Ketones in the morning.

significant ketones that would need attention is anything over 1.5mmol/l.........

now I say significant, but this is me talking about a sick day scenario as opposed to fasting ketones......

but its still a good guide......

the levels you have posted are normal I would say.......

Those ketone levels are completely fine.

The danger is when glucose levels are high (13 mmol/l +) and ketones are high and rising. It indicates a lack of insulin in the body so action needs to be taken immediately otherwise diabetic ketoacidosis will ensue. If you want more clarification, I'll tag @LucySW who knows more about this topic than me

Because she fasts, she is using fat as fuel - it's a form of nutritional ketosis, where the body starts to burn fat and produces ketones as a by product. As her blood glucose level is normal and flat, there is nothing wrong here. Please leave her basal alone and stop trying to get rid of the ketones.

They are highly unlikely to be a sign of Diabetic Keteoacidosis in this case and it is perfectly normal.

What basal is she on @Gemmablower?

It may be possible to split her basal into overnight and daytime to allow more flexibility.

I wouldn't worry about ketones unless she has high blood sugars.. Ketones are normal in fasting situations such as hers.

I wouldn't increase basal to deal with post meal spikes, i would first be sure she is counting carbs correctly, and injecting at least 15 minutes prior to eating AND is eating low carb meals (as well as being in the 4-6mmol/L range pre meal)

Tim explained it, Gemma. When you burn fat, you produce ketones. Once you have burned all the carbs you last ate, you burn body fat. But ketones are only dangerous when blood sugars are also high. In fact you shouldn't even test for ketones when blood sugars are NOT high. What's happening is good, not bad. And no, you don't feel bad with ketones at that level.

Yes, I don't know why professionals can't tell you. But you might consider that they are telling you but you are not able to take it all in at once. Like TIm told you above and you didn't take it in.

Stop testing her ketones when her bloods are normal. Stop worrying and tinkering when her blood are normal. Don't over correct.

Also for a child, twenty minutes before a meal might be too long. If she's slim, and obviously she's smaller than an adult, she will be more sensitive to insulin so they onset time is likely to be quicker. But generally, yes, you have learned some useful things here.

Have you read Think Like A Pancreas? I find having a book about this stuff to hand is often more useful than either consultations or forums, precisely because the info in a book is more organized than on a forum, and you have more time to consider it than you do I a brief meeting with a specialist.

Gemmablower said:

I know the procedure for ketones but diagnosis can make you worry when I'm seeing them.
I'm very thorough with my daughter and her safety comes first so do not do anything before I discuss it with my team first and I'm not tinkering with anything right now just simply trying to understand it.
I re read what tim wrote which was useful I suppose I was just after any more on this like the name of the process so I can look it up, I take everything on board my nurse tells me with great detail but she honestly could not tell me why and I like all the information to make informed decisions as it's so important to me. it's all about just making me feel comfortable.
I have a good book type 1 diabetes in children and adolescent which is helpful and will def get that book thank you x

Click to expand...

The process we are talking about is "Nutritional Ketosis" - it is the state that LCHFers aim to get into and stay in wherby you burn fat as a fuel rather than Carbs. Ketones are a natural by-product of this process as they are a waste product of the fat metabolism.

In a state of ketosis, typically, someone will have a blood ketone measure of 2-4 mmol/l. This is quite normal and safe. The graph below shows this:


This page may also help you understand it a little better:

http://ketodietapp.com/Blog/post/2013/11/30/Ketosis-Measuring-Ketones

I personally have experienced Ketone levels at this level quite comfortably. It is nothing like DKA, which I have experienced once in my life, and I will keep it that way.

@Gemmablower It's also worth looking at the Lean Gains blog - it's really a diet and bodybuilding blog, but what your daughter does is similar in terms of eating pattern, i.e. Intermittent Fasting. You might also find this paper interesting.

You know, Gemma, I have had Type 1 since I was 5. That's forty-eight years. Things were pretty primitive back then. My mother wouldn't recognize a ketone if it dropped on her from a great height. All we had were urine tests, which told us roughly what our blood sugars were about six hours before. And you know what? I am perfectly healthy. Remember she's a child, not a collection of symptoms to obsess about. Get her up and welcome the day with her every day. Be glad that all is well. Really, I think you need to let this morning ketones thing go.