Ketones

[smutcher]

Hi

This is my first post here but I have used this forum a lot to educate myself and want to thank you all in advance.

I'm a type 2 diabetic who takes insulin and no other medications for the condition due to stomach side effects (I take a short-acting dose with each meal and then the long-lasting insulin at bed time).

Since taking insulin my weight has been ever increasing and, after an initial improvement, my readings have started to worsen again despite no change in dose/food. In part this could also be due to recurrent infections I've been getting. I know I'm still highly insulin resistant given the dose I need with each meal. As a result I decided to start the Newcastle plan - initially using Exante products 3 times a day plus a very low carb meal in the evening. I'm probably on about 900 calories a day, so a little over the 800 guideline. I just started this last week and have lost 8.5 pounds. Still another 8 pounds to go before I hit my pre-insulin weight, and another 2 stone to go after that.

I admit I did reduce my insulin in week 1 as I adjusted to the diet as I didn't want to risk a hypo until I understood how my body would react to the change in diet, and everything seemed to go well although my sugars climb whenever I fast rather than go down.

I'm worrying about my ketones though - I can test them with a blood test on my meter. Pre diet they used to run at 0.2 to 0.3, they were 0.8 yesterday, 1.0 just now before lunch. Not sure if this is normal as I'm on lower carbs than before (probably about 60g to 70g a day max) or if it's something I should be concerned about. My sugars have shot up this week as well though (12 to 18). I've never had much information on ketones from my diabetic team and need to educate myself.

How do you know if you're on a lower carb diet whether your ketone levels, while higher, are ok, or if there's a danger of DKA? I believe it's more of a risk to type 1 diabetics, but presumably can be a danger to type 2 as well?

I'm not feeling that well, but haven't been for the last few months, so that's nothing new.

Sorry that this is rather long. I appreciate I really need to educate myself here.

Thanks in advance

 

[ert]

It's certainly something to discuss with your GP. Nutritional ketosis is blood ketones between 0.5 - 3 mmol/l. Mine were 2.2 before lunch yesterday as I am intermittent fasting every day. My low blood sugars and basal insulin keep me safe.

DKA is a risk for type 1 when blood sugars are over 13 mmol/l or if they're ill. DKA can also occur in type 2's who are no longer producing insulin, or in rare cases when they're unwell.

 

[tomcamish]

Hi,

Just a couple of questions (and reasons why i ask):

1. Are you adjusting the amount of insulin you're taking depending on what you're eating or just taking a set dosage when you eat? If you're taking a set dosage it could simplybe that you're not taking enough fast-acting insulin. Also if you're new to using Isulin, it could simply be the honeymoon period which is a pain in the backside. I found that something that only required a small amount of insulin to counteract at first then required more a few weeks later while my body got used to it.

2. Are you moving the jab site? I swap sides each time i jab, and also go up and down from just above my waistline to up towards my ribs. If you're not moving it could be that you're injecting into a spot you've used multiple times causing the insulin to not absorb correctly - effectively it's like taking a lower dose.

Failing that -it could be that your body doesn't like the insulin you're on. I was put on Apridra to start with - stung like a ***** every time it went in and wasn't really helping much. Got swapped to Novorapid (or Novo-not-so-rapid as some people call it as you need to inject at least 20 mins before you eat) and been on that ever since as it works much better.

Either way, as @ert suggested, your GP should be able to advise the best way to proceed. See if you can get on a DAFNE course (Dose Adjustmet For Normal Eating or something like that) -it'll really open your eyes as to how different foods do different things to your blood.

I found the best thing to do is to make myself a bit of a nuisance at the doctors if you're not getting the answers you need -it's your health afterall and if you're not getting the treatment you need they need to sort it out - I learnt this the hard way after being diagnosed Type 2 when I was 28, with an HBa1C of 142!! They stuck me on Metformin and Glyclazide for 18 months then my nurse broke her leg and i saw someone else - she took one look at my stats and changed my diagnoses to Type 1 which another doctor confirmed - my treatment was changed and mylast HBa1C was 89 - still way too high but getting there.

You'll get the hang of it, it's just a ballache.

Good luck.

 

[smutcher]

Thanks so much to you both for taking the trouble to get back to me and for such good advice. Sorry my response it late - been a bit poorly alas.

My ketones seem to have lowered down again now which is good (I think!). The diabetic nurse at the hospital is meant to be calling me in the next couple of weeks to go through everything so hopefully that will also help. I've also got myself signed up now for the diabetic dietician service at the hospital who should help more with dosage etc.

I'm finding that I still need more insulin (novorapid) than the nurse told me I should need per unit of carb - I suppose being type 2 I'm just very insulin resistent still. It's interesting what you said about taking it 20 minutes before eating though as the nurse told me to take it just as I was starting to eat. I'm going to start taking it earlier based on your advice to see if that helps. If not I'll ask about whether there's a different type I could try, hadn't thought of that.

I am altering the jab site though so that's one thing I'm getting right

As for dosage, I started as advised using one unit of Novarapid per 20g of carbs. I've ended up having to double that and still get high readings at times. It's a bit weird. My fasting sugars are the highest each day - they keep having me increase my evening Toujeo injection to counteract this - no luck so far. I'm on 32 units now (not sure if that's a low, average or high dose). My sugars still shoot up as soon as I get hungry in the day. I need to learn more about glucose dumping and whether there's anything else I can do to help this other than just increasing the Toujeo.

Lots to learn!

Many thanks once more.