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Ketones, advice please
- Thread starter SianyG
- Start Date
kitedoc
Well-Known Member
Hi @SianyG, I hope you are not feeling too unwell. Not fun being there!!
Good on you for posting and checking BSLs and ketone levels !!
As a T1D, not as professional advice or opinion:
1) The accompanying graph , posted by someone a while back, is really useful, shows you where your ketone level is. in the scheme of things
2) Do you have a 'sick day plan', one made with your DSN or doctor?
For example mine (and yours could be quite different) is:
a) Ring DSN or doctor to discuss and work through a list to check off and discuss: (including HOW much insulin, which insulin, how often etc)
b) reasons for this high BSL and ketones:
(i) illness - flu, urine infection (not always symptoms), tooth problem etc
---> need more insulin and some carbs and medical review
(ii) other - vaccination, monthly cycle (not me personally but in there for completeness sake),
stress/worry, (?? rebound after severe hypo) ---> insulin/some carbs
(iii) food: excessive eating and then fasting overnight ---> insulin and ? how much carbs
(iv) insulin: in date, not been frozen or kept over 30 degrees C ---> replace insulin, may need new script filled a.s.a.p.
(v) insulin delivery: missed doses, no leaking penfill ampoule?, pen plunger not advancing the rubber stopper?, injection into scar tissue?, pump not delivering insulin ? battery ? software? ?, blocked cannula --> check and replace faulty equipment if possible, re-inject in new site, change cannula , revert to mdi
c) review results over 2 hours depending on ketone level done hourly - discuss with DSN/doctor or medical advisory service
d) consider injecting small doses of short-acting insulin ( I have the syringe and longer needle + the expertise) sometimes the DSN/Dr/Advisor might suggest small regular doses of intramuscular insulin)
d) ketones still rising, bsl not settling ---> call ambulance (Better to be Safe than Sorry)
e) extreme ketones with high BSL at anytime --.> ambulance a.s.a.p.
I really hope that things settle quickly and easily for you. Your health team is your best ally in this.
Good on you for posting and checking BSLs and ketone levels !!
As a T1D, not as professional advice or opinion:
1) The accompanying graph , posted by someone a while back, is really useful, shows you where your ketone level is. in the scheme of things
2) Do you have a 'sick day plan', one made with your DSN or doctor?
For example mine (and yours could be quite different) is:
a) Ring DSN or doctor to discuss and work through a list to check off and discuss: (including HOW much insulin, which insulin, how often etc)
b) reasons for this high BSL and ketones:
(i) illness - flu, urine infection (not always symptoms), tooth problem etc
---> need more insulin and some carbs and medical review
(ii) other - vaccination, monthly cycle (not me personally but in there for completeness sake),
stress/worry, (?? rebound after severe hypo) ---> insulin/some carbs
(iii) food: excessive eating and then fasting overnight ---> insulin and ? how much carbs
(iv) insulin: in date, not been frozen or kept over 30 degrees C ---> replace insulin, may need new script filled a.s.a.p.
(v) insulin delivery: missed doses, no leaking penfill ampoule?, pen plunger not advancing the rubber stopper?, injection into scar tissue?, pump not delivering insulin ? battery ? software? ?, blocked cannula --> check and replace faulty equipment if possible, re-inject in new site, change cannula , revert to mdi
c) review results over 2 hours depending on ketone level done hourly - discuss with DSN/doctor or medical advisory service
d) consider injecting small doses of short-acting insulin ( I have the syringe and longer needle + the expertise) sometimes the DSN/Dr/Advisor might suggest small regular doses of intramuscular insulin)
d) ketones still rising, bsl not settling ---> call ambulance (Better to be Safe than Sorry)
e) extreme ketones with high BSL at anytime --.> ambulance a.s.a.p.
I really hope that things settle quickly and easily for you. Your health team is your best ally in this.
Hi @SianyG, I hope you are not feeling too unwell. Not fun being there!!
Good on you for posting and checking BSLs and ketone levels !!
As a T1D, not as professional advice or opinion:
1) The accompanying graph , posted by someone a while back, is really useful, shows you where your ketone level is. in the scheme of things
2) Do you have a 'sick day plan', one made with your DSN or doctor?
For example mine (and yours could be quite different) is:
a) Ring DSN or doctor to discuss and work through a list to check off and discuss: (including HOW much insulin, which insulin, how often etc)
b) reasons for this high BSL and ketones:
(i) illness - flu, urine infection (not always symptoms), tooth problem etc
---> need more insulin and some carbs and medical review
(ii) other - vaccination, monthly cycle (not me personally but in there for completeness sake),
stress/worry, (?? rebound after severe hypo) ---> insulin/some carbs
(iii) food: excessive eating and then fasting overnight ---> insulin and ? how much carbs
(iv) insulin: in date, not been frozen or kept over 30 degrees C ---> replace insulin, may need new script filled a.s.a.p.
(v) insulin delivery: missed doses, no leaking penfill ampoule?, pen plunger not advancing the rubber stopper?, injection into scar tissue?, pump not delivering insulin ? battery ? software? ?, blocked cannula --> check and replace faulty equipment if possible, re-inject in new site, change cannula , revert to mdi
c) review results over 2 hours depending on ketone level done hourly - discuss with DSN/doctor or medical advisory service
d) consider injecting small doses of short-acting insulin ( I have the syringe and longer needle + the expertise) sometimes the DSN/Dr/Advisor might suggest small regular doses of intramuscular insulin)
d) ketones still rising, bsl not settling ---> call ambulance (Better to be Safe than Sorry)
e) extreme ketones with high BSL at anytime --.> ambulance a.s.a.p.
I really hope that things settle quickly and easily for you. Your health team is your best ally in this.
View attachment 31300
Hi @SianyG, I hope you are not feeling too unwell. Not fun being there!!
Good on you for posting and checking BSLs and ketone levels !!
As a T1D, not as professional advice or opinion:
1) The accompanying graph , posted by someone a while back, is really useful, shows you where your ketone level is. in the scheme of things
2) Do you have a 'sick day plan', one made with your DSN or doctor?
For example mine (and yours could be quite different) is:
a) Ring DSN or doctor to discuss and work through a list to check off and discuss: (including HOW much insulin, which insulin, how often etc)
b) reasons for this high BSL and ketones:
(i) illness - flu, urine infection (not always symptoms), tooth problem etc
---> need more insulin and some carbs and medical review
(ii) other - vaccination, monthly cycle (not me personally but in there for completeness sake),
stress/worry, (?? rebound after severe hypo) ---> insulin/some carbs
(iii) food: excessive eating and then fasting overnight ---> insulin and ? how much carbs
(iv) insulin: in date, not been frozen or kept over 30 degrees C ---> replace insulin, may need new script filled a.s.a.p.
(v) insulin delivery: missed doses, no leaking penfill ampoule?, pen plunger not advancing the rubber stopper?, injection into scar tissue?, pump not delivering insulin ? battery ? software? ?, blocked cannula --> check and replace faulty equipment if possible, re-inject in new site, change cannula , revert to mdi
c) review results over 2 hours depending on ketone level done hourly - discuss with DSN/doctor or medical advisory service
d) consider injecting small doses of short-acting insulin ( I have the syringe and longer needle + the expertise) sometimes the DSN/Dr/Advisor might suggest small regular doses of intramuscular insulin)
d) ketones still rising, bsl not settling ---> call ambulance (Better to be Safe than Sorry)
e) extreme ketones with high BSL at anytime --.> ambulance a.s.a.p.
I really hope that things settle quickly and easily for you. Your health team is your best ally in this.
View attachment 31300
Thank you, I don’t feel un well at all. I feel fine, iv never had high ketones before, not even when I got diagnosed 2 years ago. The issue I have is that I don’t have any more ketone strips left to test later on, but iv been drinking so I hope it sorts itself out
Hi @SianyG, I hope you are not feeling too unwell. Not fun being there!!
Good on you for posting and checking BSLs and ketone levels !!
As a T1D, not as professional advice or opinion:
1) The accompanying graph , posted by someone a while back, is really useful, shows you where your ketone level is. in the scheme of things
2) Do you have a 'sick day plan', one made with your DSN or doctor?
For example mine (and yours could be quite different) is:
a) Ring DSN or doctor to discuss and work through a list to check off and discuss: (including HOW much insulin, which insulin, how often etc)
b) reasons for this high BSL and ketones:
(i) illness - flu, urine infection (not always symptoms), tooth problem etc
---> need more insulin and some carbs and medical review
(ii) other - vaccination, monthly cycle (not me personally but in there for completeness sake),
stress/worry, (?? rebound after severe hypo) ---> insulin/some carbs
(iii) food: excessive eating and then fasting overnight ---> insulin and ? how much carbs
(iv) insulin: in date, not been frozen or kept over 30 degrees C ---> replace insulin, may need new script filled a.s.a.p.
(v) insulin delivery: missed doses, no leaking penfill ampoule?, pen plunger not advancing the rubber stopper?, injection into scar tissue?, pump not delivering insulin ? battery ? software? ?, blocked cannula --> check and replace faulty equipment if possible, re-inject in new site, change cannula , revert to mdi
c) review results over 2 hours depending on ketone level done hourly - discuss with DSN/doctor or medical advisory service
d) consider injecting small doses of short-acting insulin ( I have the syringe and longer needle + the expertise) sometimes the DSN/Dr/Advisor might suggest small regular doses of intramuscular insulin)
d) ketones still rising, bsl not settling ---> call ambulance (Better to be Safe than Sorry)
e) extreme ketones with high BSL at anytime --.> ambulance a.s.a.p.
I really hope that things settle quickly and easily for you. Your health team is your best ally in this.
View attachment 31300
Also I don’t have much support from my diabetic team, I fact iv only seen them once since I was diagnosed. I don’t have a sick day plan ect
Also I don’t have much support from my diabetic team, I fact iv only seen them once since I was diagnosed. I don’t have a sick day plan ect
FWIW I don't have a sick day plan either - but I prefer to work out my own doses and have the tools and experience to do this.
I see the DS team every 6 months or so, and if I wanted extra support I'm pretty sure they'd help.
kitedoc
Well-Known Member
Hi @SianyG,
Please do try to contact your team. Or an advisory service via your emergency number for ambulances etc.
High BSLs and ketones must get their attention.
(((((((((That combo in a T1D particularly is a red alert.)))))))))
Trying to sort through it yourself for the first time is very risky.
Please do try to contact your team. Or an advisory service via your emergency number for ambulances etc.
High BSLs and ketones must get their attention.
(((((((((That combo in a T1D particularly is a red alert.)))))))))
Trying to sort through it yourself for the first time is very risky.
HI @SianyG How are you feeling today ?
I've been diagnosed over 7 years and despite having many high BG in this time i've never tested for ketones, this would only change if.. I was feeling unwell or if I had been running high for say a day or so and there was no change in my high readings, high for me would be above 17 mmol/l.
If you have quick acting on board and are feeling ok despite the high readings then test every 2 hours, drink lots of water to help flush the glucose out, also have a plan on how to tackle with insulin in regards to corrections, my personal plan is quite aggressive but as I have a continuous glucose monitor I can check frequently, speak to your DSN about this and get some guidance on what to do.
If you haven't done the DAFNE course yet - Dose Adjustment for Normal Eating - then get your DSN to enrol you, it covers sick day rules which is vital for any t1/insulin dependent diabetic to know.
I've been diagnosed over 7 years and despite having many high BG in this time i've never tested for ketones, this would only change if.. I was feeling unwell or if I had been running high for say a day or so and there was no change in my high readings, high for me would be above 17 mmol/l.
If you have quick acting on board and are feeling ok despite the high readings then test every 2 hours, drink lots of water to help flush the glucose out, also have a plan on how to tackle with insulin in regards to corrections, my personal plan is quite aggressive but as I have a continuous glucose monitor I can check frequently, speak to your DSN about this and get some guidance on what to do.
If you haven't done the DAFNE course yet - Dose Adjustment for Normal Eating - then get your DSN to enrol you, it covers sick day rules which is vital for any t1/insulin dependent diabetic to know.
