Ketones and High BG

CosmicOwl said:

Do ketones always present with high blood sugar? I’m not quite sure how it works as sometimes when I have high sugars and I test, my ketones are in the normal range (I’m type 1), can someone help me understand?

Can diet, amount of water you drink etc keep ketones low even if your sugars are high?

Thanks!

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Hello, I’ve been told if you stay consistently above 14mmol/l, ketones will show and if you get one high reading of 16-17mmol/l, ketones will again show. Ketones is when you don’t have enough insulin, you are excessively going to the toilet and you are extremely dehydrated. When your sugars are high, you’ll need to correct with some insulin to bring it down. If your ketones are above 2-3mmol/l, you have to go to A&E.

CosmicOwl said:

Can diet, amount of water you drink etc keep ketones low even if your sugars are high?

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I don't think so, with high bg ketones show up because of a lack of insulin if I understand correctly. So it needs insulin. Which is needed with high bg anyway in T1.

Hello @CosmicOwl - are you running consistently high or is this a rare event for you ?

CosmicOwl said:

Do ketones always present with high blood sugar? I’m not quite sure how it works as sometimes when I have high sugars and I test, my ketones are in the normal range (I’m type 1), can someone help me understand?

Can diet, amount of water you drink etc keep ketones low even if your sugars are high?

Thanks!

Click to expand...

Ketones can be present in your blood with normal blood sugars if you are eating a low carbohydrate diet or keto, as I do. I have to dose for 50% of the protein and all of the carbohydrates so that I end up with 'trace' ketones otherwise I would have ketones between 1.5 and 3 mmol/L which are typically found in 'normal people' on this diet. As I type 1, I don't like running these higher values. My consultant suggests as a type 1, I don't have homeostasis, the ketones could continue to build up past 3 mmol/L, which is why they are against keto diets. This build up mostly occurs when sugars are constantly above 13 mmol/L, due to a lack of insulin to clear them away, but can occur with normal blood sugars if you are ill.

Just to add to the confusion, (and because I'm in that sort of mood), you can present with high bg and high ketones without being in ketoacidosis.

(Personal experience here) I had a vomiting bug over about a week. This resulted in low food intake, hence high ketone production from ketosis. I had been keeping my bg reasonably low with insulin. Just before admittance to hospital I was desperately thirsty and drank the only fluid available - lucozade. So, I presented with high bg and ketones, but didn't have a low blood pH, so wasn't acidotic. Kept the doctors amused for a good couple of days.

It shouldn't need to be said, but this is an unusual set of circumstances. If you have high bg and ketones, go to a hospital.

CosmicOwl said:

I didn’t realise some of my insulin expired (due to heat) and had high BGs for several days but I didn’t develop any ketones over 0.3, would that be unusual? They make it sound like you’d go into DKA very rapidly! I haven’t really ever had ketones go very high (1.3 being highest), even when I was diagnosed as it was caught so early!

It makes me feel like it’s not type 1 if that makes sense, despite them 100% confirming it is (I’ve had it for like 7 years now), my understanding is usually presence of ketones = type 1 so I’m just trying to clarify why I’ve been so lucky in not ever having super high ketones! Can honeymoon periods last this long?

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Some people don't develop ketones as quickly as others, your basal insulin may have helped you to some extent. If it was just fast acting insulin, it may have been a different story. Like you said, there are people who are diagnosed early before it got bad. Mine was dangerously high before I got my official diagnosis. The honeymoon period varies between everyone, I didn't have mine because my pancreas packed up when it was caught.