exercise and ketones with diabetes

[aylis]

Hello, i am just starting my weightloss journey and i have type 1 diabetes but i have noticed after exercising i am getting ketones, i am just wondering if this is common or if anyone has any tips or knows how to stop this happening? thankyou

 

[EllieM]

Hi @aylis and welcome to the DCUK forums how many ketones are you getting?

 

[aylis]

Hello , thankyou , so i had done a 5 mile walk, got home and tested my ketones and they were 1.2 but my blood sugar was reading at 12.3mmol (which is a normal bloodsugar for myself), i didn't feel sick or thirsty or anything just tired but assuming that was from the walking. I have been reading up about ketones being caused by exercise but i guess i'm just completely in the dark and unsure if i should ignore the ketones after exercise or if i need to treat them

 

[Melgar]

Pondered whether I should say something here as different factors at work for me as I'm not on insulin, so the dangers of DKA are not there for me. Although I do not produce enough insulin. I am not on a low carb diet, I watch my carbs, but in no way am I on a low carb diet. The reason I mention that is, I'm a fitness junkie and I am always producing between 0.5 to 1.5 ketones in my pee. I also have issues keeping my weight on. Obviously different concerns for you @aylis so take what I say with a pinch of caution.

 

[EllieM]

@aylis are you in nutritional ketosis?

I'm not and while I wouldn't be desperately bothered by ketones of 1.2 I wouldn't be very happy about them either, particularly while accompanied by a bg of 12.3 .

I regard ketones of up to 0.6 as normal. but I stress I'm not in nutritional ketosis though I am quite low carb.

Not sure I'd risk starting exercise with a level of 1.2

Ketones, diabetic ketoacidosis, and type 1 diabetes - Breakthrough T1D

What do ketone levels mean with type 1 diabetes? How do ketones cause diabetic ketoacidosis (DKA)? Learn about the symptoms of DKA.

www.breakthrought1d.org

 

[aylis]

I wouldn't say i am, i don't restrict my carbs at all i roughly have around 120-170g per day according to my carbs&cals app , i have recently started a calorie deficit for weight loss , i will speak to the dietitian on my next appointment, i don't have a clue when it comes to fitness and diabetes , one thing i have noticed both times my ketones have spiked i haven't ate anything carby before exercise so i'm going to try eating something with carbs beforehand and see if that makes a difference, i really appreciate the advice thankyou

 

[EllieM]

one thing i have noticed both times my ketones have spiked i haven't ate anything carby before exercise so i'm going to try eating something with carbs beforehand and see if that makes a difference, i really appreciate the advice thankyou

Good luck. I find that some kinds of exercise make my bg go up so I would definitely watch both my bgs and ketones in your position. Presumably you'll be injecting for those carbs?

 

[aylis]

yeah i do carb count for insulin, i know i'm definitely getting enough insulin a day thats why the ketones are confusing me just after exercise, on days i don't exercise my ketones are always 0.1

 

[EllieM]

yeah i do carb count for insulin, i know i'm definitely getting enough insulin a day thats why the ketones are confusing me just after exercise, on days i don't exercise my ketones are always 0.1

Depending on the exercise, I can find it pushed my insulin needs up or down. eg on a long walk I am more likely to go low, while high intensity exercise in a gym often makes me need more insulin. I would assume, not necessarily correctly, that ketones plus a high bg means you need more insulin, not more carbs. When I went to the gym before I got my pump I always took both my insulin pen and glucose, and both got used on occasions.

Exercise and Type 1 Diabetes - Breakthrough T1D

Learn about exercising with type 1 diabetes, including monitoring insulin-on-board and fueling your body during your workout.

www.breakthrought1d.org

I'm going to tag @Juicyj who knows a lot more than I do about exercise and T1.

 

[SimonP78]

See e.g. here: https://www.diabetes.co.uk/forum/threads/ketones-with-normal-blood-sugars.206883/post-2732421

My morning ketones were 0.6 (at some point, I don't test very often - in fact only about 4 times in the last 20 years and all of those in the past year since getting a meter!), and post exercise can be in the mid-2's after a long endurance ride.

I'd not worry at all with those levels, I think concern about ketones is rather blown out of proportion for those on MDI. But are you on MDI? The concern for those on a pump is that if they get a blockage they may end up with no IoB at all (not even basal) which could cause problems.

Some other threads about ketones:

Ketones, potential illness and low carb diet

Hi all, I started a low carb diet at the end of December to help improve my blood sugar control. I eat around 30g of carbs a day now and it really has helped me get my numbers under very good control. I have a 1 year old son who goes to nursery and brings all sorts of illnesses home nearly...

www.diabetes.co.uk

Normal ketone values?

I note a distinct fear of ketones amongst those new to the fold. Some people are diagnosed and are in DKA at that point, which will obviously make you weary (I've no idea what state I was in when diagnosed, long long time ago.) There's a risk for T1 on pumps if you have a diffusion set failure...

forum.diabetes.org.uk

Random ketones

I have been type 1 diabetic for over 20 years and have in the past year gone in to a closed loop system. I was away on holiday last week and as I know I tend to run on the higher side on holiday I reduced my carbs intake and ended up with ketones at 1.9. after advice from my diabetic nurse to...

forum.diabetes.org.uk

What level of ketones is normal for, like, a non-diabetic?

What ketone level would we need to be to be the same as a non-diabetic? An average person, average day kinda thing. Like, would it have to be literally 0.0, or, for example, anything up to 0.3, or 1.4 "normal" etc?

forum.diabetes.org.uk

I would try to reduce BG though, or is that just normal for you during exercise? If you do decide to try to fix BG during exercise be cautious with the amount of bolus you take as it can become very effective (though it depends what you're doing - the liver helps by producing glucose of you're nervous about what you're doing, or if it's "hard" for your body. Both of these effects go away with habituation (across multiple sessions), but also reduce during a given exercise session, at which point muscle insulin sensitivity is also increasing so you get the double whammy of less hepatic glucose and high sensitivity)

 

[aylis]

thankyou Simon that makes total sense to me now , really appreciate your help.

 

[Antje77]

i know i'm definitely getting enough insulin a day

You said that 12.3 is a normal blood glucose for you, is that just a short spike after food or a regular type of level throughout the day?
If you're often at that level for a bit longer, have you looked into your insulin doses?

I can't help you on the ketones, I have no means of testing for them, but like @EllieM I would be mildly uncomfortable with your ketone level combined with BG over 12, and I would worry about ketones and BG going up.

 

[aylis]

I basically had really bad control of my diabetes and my blood glucose would sit at 17-19 throughout the day, i've now started taking it seriously but after discussing my fears with my doctor we decided to bring my bloods down gradually so currently my bloods sit between 10-13 throughout the day until my next appointment where my dosages will be adjusted to bring my bloods down further

 

[SimonP78]

I can't help you on the ketones, I have no means of testing for them, but like @EllieM I would be mildly uncomfortable with your ketone level combined with BG over 12, and I would worry about ketones and BG going up.

Conversely I'd not be too bothered as long as I'd done exercise (and therefore that was the likely cause) and had insulin on board.

I just looked at one of the links I posted (above) and I see that I had ketones of 2.3mmol/l and BG of 13.3mmol/l on one occasion and ketones of 2.3mmol/ and BG of 16.9mmol/l (!) on another - both before bed after a long ride.

I don't usually run that high unless I've misjudged something and that seems to have been the case here too having overestimated the effect of the exercise of muscle insulin sensitivity.

 

[Antje77]

I basically had really bad control of my diabetes and my blood glucose would sit at 17-19 throughout the day, i've now started taking it seriously but after discussing my fears with my doctor we decided to bring my bloods down gradually so currently my bloods sit between 10-13 throughout the day until my next appointment where my dosages will be adjusted to bring my bloods down further

Sounds like you're doing very well at the moment, keep up the good work!