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Ketones confusion

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FindingNemo

Well-Known Member
Messages
71
Not posted in a while.

As you all know, my control is not good, and we have been there before, so this post is not about the whys and whats of that, and am getting apropriate help.

But, my sugars run extremely high, but I seem to have stopped producing ketones a lot of the time. I can have in high 20's or even off the meter and be ketone free. I saw my dsn last week, and she tested my blood ketones with a BM of 27, ketones 0.0. Other times I can get ketones as expected, but this appears to be happening less and less.

Physiologically, I don't get it, neither did she. She was going to investigate with both consultants at my hospital and the consultants at a major London unit that she also works at, but have yet to hear anything.

I am not looking for 'hints and tips' to achieve the ketones, just looking to understand what is going on.

Any ideas?
 
Hyperglycemia and effects:
Untreated high blood sugar can cause a life-threatening condition called ketoacidosis. When the body doesn't have enough insulin to change glucose into fuel, your body uses fat for energy. Toxic acids called ketones form when your body breaks down fat. Some ketones are flushed from your body in the urine, but others stay in your blood. Symptoms of ketones in the blood include headache, nausea, vomiting, dry mouth, stomach pain, shortness of breath, fatigue, and fruity smelling breath. There are home testing kits to check for ketones in your urine, but you'll need to call your doctor immediately for help to lower your blood sugar level.

Considerations
Even if you are taking medication or being treated for high blood sugar, you can experience hyperglycemia. Sometimes you eat the wrong foods or don't get enough exercise. Infection, illness, and emotional stress can cause blood sugar to rise. Using expired insulin, not taking enough insulin, or forgetting to take your medication can make blood sugar levels go up. Pay attention to symptoms and monitor your blood sugar levels so you can take care of problems as soon as they arise.

Prevention/Solution
If you have symptoms of high blood sugar, check your blood sugar level. If it's high, check your urine for ketones. If there are no ketones, make sure to take your medicine on schedule. Keep track of levels so your doctor can change the dose or time you take your medicine. Don't drink beverages with sugar and eat less. Get a lot of exercise. Physical activity can lower your blood sugar unless you have ketones in your urine. If there are ketones present, exercise can make your blood sugar higher.

Hope this helps.

Ken
 
Thanks Ken,

I do understand all that, I just don't get physiologically why at blood sugars of 25+, I no longer seem to get the ketones.

My dsn has checked with various consultants and they cannot explain it either.

I have since discovered that if I have the occasional bolus and bring my BMs into the teens then when it rises again I do get the ketones, but not if I maintain a high bm.
 
Hi Findingnemo,

When the body has insufficient blood sugar to meet its energy needs it burns fat. Ketones are produced as a byproduct of burning fat and are used as an alternative energy source to the sugar. With your very high blood sugar levels, it is not surprising that your body has no need to burn fat and therefore no ketones. What amazes me is that your diabetes team appear to not understand this as it is GCSE level biology!
 
Cheers Dennis. I was just about to post something very similar until it vanished into thin air - AGAIN. :?
I too was wondering why the HCP's seem to not know the answer when we as humble T2's can work it out. :lol: :lol:
Ken.
 
Ketones in themselves are not a propblem they are a sign of fat burning.
If you have high blood sugar and ketones, it usually means too little insulin. that can be DKA and life threatening. High Blood sugars without ketones are not a good thing, but not an emergency. You can be running on that sugar if you have enough insulin.
Atkins dieters try to ensure they produce ketones to check if they are burning fat. that's called dietary ketosos and is harmless in a non-diabetic.
Dietary ketosis isn't harmful in a diabetic either.Especially if the BG is low.
So you really only need to worry if you have High BG and Ketosis. that's when you go to A&E
 
Hi,
I agree with Hana. My understanding is that ketones are produced when there is a relative lack of insulin - when there is insufficient basal/background insulin present to meet your body's 'housekeeping' needs. Therefore you can have high blood glucose with no ketones if you have had your basal (eg Lantus), but have not had enough bolus (eg Novorapid) to cover your carbohydrate intake. The crucial thing is that you have enough basal - then you will not become very ketotic, although you may have a trace of 'starvation' ketones when you haven't eaten for several hours.

Equally a Type 1 can have a low blood sugar (even be hypo) and be ketotic. This happens, for example, during a vomiting virus, when the person is unable to keep anything down, and yet they require MORE insulin because they are sick and therefore have to be put on a drip to have the insulin they need (at an increased basal rate) balanced with glucose fed directly into the bloodstream to keep them above hypo level.

I stand to be corrected here, but when there is insuficient insulin in the bloodstream, the glucose gets 'trapped' in the blood and cannot be released into the cells to fuel the body (provide energy). A high level of blood glucose is no use at all if the cells cannot access it for energy. So having high blood gucose levels means that your body will in fact burn stored fat and then lean tissue to fuel itself as it cannot access the glucose in the blood. This is why exercising when ketotic can be dangerous as it exacerbates the situation by forcing your body to burn more stored fat, which creates more ketones and so on - a vicious circle.

My guess would be, Nemo, that your basal insulin needs are being met, and that is why you are not producing ketones, despite having high blood glucose levels.
Regards
Sue
 
Hi Nemo,

I had the same confusing reponse to you when I called the clinic to ask whether it was more important to keep the ketones down or the BG down (as with you, I have no ketones when my BG is high, but if it goes below 16 I get ketones and if it goes below 13-14 I get very high ketones. The nurse made the same sort of comment i.e "this can't be happening, you only get high ketones if your BG is high"). As people have commented here that is just nonsense, since your body will only chew through fat cells when it thinks it isn't getting enough energy.

My query would be why, if you are on insulin, you are getting BG readings in the high 20s? Doesn't this just suggest that the insulin isn't working and that something else should be done? (a Q. for anyone this).

A further question is whether when / if your insulin does work and your BGs go to normal, do you then find you are still getting high levels of ketones when BG is 'low but normal' , or is it just when the insulin doesn't seem to be working and your 'low' BGs are actually still quite high (in the teens or whatever)?

:?
 
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