DKA risk if 2.7 keystones but blood gas clear?

[PurpleSky1111]

Hi everyone,

So I’m in hospital for a non diabetes related infection. It’s a pretty bad one so I’ve a temperature of 39 degrees that won’t budge and I’m on numerous IV antibiotics.

I’m a t1 diabetic too.

I don’t have any method of testing my keytones with me as I’m on a surgery ward and I was rushed in here due to serious infection.

I was quite concerned yesterday that I may have keytones so I asked and they borrowed a set from a medical ward and my keytones were 2.7.

The dr decided to do my blood gasses and they came back clear, so now - nobody is worried at all.

I’ve always thought keytones had to be regularly rechecked, but does clear blood gasses mean actually you’re fine?

I think not, but dr thinks so. I’m looking for backup to query them as they are rushed off their feet, but I’ve no means of testing my keytones with me at present!

Thanks everyone for any knowledge you can spare!

Lins

 

[kitedoc]

Ni @PurpleSky1111 , Sorry to hear you have had to go to hospital. It sounds like the infection might have stirred up the BSLs.
From my reading and experience as a T1D, not as professional advice or opinion: I looked at Diabetesselfmanagement.com - Getting to know your ketones and ncbi.nil.nih.gov - Review of Diabetes Studies 2016 Winter 13(4) Ketan Dhatariya. Blood ketones: measurement, Interpretation, and Utility in Management of Diabetic Ketoacidosis. - ketone finger prick meters are said to be accurate up to 3.0 mmol/l, the > 3.0 mmol/l is severe and likely to be DKA, 1.6 -3.0 mmol/ is high risk of DKA.
But these days apparently a venous blood sample can be used to look at blood gases as they are less painful and less complicated to obtain than arterial blood samples (and the latter publication above mentioned that venous sampling for blood gases in the UK is routine.) The acidity of the blood and the amount of compensation for the acidity of the blood (bicarbonate measure) seem to be the main arbiters of what is DKA and what is not. But I would seek a professional opinion if I were you..
Of course the measurement is only a snapshot and does not of itself predict how things will be at another time.
I would hope they have a protocol in the hospital for managing a patient with high BSLs, diabetes and elevated ketones -
of perhaps 'pre' DKA status.
Perhaps ask for a copy of the policy so that you can see if the staff are following the protocol, including measurement of ketone levels progressively.
Perhaps also ask for consultation with the diabetes team or a DSN to help you manage the surgical orientation of the staff and ward you are in. (That is, find someone who knows what they are talking about)! Best Wishes for a speedy recovery !!

 

[PurpleSky1111]

Thanks for the reply!
I knew I didn’t have DKA yesterday, just keytones.

It just concerned me that they thought once the blood gasses are done then I no longer need to be checked!

The article you’ve mentioned and the advice about either asking what their policy is or asking to also speak to their endocrinologist (diabetes is drs surgery’s only here for grown-ups they do t have a special department!) is good.

I’ve been in a few more days now anyway so I’m more lucid and settled - I’ll figure out best way to get some strips and just test myself.

The best thing they’ve done so far is let me manage my own blood sugar/insulin - mainly because I confuse them when I say things such as “carb-counting” and “I don’t do a fixed amount of insulin” or”no I haven’t done that 8 units for dinner, that was an average to keep you happy and I actually haven’t eaten so won’t be doing any”

 

[ringi]

Remember people with DKA normaly feal very sick and that dehydration is a risk factor. So unless you are more dehydration then yesterday or are feeling more sick, I drought there is much risk of DKA.