ketones - God's joke for the diligent diabetic?

[increasingly cynical]

Hi All,

Sigh... latest medic seems to have half a brain and has done a 'GAD' test to see if I have an auto-immune problem... whilst waiting for this to come back, we agreed that it was sensible for me to go low-carb and do more exercise... fine as I love exercise and have no issues with diet... however, he suggested that I get some 'ketostix' and measure ketones regularly.... I thought at the time that this was because I was running such high BGs (20s to over 30) despite not eating all that much.

Measured my ketones whilst still running v. high BGs... no ketones - great ( I thought), worked hard with the low carb and exercise... also great (I thought) BGs coming down rapidly, down to 13s.. then... ketones rapidly up, if my BGs are around 12 or 13 mmol/l my ketones are at between 4-8 mmol/l.... if my BG rises again my ketones drop... what a joke!!

Will this absurd pattern alter if I start taking insulin? If so, what are the mechanisms involved?

Thanks once again, this disorder could challenge a registered genius!

:|

 

[rach]

Just a thought but how many carbs a day are you eating now? Because ketones are not always bad: non diabetics can have "fasting ketones" when waking especially after not many carbs the evening before (up to + or even ++ on the ketostix). Also people on the "ketogenic" diet, generally thought of as <50g a day I think, will produce ketones and still be healthy.

If you are eating lower carb it could be making your blood sugars fall, but also the ketones apparently increase?

However be on the look out for signs of dangerous high sugars/DKA (extreme thirst, blurred vision, abdo pain, vomiting) as I know for my blood sugars, and the fact I do not eat low carb enough to be producing significant ketones, I would be worried above about 14mmol/L.

 

[lucati]

It could be ketosis, where your body needs to get some of the energy you need from fat storage (i.e. by using ketones), but this isn't as a result of a lack of insulin or high blood sugars. Just make sure the ketone levels aren't going above trace amounts (on a ketostix) I'd say. If they are, try and drink more water to flush them out!

 

[hanadr]

ketones are a fuel for humans and if you cut carbs, so that you metabolise fats, you will produce them.
Atkins dieters deliberately set out to get into ketosis and some medical conditions are improved by it.
Dietary ketosis is a benign condition and perfectly healthy if Bg is normal.
High blood Glucose with high ketones is a dangerous combination, but if your Bg is low, a few ketones are harmless.

 

[increasingly cynical]

Hi,

Thanks again all.

The ketones do seem to go up when I exercise (and glucose goes down¬) so I guess it is, as people suggested, the body trying to burn fat for fuel (what a great weight loss programme! :wink: ). Drinking lots of water was a good suggestion and seems to work.

Is 8 mmol/L ketones (ketostix +++) with a BG of 14 still OK and, if not, will that type of ketone reading go down if I am put on insulin (I am guessing that the aim of insulin is to allow glucose to go to the bits of the body that need it, rather than sitting in the bloodstream and therefore the body should realise that it doesn't need to burn fat?)

 

[lucati]

Well I'm assuming you have type 2 diabetes then? Well high sugar levels and high ketones are not a good combination, and if I were you I'd go and see your doctor asap as you might need to change your medication/start taking insulin. The most important thing is to have blood sugar levels consistently under 7mmol/l I'd say, so we need to take care of that first and foremost.

Actually we seem to have similar problems, my sugar levels have been going up post meals ever since I reduced how many carbs I eat. That said, I'm type 1 and my ketone levels aren't going anywhere near as high as yours. But I'd say see your doctor asap.

 

[lucati]

Oh and insulin essentially is the hormone that the body uses to turn the sugars your body produces (from the food you eat) into energy for your cells. If your sugar levels are high, it means you aren't producing enough insulin.

 

[increasingly cynical]

Hi Lucati,

Thanks for your comments. I think the doctor is currently assuming that I have 'LADA'.

I'm guessing that if you have Type 1 it would be expected that your BGs would go up if you cut down on carbs (as the body will assume that it is not receiving energy and will therefore turn fat into energy)?? Am I understanding that right? However, if you are taking insulin (and I assume that you must be?) I would have thought that this wouldn't happen, as you will be taking in energy of some sort and surely the use of insulin would mean that your body would recognise this? Maybe I have misunderstood something of the way in which insulin works ?

I'm seeing the doctor on thursday, so it will be interesting to hear his comments (unless they are the blank '?' which I've been getting for nearly two years now!)

 

[lucati]

You're very welcome!

Well all type 1 diabetics have to take insulin shots; you might not know but the essential difference between type 1 and type 2 is that type 2's produce some insulin, but may not always be producing enough, whereas type 1's essentially produce no insulin. Some type 2's eventually become type 1, or, like me, are diagnosed with type 1 straight away.

The problem I have (as I have put in my post viewtopic.php?f=15&t=7191) is that I'm not sure how to adjust my insulin levels now that I am eating less carbs! You are right that if you don't get enough energy from carbs, your body automatically produces ketones to break down fat from your body into energy. It's for this reason that the Atkins diet (and similar low carb diets) are such a popular choice...you can't help but lose fat! You have raised an interesting point though; remember, my body doesn't produce insulin, it only uses the insulin I inject to give me energy. So any excess won't make my body produce ketones. What produces the trace amounts of ketones for me is exactly the same reason for a non diabetic..it's a form of ketosis. Now there's a totally different situation for diabetics where your body produces ketones because long term you aren't injecting enough insulin. What happens (to the best of my knowledge) is that as you aren't injecting enough insulin for the carbs you are eating, your body assumes that you don't have enough energy coming in, so again it produces ketones to get energy from the fat in your body. The problem for diabetics in this case is that as you aren't having enough insulin, your sugar levels are high and you feel thirsty, because you have alot of sugar in your blood and the only way to reduce it (without enough insulin) is through passing urine.

Remember, insulin isn't energy itself, it's what the body uses to create energy for all the cells in your body. And whether you need insulin for the fat that the ketones break down, I don't know. Does anyone have any idea?

 

[increasingly cynical]

Hi Lucati,

Thanks for your reply. I read your other post as well. That sounds really interesting - although obviously something of a worry for you! It does sound as if we have similar issues in terms of a lack of correlation between food intake (and in your case insulin) and blood sugars / ketones. I still haven't got my head around the ketones thing, but will read through your reply again and also look at the research literature.

Have you ever kept an 'exact' record of your intake (i.e the actual amount of carbs, fat, sugar, proteins etc in each meal) and correlated it (statistically) with the change in blood glucose between 1 to 2 hours afterwards? I have been sad enough to do this for a few months now and have found that there is an 0.01 correlation (i.e virtually no corrrelation) between quantity and type of fodd intake and blood glucose. This is controlling for things like exercise etc. which might alter the assumed impact of food. The lack of a correlation worries me because I don't see how it is possible to adjust insulin appropriately (I am not on insulin yet but the doc wants to discuss this) if the same 'food input' can do very different things to blood glucose. Maybe this is your problem too? :? (by the way I am also slim, vegetarian and like exercise!). If so, I would guess that there has to be some underlying process other than lack of insulin which is governing the blood glucose levels?