ketones/ketoacidosis

[increasingly cynical]

Hi,

I wonder if people could help me by giving me some advice from their experience regarding ketones/ketoacidosis?

Since I improved my blood glucose control I have started running consistently high ketones (3 or 4 on the urine sticks constantly). It is a pretty obvious correlation - if I allow my BG to go up I run normal ketones, if BGs go down, even to quite 'high' absolute levels (like 15mmol) the ketones shoot up. my consultant tells me the BG needs to come down, but also adds that high ketones are bad and ketoacidosis is the main killer of type 1 diabetics..

What are the symptoms of high ketones/ketoacidosis? I don't feel that much different when my ketones are very high, even if this is for several days. If I get high ketones every time I control my BGs is there anything I can do? is it better to have high ketones and 'low' BG or vice versa?

Is this equation just something that the medical profession wants to ignore because they simply cannot square the circle?

What has anyone else done in this situation?

Than :? ks!!

 

[moonstone]

I'm so sorry that I can't answer your question, as far as I know I've never got above +1 which is bizarre enough in itself, but I do know that my nurse told me - and she's at King's College Hospital so I have every reason in the world to trust her advice - that if I ever hit +2 or +3 I should go immediately to A+E. Therefore, I'm worried about what you're saying and as it can have such serious consequences, I think you should be asking your consultant or your nurse about it as soon as you can. If there's something else at play in your system maybe, then the medics need to pinpoint it. What are your ketones when you're in the non-diabetic range? You mentioned 15 but what about 4-7? I can go very high (in the 20s) and not get them, which I must add I don't do very often, and only by mistake - plus, I've been on a drip in A+E having thrown up several times, seriously dehydrated and with a savage throat infection, yet only shown traces. What you're saying doesn't seem to make sense, so please talk to a specialist - I don't want to be alarmist but I know that what you're saying is no good for you and isn't right xxx

 

[wibbler]

I must confess that your post has confused me somewhat...
You say:

If I allow my BG to go up I run normal ketones, if BGs go down, even to quite 'high' absolute levels (like 15mmol) the ketones shoot up

and

is it better to have high ketones and 'low' BG or vice versa?

This sounds like you have things the wrong way round in your head!

It's better to have low (no) ketones, and low BG.
Thinking varies a little on the ideal BG range, but personally, I aim for a BG of less than 10mmol, which is higher than a lot of people will like, but I just can't get any better than that (and I've been trying for the last 18 years!).

Ketones present when you have high blood sugar - you're saying that your BGs are going down to levels like 15mmol - that means that your levels are dangerously high, and you need to be seeking urgent advice from your diabetes team. 15mmol is more than high enough to trigger ketone production. If you can get your levels down below 10mmol, you'll probably find ketone production will stop. As a side-effect, you'll also feel more healthy, as ketones don't make you feel good!

One last thing: when you said "If I allow my BG to go up I run normal ketones" - that doesn't make a lot of sense unless...what are you considering to be 'normal ketones' - if you're getting negative ketones, and so are increasing your BG to get a positive reading - don't! - You are aiming for negative ketone results.

Hope I've helped a little

j

 

[cugila]

Here is a link to Ketones and Low Carb diets.
http://www.diabeteshealth.com/read/2006 ... ate-diets/

A small extract:
Dietary ketones are more common than most people realize. As well as being caused by low-carbohydrate eating, they will occur as a result of any weight-loss plan when fat is burned or even after an overnight fast.

It is unclear if the OP is a LC'er and it is not clear either if a T1 or a T2 on Insulin ?

 

[increasingly cynical]

Hi,

Thanks to people who have replied. Hmm, situation seems to be unclear then. Does anyone else have consistently high ketones (3-4 on the ketostix)? If so, what are your BGs when you have these? What have your consultants said? All I have heard so far from both medics and others is "this can't be happening".... but it is...I am sure I am not the only one....??

:?

 

[jopar]

I'm confused by your post, as you don't say if you are low carbing or not!

What does need to be rememebred is ketones are a by product... The amount showing in the urine will be timed delayed...

When the body start to produce ketones (in a diabetic eating a normal diet, not low carbing) will be individual to that diabetic, in general one would start to check for ketones if BG's goes above 11mmol/l...
I haven't had ketones for a long while, but many years ago when I was having my last daughter my BG only had to hit around the 8 mmol/l mark, and DKA would start to set in and land me in hospital, and I wasn't allowed home until I had been totally clear of ketones for 24 hours..

If one is low carbing it is slightly different and much harder to detect whether one is heading towards DKA or the ketones is just a by-product of the low carbing...

If BG are raised and ketones present, get medical advise as soon as possible, and if you feel sick or have stomach pains in any way go straight to A&E..

If ketones are present, but BG's normal then consider if you been eating low carb foods, if your BG has been raised etc several days before, as this might give indication if it's low carb diet related or ketoacidosis related and needs sorting...

If ketones are present and BG normal, you feel unwell or have stomach or muscle cramps, get it checked by a medical professional as quick as possible...

I think this is the problem when using insulin and a low carb diet, sometimes it can cloud what is happening.. are the ketones present just a by product of low carbing or are they the start of DKA?

 

[fergus]

If one is low carbing it is slightly different and much harder to detect whether one is heading towards DKA or the ketones is just a by-product of the low carbing...
I think this is the problem when using insulin and a low carb diet, sometimes it can cloud what is happening.. are the ketones present just a by product of low carbing or are they the start of DKA?

Nonsense.
DKA is a consequence of abnormally high blood sugars and a relative deficiency of insulin.
It has absolutely no connection with whether one follows a low-carb diet or not. :roll:

fergus

 

[Celtic.Piskie]

http://www.lowcarb.ca/tips/tips011.html

I think they meant the ketones, rather than DKA.

Ketones can be present in a low carb diet and not with DKA.

On a very low carb diet you could have low blood sugars, ketones, but not DKA.

 

[Dillinger]

Thanks to people who have replied. Hmm, situation seems to be unclear then.

It is ! You need to let us have some more information ;

What type of diabetic are you?
What medication are you taking for your diabetes?
What diet are you following?
Give us an estimate of daily carbohydrate consumption?
Just to be clear when you say blood glucose levels 'go down' you do mean that the numerical number goes down don't you? You say "if BGs go down, even to quite 'high' absolute levels (like 15mmol) the ketones shoot up" Which doesn't make sense unless you mean that your blood sugars are normally above 15mmol/l?
What blood sugars do you normally have on waking and 2 hours after breakfast and lunch?

Once we have a bit more precise information then we could probably help.

Dillinger

 

[phoenix]

Dillinger is right, its quite difficult to comment when we don't know what methods you're using from control. Previously it appeared that you were possibly LADA and were reluctant to use insulin.
If this is correct it maybe that it is of because of your fluctuating, though deficient insulin levels that you are having seemingly contrary readings.
ie you have very high blood glucose, eventually your remainign insulin brings it down a bit but when you test your urine it reflects higher ketones produced some hours earlier.
However there is a condition that I wrote about in an earlier posting: euglycaemic DKA.(although your loweer levels are far higher than normal anyway). This is why your consultant is right to be concerned.

Ketones can build quickly, even at relatively low glucose levels. The acidic nature of high ketones can be dangerous whether glucose levels are high or low. There is a condition known as euglycaemic DKA (DKA not associated with hyperglycemia). It is not that common: one study found it in just over 3% of cases, but it is not benign. It can happen during infection, pregnancy, stress but also as a result of a build up of ketones resulting from fasting or 'starvation 'as some of the papers put it . Why it happens to some and not others (or sometimes and not at other times) is not known. It may be because some type 1s have an inefficient counter regulatory system or that in some it deteriorates over time. (another one of the differences?).
Missed or insufficient insulin is obviously often a factor in the majority of cases of DKA . Unfortunately missing insulin happens relatively frequent in adolescent (and perhaps not so young) type 1s.One paper suggests that 20% of admissions for DKA in females may be caused by missed doses of insulin often coupled with fasting ( often to lose weight.)Missed or insufficient insulin is obviously often a factor in the majority of cases of DKA .

I dscovered quite a bit about it at the time but I'm on the wrong computer to find all my sources.
Here is some mentions that google found for me
http://www.springerlink.com/content/h5633275346v3657/
http://www3.interscience.wiley.com/journal/85514741/abstract

As to the symptoms, of DKA, the early ones are those often experienced before diagnosis.
Early signs:
Feeling tired or fatigued
Excessive thirst and/or excessive urination
Signs of dehydration such as dry mouth
These are the later signs.
Nausea/vomiting
Abdominal pain
Confusion
Rapid, deep, labored breathing (Kussmaul's respirations)
Breath that smells fruity
Fever
Unconsciousness
It was rapid breathing during an attempt at exercise that sent me to the doctor, but by the time I saw him I felt fine again. (presumably my own residual insulin brought the ketone levels down a bit) so I can understand that you actually don't feel too bad.
I was totally shocked when I was sent straight to hospital and put on a drip. It was only when my blood glucose levels were controlled (and acid balance restored) that I realised that I had got used to feeling ill. Feeling normal was great.

 

[increasingly cynical]

Thanks very much for all the information provided. A couple of people have asked a number of questions to help clarify (it is very kind of you to take the time to go into this depth - thank you again) I will think through all the replies and the questions asked and try and post a coherent picture over the weekend.

In the meantime to clarify the 'medical view', my consultant said that taking insulin will not resolve my ketone problem, as the ketones are produced by the liver 'thinking' that the body is starving and therefore turning anything it can (fat, body tissue etc) into energy. His view is that in the 'old days' the medical profession killed Type 1 and LADA diabetics by telling them to low carb and hence stimulating the liver to turn other tissues into energy producing high ketones and ultimately ketoacidosis (does anyone who low carbs to a significant extent check their ketones - if so, do you have the same problem of high ketone readings?). Taking exogenous insulin, he feels, does not resolve this issue, as the sugar is still not diverted to where it needs to go, so the insulin keeps BGs down, but the liver still 'thinks' the body is starving. I asked him about symptoms/treatment for ketoacidosis and he said much the same as this forum in respect of symptoms and said, essentially, that when people go into hospital with DKA they put them on a drip with electrolytes. Well, frankly, I can take electrolytes at home and he is right, if I take electrolytes the ketones go down regardless (as, in line with his views also, they do if I take more carbs). Hmmm..

More info, more questions - sorry! :?

 

[fergus]

Interesting.
I wonder if your doctor is suspicious of the condition Pheonix referred to, euglyceamic DKA?
Otherwise, insulin will pretty reliably lower your ketone level. It is the very lack of insulin which prompts the body to mobilise stores of fat and protein for fuel because it cannot find a way to bring glucose through the cellular membranes to the mitochondria for fuel. When insulin is re-introduced, the glucose is removed from the bloodstream and the fat and protein stores are spared because they are no longer required for cellular energy. Hence blood glucose and ketone levels fall.

All the best,

fergus