I told my GP about the Ketones(this is when I still had the type 2 diagnosis) He tested my urine and it was negative.he then said I probably had defective Ketostix and as a type 2-I wouldn't get ketones and not to worry.Now things have changed I'm worried about possible DKA and a chat with the team is called for now.
 
Paul1976 said:
I'm going to speak to the team on friday when they're teaching me to inject with the pen.
A while back-I told my GP about the Ketones(this is when I still had the type 2 diagnosis) He tested my urine and it was negative.he then said I probably had defective Ketostix and as a type 2-I wouldn't get ketones and not to worry.Now things have changed I'm worried about possible DKA and a chat with the team is called for now.
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I wouldn't wait till Friday, give them a ring this afternoon and as tell them about your high ketones/bg readings.
 
I'll leave them a message for a ringback from either the endo or the specialist nurse,they're pretty good at getting back to you the same day.
 
For the IDD you can't rely on BG's to determine if high levels of ketones is nothing to worry about..

The danger point for DKA, is levels above 12-14mmol/ls range hence why we'll told if we hit 12mmol/l to start checking for ketones etc... But you can also hit DKA with lower levels than this, there are several factors involved where this might happen, I know it happens because my last pregnancy if my BG hit 8mmol/l I started to go into DKA landing in hospital..

So personally I think that if ketones are present then you need to be cautious to what they actually mean..
 
Back OT - no-one has mentioned that you seem to still be taking 2x500mg of metformin?

If you are going low, the first thing I would do in your situation (ie - trying to lose weight) is cut some (maybe 1 or even a half) metformin...

Not advice - just what I'd probably do.
 
xyzzy said:
Somewhere you said yesterday that people like me live in the "twilight zone" (50 - 100g) and that wasn't a good idea?
Click to expand...

I meant if you are going to go "VLKD" then there isn't much point in hanging around in the 50-100g range, because you're going to have to take the "pain" of adaption anyway, so it's probably worth getting it out of the way.

I actually think that 50-100g is a great "sweet spot" for most (NIDD) T2s, I could easily manage my BG somewhere in that range, but there are also significant advantages to going lower (for me at least) if you are prepared to make the sacrafice. Most of the reason that I'm at <30g is for my running, I'm trying to increase my endurance without carb-loading (and decrease my weight). Now that I've been back on it for 2.5 months, I'm not sure if I'll ever go back to regular "low-carb" because my control is so good, and I feel so fit and healthy.
 
Grazer said:
Unbeliever said:
Is it worth "carbing up " before the blood test? What will they do if they find ketones?
Click to expand...

Understand your thinking, but can it be right to do something you don't think is right for your health (carbing up) just to stop some apparently badly-informed medical staff drawing the wrong conclusion?
Perhaps instead you could prepare a well-argued reason for WHY you would have ketones and why it's ok - in simple terms they can understand of course! Something like
"Obviously, as you'll be aware, it would be alarming if I had high levels of Ketones showing with high BG levels. However, as my BG levels are extremely good (brief show of BG testing results) the ketones I'm displaying are merely reflecting the fact that I'm eating a lower level of carbs and burning body fat as a result; so, as I'm sure you'd agree, nothing to be concerned about." Back-up printed off internet quotes about ketones to be on hand!
Alternatively, just tell them "my body, so shove it!" :lol:
Click to expand...

There ARE no terms simple enough for my HCPs. I might be able to express your alternative suggestion in sign language , however! I have had many a discussion wih them about various matters as I do tend to defend my own beliefs and have learnt to be quite assertive since diagnosis. Unfortunately they have very closed minds and very short memories!
The last time hey interfered - with my blood pressure - I suffered yot another massive bleed in my eye. They did not recod this properly and now deny any responsibility although they were errified at the ime. hey scare me.
 
Unbeliever said:
There ARE no terms simple enough for my HCPs. I might be able to express your alternative suggestion in sign language , however! I have had many a discussion wih them about various matters as I do tend to defend my own beliefs and have learnt to be quite assertive since diagnosis. Unfortunately they have very closed minds and very short memories!
The last time hey interfered - with my blood pressure - I suffered yot another massive bleed in my eye. They did not recod this properly and now deny any responsibility although they were errified at the ime. hey scare me.
Click to expand...

See the problem is that while regular Low Carb Diets are often frowned upon by HCPs ("You do need to eat some carbohydrates Mr Borofergie") ketogenic diets are completely beyond the pale.

It's no surprise that (from the other thread) they don't like us dealing with our own Diabetes, when some of us are prepared to push beyond the boundaries of what they consider is a "safe diet".

Maybe take a print out of this to show your Doctor:
http://www.nutritionandmetabolism.com/content/5/1/9

While low carbohydrate diets may not be appropriate for everyone, choices should be left to individual physicians and patients. Key points that bear on the assessment of benefit vs. risk of carbohydrate restriction are presented below. The discussion focuses on type 2 diabetes but many of the principles will apply to metabolic syndrome and possibly to type 1 as well[6,7].

1. Carbohydrate restriction improves glycemic control, the primary target of nutritional therapy and reduces insulin fluctuations.

2. Carbohydrate-restricted diets are at least as effective for weight loss as low-fat diets.

3. Substitution of fat for carbohydrate is generally beneficial for markers for and incidence of CVD.

4. Carbohydrate restriction improves the features of metabolic syndrome.

5. Beneficial effects of carbohydrate restriction do not require weight loss.

Carbohydrate restriction is an intuitive and rational approach to improvement of glycemic and metabolic control. Data demonstrating that weight loss and cardiovascular risk are also improved remove these barriers to the acceptance of carbohydrate restriction as a reasonable if not the preferred treatment for type 2 diabetes. Finally, carbohydrate restriction is a potentially favorable diet for improving components of the metabolic syndrome and thereby for the prevention of diabetes.
Click to expand...
 
Thank you. I already have a sheaf of printouts for them. My main problem is that the doctors will pass any problems over to the nurse who is totally incapable of understanding any of it.
The only one of the Drs who is prepared to voice any opinion at all about anything diabetic , memorises whole pages from the DUK site and quotes them at you whether relevant or not.
These people are the bane of my life. They have their own agenda and are not open to reasonable discussion.
It is the worrse part of my diabetes.
I am still suffering side effecs from my procedure on Friday and will coninue o do so for some ime yet.
I really would go through this every week rather than have an annual review with my local practice. At leas in the hospital I am fortunate enough to be cared for by intelligent professional and caring people.
I will certainly printout the above though, ias it may be useful if I am passed on to an intelligent person.
They are actually quite angry with me in the Practice for reducing my levels considerably by by-passing them. They wanted me o gom onto insulin a while ago when there was a finacial incentive on offer and I caused them o lose out by my refusal.

Thanks again for your help.
 
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