Ketones

Are you eating low carb?

If you are low carb as @Diakat says then the presence of ketones is nothing to worry about. If ketones are paired with high blood glucose it signifies diabetic ketoacidosis. Here’s what this website says about the difference:
https://www.medicalnewstoday.com/articles/324237.php

bonkers82 said:

Hi folks. Im not on a low carb diet. If anything i would have to many carbs. I nor the gp can understand the high ketones but perfect glucose x

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Your doctor needs to do some reading and ****** quick by the looks of it!



Edited by mod for profanity.

Having ketones in the urine without any of the very serious symptoms of keto acidosis - which I will not bore you with as you would be feeling really ill if you were in keto acidosis, but the first one is high blood glucose so I do wonder why you were sent to hospital and what was in the drips you were put on.

bonkers82 said:

Have type 2, metformin, gliclazide and jardiance. Was at routine check up, blood glucose levels perfect. Diabetic nurse checked my urine, it showed ketones. DN checked ketones using blood check, ketones initially at 1.1. Was sent to A &E, levels rose to 3.2. After 2 drips they dropped to 1.1. Hospital released me. How can I monitor my ketones as my glucose levels are normal. Even my DN and gp are lost as to why this has happened?????

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Hi @bonkers82,

Jardiance (empagliflozin) can cause euglycemic ketoacidosis (it's one of the known side effects, but not saying that's what it is as long as ketones are not excessive) -- if you google these two terms you'll find loads of information.

Meanwhile, it's probably a good idea to keep monitoring ketone levels (you can get ketostix at your pharmacy) while setting up an appointment to talk to your GP/DN about this.

Let us know how you get on.

Hi @bonkers82

As already mentioned, it really doesn't seem anything worrying. You've likely got ketones in your urine because your body is burning fat. Again, as already said, it's when you show ketones AND high blood glucose levels that there is a big problem.

@bulkbiker has hit the nail on the head by saying your GP and Diabetes nurse, and A/E staff, need to do a bit of basic study. However, they do tend to go into 'panic' mode when ketones are present - because they lack information about the body and how it metabolises.

Probably not the best article in the world but just had a quick look for you - https://www.womenshealthmag.com/health/a25133977/ketosis-vs-ketoacidosis/

Showing ketones in urine is very different from ketoacidosis and it's the latter the 'professionals' are thinking of

Have a good night's sleep, without worrying

Hi @bonkers82
Hope you get your doc to listen and appreciate your situation, so good luck with the appt!

As said above you can monitor ketones using urine dip sticks, or (better and more accurate) by a blood testing meter, very similar to your blood glucose meter.

since you have a history of ketones while on medication I think you would be entitled to demand a ketone meter if you are ever, in future, on any medication known to cause ketones.

sorry you have had to go through this.

bonkers82 said:

Went to doctors this morning. Ketones checked via blood. They were 3.5, so im back in a&e hoping to be seen soon and by a specialist from the diabetes team or endocrine dept. Thoroughly fed up

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Have any of them actually read the slip of paper that comes with your medication?

Great reason to work on what you eat and reduce medication as much as possible maybe?

The symptoms of Keto acidosis are pretty striking - fatigue vomiting abdominal pain dry mouth - a great long list. The diagnostic feature most significant is high blood glucose..
That you were sent to hospital in obvious good health, and so much trouble stirred up is not very reassuring.

bonkers82 said:

Discharged from a&e, ketones 3.2. Apparently the issue is a positive change in my lifestyle i made around 3.5 weeks ago. Only return if i feel unwell

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what was the positive lifestyle change you made?

Pleased to hear someone had some good sense in A/E eventually. Talk about wasting your time, to say nothing of wasting NHS money. Sorry, that sounds like I'm blaming you, @bonkers82 but I'm meaning your GP, Nurse etc.

Like I said, pleased to hear you're considered OK now. Hope you aren't paranoid about ketones now, though

@bonkers82
A word of caution. (This already referenced by @ziggy_w )
Diabetic ketoacidosis is normally diagnosed by a combination of high ketones and high blood glucose.
However if you are on medication that causes you to pee out sugar this can reduce your blood glucose readings when you are actually in ketoacidosis. Jardinace is a drug which causes you to pee out sugar.

So for someone who is on Jardinace and is showing rising ketones then A&E is probably a sensible move because DKA or EKA can develop very quickly and is dangerous if not treated promptly.

The ketone levels that you are showing are not considered dangerous for a T2 but are "blues and twos" for a T1.

As a rough guide up to 5 on the ketone scale is fine if you are on a keto diet. I've been up in the 4s whilst fasting.

However, for a T1 or an insulin dependant T2 it is different.
https://www.diabetes.co.uk/diabetes_care/testing-for-ketones.html
"
WHAT SHOULD THE KETONE TEST RESULTS BE?

• Under 0.6 mmol/L – a normal blood ketone value
• 0.6 to 1.5 mmol/L – indicates that more ketones are being produced than normal, test again later to see if the value has lowered
• 1.6 to 3.0 mmol/L – a high level of ketones and could present a risk of ketoacidosis. It is advisable to contact your healthcare team for advice.
• Above 3.0 mmol/L – a dangerous level of ketones which will require immediate medical care.

"
Your reading of 3.2 is up in the danger area by that guidance.

So if, and this is a big if, you aren't producing enough insulin to control your BG and this is being masked by the Jardinace flushing glucose out of your bloodstream then you could be showing symptoms of EKA. That is, your body isn't managing to get glucose into the tissues for energy and so is breaking down fat (and possibly muscle) for energy.

We can't diagnose, obviously, but it might be worth asking your GP if you can have your insulin levels checked because it seems that if you are producing adequate insulin then you aren't at risk from those ketone levels, but if you aren't producing enough insulin then the trips to A&E may have been a sensible move.

TL;DR - Jardinace can mask some of the symptoms of DKA which can lead to EKA.