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Ketones

Discussion in 'Type 1 Diabetes' started by jessie, Feb 28, 2011.

  1. jessie

    jessie Type 1 · Well-Known Member

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    Hi,

    I'm sure this subject has been covered before although I can't find the specific answers I need...

    I was wondering if one of you knowledgeable people could please explain (in basic terms!) about ketones.

    The main areas I'm unclear about are:

    Are ketones only 'bad' when coincided with high blood sugar?

    Can a high protein / low / medium carb diet cause ketones and if so can these be tested for with urine sticks even if blood sugar is at a good level?

    Can ketones (without high blood sugar) be dangerous when pregnant?

    Confused :?
     
  2. Snodger

    Snodger · Well-Known Member

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    hi there,

    as I understand it, ketones are what the body produces when it can't get enough energy from blood sugar. So, the body thinks it's starving and starts to turn bodyfat into useable energy.

    So, if you aren't eating enough carbs, yes, you can get ketones and normal blood sugar.
    And, if you have no insulin or can't use the insulin you've got, the sugar's in your blood but can't be actually used by the body, so you can get ketones AND high blood sugar.
    You can test for ketones using urine sticks that detect ketones. (not sure which ones you are using?)

    Too many ketones for too long changes the acidity level in your blood and starts to poison you, whatever your blood sugar. Some people argue that it is possible to manage with high ketones for quite a while without ill-effects. Personally I would NOT want to try it.
    Ketones plus high blood sugar leads to diabetic ketoacidosis, which is grim. See http://www.diabetes.co.uk/diabetes-comp ... dosis.html
     
  3. viviennem

    viviennem Type 2 · Well-Known Member

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    I can answer only one part of your question, Jessie, but there are some answers I would like myself, if anyone can help?

    A low-carbohydrate diet produces ketones in the urine. As far as I understand it, this is because, in the absence of glucose from carbohydrates, your body starts to use ketones from stored fat for fuel and some of these show in the urine. This is called 'ketosis', can be tested for with the normal urine sticks, and can and does happen even when your blood glucose levels are 'okay' - ie, mid-5s.

    'Ketoacidosis' is the dangerous one, associated with high blood glucose levels as well as ketones in the urine.

    What I'd like to know is, do you feel ill if you have ketoacidosis? How would someone like me, who normally has ketones in the urine from my low-carb diet, know if I had ketoacidosis?

    All answers gratefully received!

    Viv :)

    (Type 2)
     
  4. sugarless sue

    sugarless sue · Master

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    You partially answered yourself Viv.
    First you would have high Bg levels, also you may have some of these symptoms.

    Ketones can occur in pregnancy when there is excessive morning sickness. Ketones mean you are burning muscle for fuel. Not a good thing in pregnancy when you need all the energy you can get.

    This is definitely one to discuss with your midwife who has more specialised knowledge of the subject than I have !
     
  5. Snodger

    Snodger · Well-Known Member

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    You'd get all the high-blood-sugar symptoms like thirst and tiredness, plus you'd get deep rapid breathing, your breath would smell of pear drops (acetone), you might feel sick.

    When I was undiagnosed, as a teen, my mum realised I was close to ketoacidosis by the fact that I smelt of pear drops. As I recall the discussion went something like: have you been eating pear drops? No? Then you're coming to the doctor!
     
  6. viviennem

    viviennem Type 2 · Well-Known Member

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    One thing I have noticed on a low-carb diet, is that I'm not constantly in ketosis. Whether my urine shows ketones depends on what time of day I test for them. I haven't been testing for a while, so I can't remember when it's positive (!) I'll maybe start again and check. The ketostix need using up anyway.

    Maybe it's because you're not constantly producing ketones when in ketosis that it's not dangerous like ketoacidosis?

    Viv :)

    Thanks for the info :D
     
  7. sugarless sue

    sugarless sue · Master

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    Its the combination of high Bg levels plus ketones that is dangerous( Ketoacidosis).

    Ketosis i.e ketones with lower Bg levels is not dangerous. It only shows that you are burning muscle for fuel. If you are on a low carb diet then this will show up in urine. If you eat a lot of protein in a meal then this will tend to knock you out of ketosis as around 60% of the protein converts to glucose.
     
  8. noblehead

    noblehead Type 1 · Guru
    Retired Moderator

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    Jessie,

    As far as I am concerned ketones in the urine are bad news no matter what your diet is or how good/bad your control is, my diabetes consultant warns his patients of the dangers of ketones and its long-term effect on the kidneys, he spoke about this only 2 years ago when I attended the DAFNE course.

    I suggest that you speak with your own DSN or consultant for further clarification on this matter.

    Nigel
     
  9. Snodger

    Snodger · Well-Known Member

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    No, this is not something that all doctors/scientists agree on. That's why I was very careful to state that some people think this, but others do not, in my earlier post. Like noblehead, I would not want to have ketones in my urine for a long time. I respect your opinion that you are happy to live with ketones, but many experts would not agree that it's safe to do so - particularly at high levels and for a prolonged period.
     
  10. cugila

    cugila · Master

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    This one will run and run ! Sue was answering a T2 who posed a question who is a low carber so obviously Ketosis at low levels is a natural part of that diet. In the same post Sue also stated that ketosis and HIGH Bg was dangerous which is correct.
    Very small levels of Ketones can be dealt with fairly easily by drinking larger quantities of water to excrete them from the Urine. Small amounts are also common in the Urine of those who are losing weight.

    Ketones are produced when the body is burning fat for energy. This happens naturally if you are exercising to lose weight. If it happens too much too fast, it is not natural. Moderate or large amounts of ketones in your body are very dangerous. They upset the chemical balance of the blood.

    As for the debate.......yes, there are conflicting views about it. There is also the view from other medical professionals that ketones are only damaging to the kidneys if they are ALREADY damaged, hence the advice not to follow a Ketogenic Diet, not a problem if the Kidney's are healthy.

    I think the most significant danger is the risk to Pregnant women, Alcoholics, or persons suffering from Kidney or Liver disease. They should never undertake a ketogenic diet.

    We just all have to make our own choices regarding this after taking medical advice.

    It would be interesting to hear from those that low carb, whether Type 1 or Type 2, just what levels of Ketones they actually have in the Urine........ :?:
     
  11. jessie

    jessie Type 1 · Well-Known Member

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    Thanks for all the replies... I think I started something!!

    How low carb would a 'Ketogenic Diet' need to be may I ask? And does high protein prevent ketones?

    Think I'll get those dip sticks out and start testing, I would personally rather be on the safe side.

    Thanks again,

    Jessie. x
     
  12. phoenix

    phoenix Type 1 · Expert

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    Ketones are caused by the body breaking down fat. This happens for either or both of 2 reasons. Firstly, insuffcient insulin; Insulin acts to control the breakdown of fats. Normally this breakdown goes on all the time but if there isn't enough insulin the process goes into 'overdrive' .
    Secondly it the body doesn't have enough glucose for energy it will again make use of fat .This happens either in fasting (starvation) or for example during endurance exercise. In both cases the ketones production will stop if glucose is supplied and sufficient insulin is present However any amount of ketones can cause some insulin resistance so more insulin than normal may be needed once ketones are present.

    It is possible to get DKA pregnant or not with lower blood glucose levels. When not pregnant it is quite rare (n the west, less so in developing countries) and is usually asscociated with another illness (diarrrohea/vomitting). However,at one hospital they studied 20 subsequent cases of DKA presenting in pregnant women, of these 20, 2 of them were euglycemic (had blood glucose within 'normal' levels).
    Montoro et al 1993
    If you are pregnant then you should (according to the American Diabetes Association) check for ketones when you have high glucose levels and if you are ill. Though, that's no different to any other T1.
    Managing Preexisting Diabetes for Pregnancy
    Summary of evidence and consensus recommendations for care
    http://care.diabetesjournals.org/content/31/5/1060.full

    Obviously If present then you should seek advice from your doctor/midwife... or better still know what to to in advance...just in case.

    Like Nigel's, my consultant doesn't think any level of ketones is a good idea, he instructs people on pumps (who are at risk of insufficient insulin in the case of non delivery) to test for ketones every morning, irrespective of glucose levels. I must admit I don't .
    It did hit home how quickly they could appear when a cannula fell out during a run. Instead of my normal very low glucose level after runnning, I had relatively high levels and ++ on a urine strip.
    I've also had a positve result (+) during a D&V bug, and that time glucose levels were low (hypo at one point). Throw insufficient insulin into the mix and those 'starvation' ketones could quickly develop into something less 'benign'. We had someone writing about that happening to them and the resultant DKA not so long ago.
     
  13. viviennem

    viviennem Type 2 · Well-Known Member

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    You did start something, Jessie, and I'm very grateful - I've learned a lot, so thanks, everyone!

    Yet another argument for low-carb Type 2s to keep testing bg levels? Or could it be used as an argument against low-carb? Maybe safest not to bring it up with my GP :lol: :lol:

    I've only once had a high level of ketones (dark purple end of the stick). Usually I'm just one or two colours darker than 'none', and as I said, it's not all the time. I think I'll start testing for ketones again, just to inform myself. The sticks aren't too expensive, and a pot lasts quite a long time.

    By the way, low-carb slimmers - if you drink alcohol your body starts running on alcohol instead of ketones or glucose, and stops the weight loss until it's all used up - about 3 days. Gives me a giggle - I knew I was up there with the Jeep! :wink:

    Viv :)
     
  14. RebeccaSmith

    RebeccaSmith · Well-Known Member

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    While I was suffering badly from anorexia and doing 5 day fasts, I had ketones averaging 1.9 using my blood testing machine. I had the horrid fruity taste in my mouth, but other than that was pretty much symptom free. I think your body gets used to the symptoms after a while - if I skip meals now and have slightly raised ketones, I feel horendously sick. When they reached their highest at 1.9, I was quite scared as it's a really dangerous tipping point, where you seem okay and then you're so not okay the next minute. All I can say is, I wouldn't meddle with it and I would assume that each person is able to handle them differently...like, 3.5 for bloods may feel okay for one person and make another person feel disgusting..
     
  15. TheSparkyPony

    TheSparkyPony · Well-Known Member

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    Can I just quickly add, that low levels and ketones CAN be dangerous.

    I was always under this impression, but landed in hospital with DKA in early January with a lab BM of 8.4 and a ketone level of 7.2 (very high!)

    Granted, I had a kidney infection of which I wasn't aware of at the time, but I put off getting checked out as I have always been under the illusion you have to have high levels and ketones to be in trouble, and felt rather embarrassed repeating this at the hospital :oops:

    Just some food for thought, there :)

    ETA - For those uncertain of the signs of DKA, you'd pretty much know if you had it, but for any unsure, here are the main symptoms.

    Nausea,vomiting, stomach ache, thirsty, frequent urination, acetone/pear drop smelling breath (I had the taste of nail polish remover in my mouth with DKA!).
    When the acidosis is getting worse, you'll experience breathlessness/deep laboured breaths, known as Kussmaul's respirations. Tachycardia (pulse over 100 bpm) and low blood pressure are common symptoms too.
     
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