DKA!???

Well this reply might be a bit late but check both are still in date then retest with both.

Elise Broenlund said:

Hello,

I just tested for ketones. The FreeStyle Optium Blood meter says ketones are 0,5, but when I test with urine test strips it says +++, purple colour which is the darkest colour and means really high.

What do I believe???

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How do you feel? What made you test in the first place, and then test again with an alternative method? Ketostix are notoriously unreliable, and go off' quickly once the canister is opened.

I had a similar issue with using Ketostix that are out of date. My urine dip test at home showed purple for leucocytes, indicsting possible infection. I noticed that the sticks were already turning pink and a simple test with tapwater showed the purple may well be due to out of date strips. However, I was suffering some slight discomfort 'down there' so when I had my bloods tested, I asked the health care assistant to do a quick sample check. It turned deep pink, and so my sample was sent off to the lab for cultures. The results came back that the sample had congealed in the pot, and showed off the wall readings. The lab said it was contaminated, and my GP patted me on the head and said to do another test in 3 months time to see if things were still giving warning signs. They will not do a lab test for 3 months due to cost. So I am left feeling uncomfortable but unresolved. I have my annual assessment next week so will take another sample with me.

DKA is no a laughing matter, so please re-test as suggested above, or maybe a pharmacy will offer to test. Generally DKA has definite symptoms that go with it such as very high blood glucose levels. I have to ask if you are taking a Gliflozin type medication (SGLT-2 inhibitor), since these have been shown to trigger DKA with relatively low bgl readings (around 10 mmol/l)
See the FDA warning:
https://www.fda.gov/Drugs/DrugSafety/ucm446845.htm

Elise Broenlund said:

Hello,

I just tested for ketones. The FreeStyle Optium Blood meter says ketones are 0,5, but when I test with urine test strips it says +++, purple colour which is the darkest colour and means really high.

What do I believe???

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How are you now @Elise Broenlund ? Was your BS high when you tested for ketones? Were you ill?

Honey, you will feel rubbish if your bloods are high all the time. Do you correct when you get high readings? Do you have a diabetic team you can talk with?
No one likes hypo but you can have better control with few hypo which will help you feel better.

Elise Broenlund said:

My bg has been high for 5 months, due to everything fallen out of control after some personal events in my life. My bg has been everything from 10 to 25 for that long and its gotten to the point where I am happy any day I have a bg below 8. That is why I test for ketones once a day now, I also ended up in DKA in February. I know it is not a joke, but somehow I am not afraid of it occurring again. Maybe a tiny bit, but I am more afraid of hypos as I have had 3 severe hypos in a very short amount of time. The fear of hypos is also a big contributor to me running my levels high. If my levels are below 7 I`m too scared to even take any insulin, because I have seen 1 unit of novorapid drop me 15 points.

I checked the test strips, the urine ones expire in June 2017 and the ketone test strips expire March 2018. I don`t mean to be complaining a lot or whatever, but I feel like **** all the time. I have felt like **** for months no reason, even if my bg`s are normal. Nauseous, headaches, burning/tingling/stabbing pain all over my body. It is so bad now that any day I actually feel normal I think something`s wrong, because normal feels strange to me right now. So based on symptoms it is impossible for me to know if it is DKA developing, even though I know it will happen continuing like this.

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I used to have the same approach to hypo's and high levels, but have modified it when I started testing again, and saw the spikes for myself. I am not on insulin myself, but as a T2 on orals my hypo's are a walk in the park compared to those induced by insulin, so I understand your preference for running high.bgl.

I cannot explain the difference between your meter and the test strips. It seems that both should be reliably reporting the same outcome, but clearly are not. Although i have a NEO myself, I have never used it for ketones, so have no experience, and cannot advise you. It does seem probable that you could be experiencing elevated ketones, but short of doing a parallel ketone test with a different meter or with new strips to try to isolate which is telling porkies, it will be difficult isolating which to believe.

@Elise Broenlund First of all, I'm sorry that personal events have affected your control. Don't blame yourself for that. It's really hard when personal things get in the way and it's completely normal for your control to be affected.

Have you got a good diabetes team that can help you gradually take back control? They could help you gradually lower your blood sugars over a period of time and help you get your confidence back a little.

You're not the only one with a fear of hypos. If you look through the Type 1 section, you'll see a number of people like you. You're not alone.

Would you like me to move your thresd to Type 1 where you'll get more replies and support from other Type 1s who know how hard it can be?

High blood sugar will make you feel ****. If you can reduce your blood sugar, then you'll feel a lot better - both physically and mentally.

@Elise Broenlund, are you insulin sensitive? Dropping 15 points with only 1 unit of insulin is pretty drastic. Was this a one-off or has it happened several times? Maybe there was alcohol involved too, or lots of exercise?

Do you have a half unit pen? (Oops, I've just checked and see you only use Novorapid, so presumably you're on the insulin pump!) If this is the case it should make things easier. You could contact your DSN to check your pump is on the correct settings. You could also ask for a trial of a cgm, to find out what's going on.
If you aren't on the pump, you could still ask your DSN for advice and, as you're worried about hypos, maybe she'd let you try the Freestyle Libre. Unfortunately this doesn't alert you when you're going hypo, like a cgm does, but it does show what's happening to your blood sugars.
Meanwhile, test before and after meals, count carbs accurately and see if there are any patterns showing. Your DSN will hopefully be able to help, as she'll have your records and will be able to suggest things we can't (or shouldn't).

@Elise Broenlund Sorry if this is a stupid question but when you say "15 points" do you mean 15mmols or 15mgdl (US measurements)?

Have you spoken to your medical team about this drop? Is it a regular drop and have you noticed a pattern with it such as after exercise or some foods?

Elise Broenlund said:

I mean 15 mmol.

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Ok - yes, that's a big drop @Elise Broenlund

Have you done a basal test to make sure it's not that contributing to the drop and that its at the right level?

Do you have a half unit pen?

If you're only using very small amounts of insulin, have you considered a pump?

Elise Broenlund said:

The drop 1 unit, 15 mmol was when I corrected a high 2 hours after I ate which is why I never correct highs anymore.
My main problem is if I get my doses right I need to be at 8 mmol, 2 hours after a meal to be safe as an hour after that my bg is 4 and I have to eat again. This happens no matter what I eat and no matter if I do a high basal and low bolus or low basal and high bolus.

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How far in advance of the meal do you do your bolus?

Elise Broenlund said:

I do not have a half unit pen, but I wish I did and yes I did try an insulin pump which is what gave me all these problems in the first place unfortunately. I don`t know why nothing can work out for me.

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My advice is to go back to basics. That is, start from the beginning and don't assume that anything is right. Obviously, get help from your DSN and do tjings gradually as it's sensible to be cautious and to change one thing at a time.

I'd also suggest considering whether a change of insulin might be something that would help.

And do ask for a half unit pen. They're incredible useful, and available for most insulins. Your DSN should have some or you can just get your GP to prescribe the correct one(s).

Don't despair. There's an answer out there for you You just need to find it - with the help of your team and hopefully the many Type 1s here, some of whom will have had similar problems.

If you don't already have it, get the book Think Like A Pancreas. It's fantastic for Type 1.

Tagging some helpful Type 1s for you : ) @noblehead @himtoo @catapillar @GrantGam @EllsKBells @tim2000s and there are many more : )