High Keytone

[Henry7]

I have a high keytone level but low glucose level ( metformin) , ( I've had starvation ketoacidosis in the past ) , is this dangerous?

 

[bulkbiker]

How are you measuring the ketones? And what level are you seeing? I'm presuming T2 if only on metformin?

 

[Henry7]

I was given a blood meter after acidosis , it was 2.8 at 1 pm , blood glucose was 4.8 mmol, (probably not enough carbs ) , I've drunk some water and pretty sure is dropping , but yeh 2.8 is pretty high, i feel fine, and am pretty sure keytone levels were ok yesterday . Thanks

 

[bulkbiker]

I was given a blood meter after acidosis , it was 2.8 at 1 pm , blood glucose was 4.8 mmol, (probably not enough carbs ) , I've drunk some water and pretty sure is dropping , but yeh 2.8 is pretty high, i feel fine, and am pretty sure keytone levels were ok yesterday . Thanks

2.8 is perfectly fine especially with blood glucose at 4.8 are you low carbing or simply one of the lucky ones that drops into ketosis at the drop of a hat? I'd need to fast for probably 48 hours to get that ketone level!

 

[Henry7]

Thanks for reply , I think your right , I think I just panicked when I saw 2.8 , especially after starvation ketoacidosis ( not as much fun as it sounds), but people without type 2 must sometimes go into ketosis and have high levels , I'm not completely sure what's going on with me , thought I had covid 3.5 months ago, went to Worthing hospital , never tested for covid but given insulin and told to inject (level8?) twice a day, ( which I didn't do ) , didn't know what hit me , had some pretty dark thoughts. Anyway have lost 5 stone since then , watch the carbs just to keep blood glucose levels down ( about a 1/4 of my cals are carbs most days , but had some eggs to use up this morning which probably caused high keytone level. After dallying with starvation ketoacidosis, now on metformin now for about 4 weeks and glucose levels seem quite low.

 

[Henry7]

2.8 is perfectly fine especially with blood glucose at 4.8 are you low carbing or simply one of the lucky ones that drops into ketosis at the drop of a hat? I'd need to fast for probably 48 hours to get that ketone level!

Any ideas?

 

[bulkbiker]

Thanks for reply , I think your right , I think I just panicked when I saw 2.8 , especially after starvation ketoacidosis ( not as much fun as it sounds), but people without type 2 must sometimes go into ketosis and have high levels , I'm not completely sure what's going on with me , thought I had covid 3.5 months ago, went to Worthing hospital , never tested for covid but given insulin and told to inject (level8?) twice a day, ( which I didn't do ) , didn't know what hit me , had some pretty dark thoughts. Anyway have lost 5 stone since then , watch the carbs just to keep blood glucose levels down ( about a 1/4 of my cals are carbs most days , but had some eggs to use up this morning which probably caused high keytone level. After dallying with starvation ketoacidosis, now on metformin now for about 4 weeks and glucose levels seem quite low.

When you say "starvation ketoacidosis" what are you describing exactly? Who told you that you had this?

 

[Henry7]

When you say "starvation ketoacidosis" what are you describing exactly? Who told you that you had this?

I walked into accident and emergency , about 4 weeks ago ,( I felt extremely unwell), they kept me in overnight and on discharge that's what they wrote after I told them I had eaten very little for a week, they did test my blood and decided it was at least to some extent acidic, which they wrote on my discharge paper.( starvation ketoacidosis).

 

[bulkbiker]

I walked into accident and emergency , about 4 weeks ago ,( I felt extremely unwell), they kept me in overnight and on discharge that's what they wrote after I told them I had eaten very little for a week, they did test my blood and decided it was at least to some extent acidic, which they wrote on my discharge paper.( starvation ketoacidosis).

Had you been ill for the previous week was that why you hadn't eaten much?
Did they measure your blood glucose levels when you were admitted.
You said they gave you insulin which implies your blood sugars were high.

 

[Henry7]

Had you been ill for the previous week was that why you hadn't eaten much?
Did they measure your blood glucose levels when you were admitted.
You said they gave you insulin which implies your blood sugars were high.

Sorry I havn't been very clear, I've been in hospital twice , first time 3.5 months ago , given insulin , didn't continue when home , lost weight by design , ended up back in hospital 4 weeks ago with "starvation ketoacidosis" given metformin, which seems to work wonders on my blood glucose levels.

 

[DCUKMod]

Thanks for reply , I think your right , I think I just panicked when I saw 2.8 , especially after starvation ketoacidosis ( not as much fun as it sounds), but people without type 2 must sometimes go into ketosis and have high levels , I'm not completely sure what's going on with me , thought I had covid 3.5 months ago, went to Worthing hospital , never tested for covid but given insulin and told to inject (level8?) twice a day, ( which I didn't do ) , didn't know what hit me , had some pretty dark thoughts. Anyway have lost 5 stone since then , watch the carbs just to keep blood glucose levels down ( about a 1/4 of my cals are carbs most days , but had some eggs to use up this morning which probably caused high keytone level. After dallying with starvation ketoacidosis, now on metformin now for about 4 weeks and glucose levels seem quite low.

Henry - As I understand things, ketones are a clinical red flag, where they are accompanied by high blood glucose levels. By high I mean, over about 12.

Where the blood glucose is lower, such as yours at 4.8, ketones are much less of a concern. The presence of ketones with lower blood sugars is known as ketosis. Where the blood glucose numbers are low, but ketones high, it is more likely to be signalling starvation ketosis, which differs from ketoacidosis, there the blood has become very acidic.

My explanation is somewhat clumsy. I wonder if my colleague, @Jaylee might be around.

 

[bulkbiker]

Sorry I havn't been very clear, I've been in hospital twice , first time 3.5 months ago , given insulin , didn't continue when home , lost weight by design , ended up back in hospital 4 weeks ago with "starvation ketoacidosis" given metformin, which seems to work wonders on my blood glucose levels.

So when you were admitted 3 1/2 months ago can you remember what your blood sugar levels were that prompted the insulin?
And what were the circumstances that led to you not eating much in the week before being admitted the second time.

 

[DCUKMod]

Sorry I havn't been very clear, I've been in hospital twice , first time 3.5 months ago , given insulin , didn't continue when home , lost weight by design , ended up back in hospital 4 weeks ago with "starvation ketoacidosis" given metformin, which seems to work wonders on my blood glucose levels.

What were your blood sugars like when you were told you have starvation ketoacidosis? Had you been eating and drinking in your usual way these days, prior to the latest hospital interaction?

What led to you going to hospital last time?

Apologies for all the questions. I'm just trying to get a better picture of what might be going on for you.

 

[Henry7]

Henry - As I understand things, ketones are a clinical red flag, where they are accompanied by high blood glucose levels. By high I mean, over about 12.

Where the blood glucose is lower, such as yours at 4.8, ketones are much less of a concern. The presence of ketones with lower blood sugars is known as ketosis. Where the blood glucose numbers are low, but ketones high, it is more likely to be signalling starvation ketosis, which differs from ketoacidosis, there the blood has become very acidic.

My explanation is somewhat clumsy. I wonder if my colleague, @Jaylee might be around.

Yes that all makes sense , I think my starvation ketoacidosis may well have developed with perhaps medium glucose levels ? Because I think less insulin is made if you starve too much , but I'm not sure , I suppose the real question is what were my blood glucose levels at the time , I was given a ham sandwich in hospital and after I think 22 mmol was mentioned for a short time , but I don't think it was anywhere near that level before the sandwich, maybe 8 or so at most . Thanks for your interest in any case.

 

[Henry7]

So when you were admitted 3 1/2 months ago can you remember what your blood sugar levels were that prompted the insulin?
And what were the circumstances that led to you not eating much in the week before being admitted the second time.

My blood sugar levels would have been extremely high on first admission as I thought I had covid and started drinking loads of orange juice , though perhaps pre diabetic I think it was an "artificial peak in blood sugar , later , 2nd admission, the starvation ketoacidosis came about by not eating for a week in an effort to lose weight.

 

[bulkbiker]

2nd admission, the starvation ketoacidosis came about by not eating for a week in an effort to lose weight.

Ok so if that was "starvation ketosis" without elevated blood sugars then as @DCUKMod said it adds up more.
A BG measure of 22 is pretty high though which is worrying especially as they had to give you insulin to get it down.
Have you seen any blood glucose levels like that since?

 

[Henry7]

Ok so if that was "starvation ketosis" without elevated blood sugars then as @DCUKMod said it adds up more.
A BG measure of 22 is pretty high though which is worrying especially as they had to give you insulin to get it down.
Have you seen any blood glucose levels like that since?

The insulin was the first admission 3.5 months ago , they didn't give me insulin 2nd time ( 4 weeks ago starvation ketoacidosis) just a drip of saline plus potassium or something and then metformin at home . The 22 mmol on 2nd visit was unusually high I believe , the ketoacidosis seemed to exagerate the level, but I could be wrong . Before acidosis my bg levels were averaging 7 ish , on strict diet , this morning on metformin I had 3.6 and 3.7 ( pork chop and cauliflower last night) but probably too low , decided to miss lunchtime metformin tablet and now 5.1.

 

[Henry7]

What were your blood sugars like when you were told you have starvation ketoacidosis? Had you been eating and drinking in your usual way these days, prior to the latest hospital interaction?

What led to you going to hospital last time?

Apologies for all the questions. I'm just trying to get a better picture of what might be going on for you.

My diet before starvation ketoacidosis was virtually nothing for a week , though I do believe I had started to eat a little in the day or so before hospital admission , so maybe that was key , (though low carb ).

 

[Jaylee]

Henry - As I understand things, ketones are a clinical red flag, where they are accompanied by high blood glucose levels. By high I mean, over about 12.

Where the blood glucose is lower, such as yours at 4.8, ketones are much less of a concern. The presence of ketones with lower blood sugars is known as ketosis. Where the blood glucose numbers are low, but ketones high, it is more likely to be signalling starvation ketosis, which differs from ketoacidosis, there the blood has become very acidic.

My explanation is somewhat clumsy. I wonder if my colleague, @Jaylee might be around.

Hi, yep pretty much summed it up. Higher than normal ketones accompanied by higher prolonged abnormal BGs is some thing to worry about. https://www.nhs.uk/conditions/diabetic-ketoacidosis/

However. If fasting or a keto diet is involved with normal BGs, that's a natural byproduct of ketones that would show traces on a meter. (Edited to add.) "nutritional Ketosis."

Welcome to the forum by the way, @Henry7 .

What insulin had you been prescribed?

 

[Henry7]

Hi, yep pretty much summed it up. Higher than normal ketones accompanied by higher prolonged abnormal BGs is some thing to worry about. https://www.nhs.uk/conditions/diabetic-ketoacidosis/

However. If fasting or a keto diet is involved with normal BGs, that's a natural byproduct of ketones that would show traces on a meter. (Edited to add.) "nutritional Ketosis."

Welcome to the forum by the way, @Henry7 .

What insulin had you been prescribed?

Hi Jayleee , Novomix 30 , level 8 on the pen twice a day, ( is that a lot?) , I don't blame them for prescribing insulin, I'm sure my bgl was very high , but it does seem like overkill now , and in fact consultant on acidosis occasion intimated as much . ( my keto has dropped to 1.3 now at 7.15 pm and feel ok , it wasn't much higher than the 2.8 earlier today when I was in hospital , 4 .2 or so , but felt pretty rough when I left hospital with a keto of 2.1 which is probably why I panicked a bit earlier, (ketoacidosis isn't pleasant)
But yes it does seem if blood glucose levels low seems some keytones ok .