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Confused By My DN

Eurobuff

Eurobuff

Well-Known Member
Messages
358
Type of diabetes
Treatment type
Diet only
Hi, I don't know if anyone has come across what I'm going through, but I'm confused after a visit to the doctors today and hope that someone can help/explain. Just over a month ago I was diagnosed with diabetes. I changed my diet completely. I am eating about 70 carbs per day. At my last visit the DN detected ketones in my urine. I was then asked to check my ketones once per day & check my BG at the same time. I've been back today and gave her the results. She said she wants me to carry on for another week testing, in the mean time I am to have another hba1c test (last one was a month ago 7.9) and she's sent a urine sample off to the lab. I have told her that I have cut out the carbs. Now this is where I'm confused, she said she thinks that I might have to go on insulin?? My results of my home testing was:
THUR 26/6 1.5 BG 6.9 8pm
FRI 27/6 0.5 BG 10.9 4pm
Sat 28/6 4 BG 8.5 9.30pm
Sun 29/6 0 BG 7.6 3pm
Mon 30/6 8 BG 8.2 9pm
Tues 1/7 8 BG 7.7 8.30pm

The first figure being the ketone figure, the second BG.

My average BG is just under 7 (this average over the last month).

When I get up on a morning my BG is between 4.8 and 6.2

Sorry to go on but I am confused as to why I would need to be on insulin?



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Were you diagnosed with T1 or T2 diabetes ? If you had a GAD test or high ketones, you may well be T1. This is the auto-immune type which means you will eventually need insulin. If T2 then that's a little different. With your reduction in carbs, combined with exercise, you may well be able to control your diabetes. This may lead to tablet or insulin but certainly not for a while yet. Maybe you should ask your nurse for more info and why he/she feels you need insulin.
 
When I was told I was diabetic, she actually didn't say which type, I assumed it was Type 2 because of my age (42) ?? I haven't heard of a GAD test, so I would assume I haven't had one. The only way my ketones have been tested so far is 2hrs after eating with a stick that I pee on! She has sent a sample off today which she said will be tested for protein, so I'm not sure what that means as well, she said its different from ketone. She said the results should be high ketone & high BG, but in my case that hasn't happened, the ketone & BG results don't seem to follow any pattern. Last week she said if there are constant high ketones it means my body isn't producing insulin, but the ketone results I am getting are up and down?


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Seems like your nurse may be a little confused. Can't see the point of regularly testing for ketones ? You need to get back to your doc or nurse and ask more questions. How we're you diagnosed ? If you have had high ketones, I would request a GAD test. You can still get T1 at any age so it's difficult to advise. If you're T2, you may eventually need insulin but that would be a last resort and long way down the line.

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mo1905 said:
Seems like your nurse may be a little confused. Can't see the point of regularly testing for ketones ? You need to get back to your doc or nurse and ask more questions. How we're you diagnosed ? If you have had high ketones, I would request a GAD test. You can still get T1 at any age so it's difficult to advise. If you're T2, you may eventually need insulin but that would be a last resort and long way down the line.

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I go back to see her next week, I'll ask then. I've looked up GAD test and it seems that May be a more definite test. I'd also read somewhere about a blood test for ketones is more accurate, but she hasn't done that either?



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The urine test for ketones is old hat now really. Should be done via a drop of blood for more accurate results. There are many BG meters that can test for ketones too. Spend some time asking questions or reading up so you have a list of questions for your nurse when you go back. Education is key and will help you make choices. To be honest though, your nurse doesn't inspire too much confidence so far. Is there anyone else you can see ? Don't get bullied into accepting insulin though without relevent tests to ensure that's what's best for you. Take care.

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mo1905 said:
The urine test for ketones is old hat now really. Should be done via a drop of blood for more accurate results. There are many BG meters that can test for ketones too. Spend some time asking questions or reading up so you have a list of questions for your nurse when you go back. Education is key and will help you make choices. To be honest though, your nurse doesn't inspire too much confidence so far. Is there anyone else you can see ? Don't get bullied into accepting insulin though without relevent tests to endure that's what's best for you. Take care.

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Thanks. I don't have much confidence in her either, but she is the only diabetic nurse in the practice. My mam is diabetic & in the past when she's tried to see a doctor, she's been told that she has to see the diabetic nurse about diabetes.
I will definitely ask about the GAD test, I will mention the ketone blood test as well. When I went to see here I wasn't expecting her to come out with what she did, so I was caught off guard. My mind just went blank when I heard the word "insulin" and went into panic mode


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Well, do your homework and have a written list of things you want to ask. Hopefully you'll get the information you need. Feel free to keep asking questions but certainly let us know how you get on :-)

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Eat 150g of carbs for 3 days. It won't hurt you and I'll put money on you not having ketones before the 3 days are up. I can't think of a quicker way to sort it out
I think she hasn't come across nutritional ketosis before
 
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jack412 said:
Eat 150g of carbs for 3 days. It won't hurt you and I'll put money on you not having ketones before the 3 days are up. I can't think of a quicker way to sort it out
I think she hasn't come across nutritional ketosis before
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I'm beginning to think she hasn't had much experience of diabetes either! Would a blood test for ketones show high if I was eating a low carb diet? I am looking online now to see if I can find a meter that I could buy to test, but if it would show high because I'm on a low carb diet I wouldn't achieve anything by buying one. I've rung a local pharmacy but they haven't got one, they've told me to go to the doctors!


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I would suspect your nurse is a tad confused.
As a norm type 1's would have ketones with high blood sugars and very rarely a type 2. So I suspect your nurse is confusing your ketones with the carb reduction ketones.
Someone else can explain it a lot better than me as I'm very tired after a very long day looking after my father who has advanced dementia.
 
If you eat less than 100 grams of carbs per day you should have ketones in your urine, it is perfectly normal. What are your pre and post prandia bg readings?
 
All this lingo is still a bit new to me. Post & Pre prandia, is this before and after meals? If so my evening meal today was pre meal 6.3 BG, 2 hrs after first bite 7.1 BG


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Totto said:
If you eat less than 100 grams of carbs per day you should have ketones in your urine, it is perfectly normal. What are your pre and post prandia bg readings?
Click to expand...

All this lingo is still a bit new to me. Post & Pre prandia, is this before and after meals? If so my evening meal today was pre meal 6.3 BG, 2 hrs after first bite 7.1 BG


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Could be nutritional ketones, but, I would be concerned of those ketone readings 4 and above, even if nutritional. May be lada (late type 1) in which case your ketones will rise at the times the body struggles to produce enough insulin in which case could lead to ketoacidosos. As said above, If it is lada, can be prolonged by diet/exercise. Eventually, needing insulin it would really help you to get.your dsn to arrange to have the gad tests, but, in the meantime keep testing as your doing.
I was showing ketones in urine (what level don't know) with a sugar reading of 9, 3 days later in a and e with dka, sugar reading hi and started on insulin and have been ever since.

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You don't need to test blood ketones. Spend the money on good tucker
Ketostix are more than enough to start the first couple of weeks. The novelty of testing wears off quick
 
Eurobuff said:
All this lingo is still a bit new to me. Post & Pre prandia, is this before and after meals? If so my evening meal today was pre meal 6.3 BG, 2 hrs after first bite 7.1 BG


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So the ketones in your urine are exactly where they are supposed to be. Low carbing and ketones are fine. No worries. Keep low carbing and test bg.
 
brett said:
Could be nutritional ketones, but, I would be concerned of those ketone readings 4 and above, even if nutritional. May be lada (late type 1) in which case your ketones will rise at the times the body struggles to produce enough insulin in which case could lead to ketoacidosos. As said above, If it is lada, can be prolonged by diet/exercise. Eventually, needing insulin it would really help you to get.your dsn to arrange to have the gad tests, but, in the meantime keep testing as your doing.
I was showing ketones in urine (what level don't know) with a sugar reading of 9, 3 days later in a and e with dka, sugar reading hi and started on insulin and have been ever since.

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I missed your post when I posted and it looks like I'm disagreeing with you. It's a coincidence and I agree it needs to be sorted . Which is why I suggested 150g of carbs to knock out of ketosis.
If the ketones are still there then it's time to worry
Cheers
 
jack412 said:
I missed your post when I posted and it looks like I'm disagreeing with you. It's a coincidence and I agree it needs to be sorted . Which is why I suggested 150g of carbs to knock out of ketosis.
If the ketones are still there then it's time to worry
Cheers
Click to expand...

I think we did a post the same time lol. no probs :)

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Thanks everyone for all your help. I know that the ketone figure does go down if I tested again an hour later. Eg from 8 to 4 or 4 to 1.5. So I don't know if that gives any more clues? When I mentioned this to my DN she said I should only test once a day otherwise it'll confuse the issue


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