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Ketones - how high is too high?

M

mariavontrapp

Well-Known Member
Messages
292
Type of diabetes
Type 2
Treatment type
Insulin
Type 2 diabetes for 8 years controlled by diet, but something has suddenly gone wrong. My Hba1c doubled to 107. My glucose levels range from 13 to 22 mmol. My ketones over night have been 1.5 on most nights. I've been put on 1mg glimepiride.

My question - when people say "high ketones", what numbers would that be? When do I need to be concerned?
 
NormalLess than 0.6 mmol/L
Medium (ketosis)*Between 0.6 and 1.5 mmol/L
High*Between 1.5 and 3.0 mmol/L
Possible DKA**Greater than 3.0 mmol/L

*People on low-carb diets often have ketone levels in the range of 0.5-3 mmol/l.

**Experts have not reached an agreement as to what level is too high; some are very conservative and say 1.5 mmol/L is the threshold, and others use a much higher 10 mmol/L threshold.

 
Thank you so much John, I was struggling to find this information
 
I am giving a non medical opinion here, but I have seen reports that a ketone reading of 4 can occur due to diet and exercise regimes, and was considered safe. Since DKA is a buildup of ketones I think the levels for DKA are normally very obvious and usually in the 20's and above. The odd one out is what is called euglycemic DKA which is associated with some diabetic medications such as SGLT2 and GLP1 medications where DKA can ccur at relatively low glucose levels (10 mmol/l) but again I think the ketone readings are still very high compared to nutritional levels. However, with high glucose readings above 20 mmol/l then there is a risk of DKA so keep checking. On a personal note, I regularly used to be in the 30's for my g;lucose readings (or as my meter put it - HI or KETONES) but I did not get DKA as my pancreas was still pumping insulin.
 
Doctors who take a ketogenic diet and fasting approach (like DRs Jason Fung and Mindy Pelz for example) say they're not comfortable seeing ketone levels over 7.
I've never seen over 6.1 and this has been during an extended fast when I reached a level of therapeutic ketosis. In nutritional ketosis my ketone level stays nicely between 1 and 3.
 
Have you got an idea what’s happened? A change in any medications? diet, stress, activity, other illness or long term infections?
 
HSSS said:
Have you got an idea what’s happened? A change in any medications? diet, stress, activity, other illness or long term infections?
Click to expand...
For 8 years I controlled my diabetes by diet. HbA1C was usually 40s or 50s. Fasting glucose was as normal this summer but I didn't test during September and October because I knew I was eating carefully and I had lost a few pounds (unusual for me). It was a big shock last week finding out that my Hba1c was 107 (almost double my March test). I was put on 1mg glimepiride on Thursday and I started doing a lot of testing. Overnight my readings have been between 18 and 22, and during the day 12-17.
I haven't changed a single thing in the last 2 months, there is nothing I have done to account for this. But I had the Moderna booster on 2nd October and was very poorly the next day with swollen glands and upper abdominal pain, also ear-drum felt like it would burst and I had a significant loss of hearing which is gradually recovering. I was so focused on my ear that I didn't give the abdominal pain a second thought, but now I'm wondering what on earth is going on
 
 
For me it's 10 mmol/l, but I'm a strict carnivore and most of my energy comes from high saturated animal fat.
 
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