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Ketones

Steve Hare

Steve Hare

Member
Messages
18
Location
London
Type of diabetes
Treatment type
Other
Is it normal to find any trace of ketones in your blood or not? I've been playing sport, and levels keep going high even though I'm not eating anything. I've only found 0.5 level of ketones from my meter reading which I know is nothing to worry about, but I've never had/found ketones before and don't really know much about it
 
My husband is type 2 .... couple weeks ago he was very poorly with chest infections and other things .... had to get an ambulance (long story) when they arrived they asked was he diabetic, said yes, they got a urine sample and found raised ketones in that and took him to hospital ..... that's the only time in all these years ketones have been mentioned ....
 
Can you clarify which levels are going high, glucose or ketone? And how high? What medication are you on?

Not eating, especially whilst doing exercise, can produce traces ketones in anyone diabetic or not.

Is there a reason why you are concerned about trace levels? Is it a problem? Are you on medication that makes DKA more likely for instance?

And finally you say you have not seen any at all before - was that because you didn’t test or were fuelled differently eg more carbs or not fasted or on different meds
 
I'm T2 for 16 years, as hard as I try, I've never been controlled so occasionally just give up. Im on 2 different diabetic tablets and rapid acting insulin, long acting insulin and Trulicity.

I had an 11:30am hockey game a my glucose levels were about 12mmol/l all morning. Played hockey game and at half time my glucose was 17.2mmol/l. So I ejected 4units of rapid acting insulin just to try and bring them down and tested for ketones which was 0.0. After game levels were only down to 14.7 and I then umpire a hockey game straight after my hockey game so a bit more running. After all this when I got home my glucose was 12.4mmol/l at 14:45pm and not eaten anything all day. Tested ketones again and they are 0.5
 
HSSS said:
Can you clarify which levels are going high, glucose or ketone? And how high? What medication are you on?

Not eating, especially whilst doing exercise, can produce traces ketones in anyone diabetic or not.

Is there a reason why you are concerned about trace levels? Is it a problem? Are you on medication that makes DKA more likely for instance?

And finally you say you have not seen any at all before - was that because you didn’t test or were fuelled differently eg more carbs or not fasted or on different meds
Click to expand...
Actually I've only recently tested more for ketones so quite easily could have had in the past and didn't know.
I love playing sport and as I'm getting older(48), my body doesn't recover very well, muscles occasionally pull during sport and muscles sieze up after every game
 
16 yrs type 2 and yet only 48hrs old? How quickly dI’d they decide to put you on insulin? I’m curious if you are a misdiagnosed type 1? Especially if you were a normal‘ish weight and active. Type 2 happens in these circumstances but sometimes those cases are a dr being ignorant that an adult can become type 1 not just kids. Did they investigate with antibody and cpeptide testing? Diagnosis aside thats also a lot of medications. In most cases if you move onto insulin it replaces most of the others. Have you had a specialist review your case or just the gp? If not I’d ask for one.

Is 12 a typical reading? If so what is your diet like? Have you reduced carbs at all? Or just cut actual sugar?

Vigorous exercise raises levels short term for a lot of people. Your body recognises you need fuel and dumps stored glucose from the liver to “help”. Sometimes it’s really not needed. Typically later in the day the levels are reduced as muscles continue burning that glucose even after the exercise stops. Longer term more muscle, more exercise actually reduces levels.
 
HSSS said:
16 yrs type 2 and yet only 48hrs old? How quickly dI’d they decide to put you on insulin? I’m curious if you are a misdiagnosed type 1? Especially if you were a normal‘ish weight and active. Type 2 happens in these circumstances but sometimes those cases are a dr being ignorant that an adult can become type 1 not just kids. Did they investigate with antibody and cpeptide testing? Diagnosis aside thats also a lot of medications. In most cases if you move onto insulin it replaces most of the others. Have you had a specialist review your case or just the gp? If not I’d ask for one.

Is 12 a typical reading? If so what is your diet like? Have you reduced carbs at all? Or just cut actual sugar?

Vigorous exercise raises levels short term for a lot of people. Your body recognises you need fuel and dumps stored glucose from the liver to “help”. Sometimes it’s really not needed. Typically later in the day the levels are reduced as muscles continue burning that glucose even after the exercise stops. Longer term more muscle, more exercise actually reduces levels.
Click to expand...
I was first put on insulin about 8 years ago and they have tried different types of insulin.
I used to be a broad stocky 80kg sportsman, played hockey since I was 14 and taught sailing/kayaking for about 8 years.
Broke my collarbone playing hockey, took nearly 2 years to get back into sport and during that time, I put on about 10/15 kgs and got diagnosed as T2 in Dec 2008. I'm now struggling to keep the weight off as I'm getting older and all the different meds. I can go from 108kgs down to 95kgs pretty quickly and it doesn't always stay off. I'm a stable 98kgs to 95kgs at the moment trying to lose more weight. I can lose and put on a few kgs weekly!

I generally only eat 2 times a day and sometimes won't eat all day until 8pm dinner by which time I'm starving and probably eat too much (they think the Trulicity is causing loss of appetite and affecting my eating routines).
I've been keeping my levels pretty good in the last month but a similar thing happened after last weeks hockey game and I ended up having a hypo down to 3 on the Saturday night and another hypo on the Sunday and Monday nights (All hypos happened when my glucose levels were over 7 before dinner and dropped to hypo while I was eating).
When I reduce my carbs I go low and if I eat carbs (even small amounts), my glucose goes high.
I've been under my GP before covid but since beginning of covid I'm now under diabetic clinic in my local hospital which has been brilliant. I've learnt more in the last few years about managing diabetes compared to 13 years under the gp.
I've been telling the doctors for years that I feel like I've been having liver dumps.
I was tested for LADA a couple of years ago and they said I was type 2.
 
Steve Hare said:
Is it normal to find any trace of ketones in your blood or not? I've been playing sport, and levels keep going high even though I'm not eating anything. I've only found 0.5 level of ketones from my meter reading which I know is nothing to worry about, but I've never had/found ketones before and don't really know much about it
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You are in a state of nutritional ketosis which is normal. Nutritional ketosis is defined as blood ketone levels of 0.5 – 3 mmol/L, which also represents the optimal ketone range for weight loss. I eat a low carbohydrate diet and follow intermittent fasting so and can see my ketone levels as high as 4 mmol/L.
When are ketones an issue? If you are ill, dehydrated and have blood sugars above 13 mmol/L for an extended period of time then you should follow sick day rules.
(mod edit to delete T1 DAFNE dosing advice)
 
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Steve Hare said:
I was first put on insulin about 8 years ago and they have tried different types of insulin.
I used to be a broad stocky 80kg sportsman, played hockey since I was 14 and taught sailing/kayaking for about 8 years.
Broke my collarbone playing hockey, took nearly 2 years to get back into sport and during that time, I put on about 10/15 kgs and got diagnosed as T2 in Dec 2008. I'm now struggling to keep the weight off as I'm getting older and all the different meds. I can go from 108kgs down to 95kgs pretty quickly and it doesn't always stay off. I'm a stable 98kgs to 95kgs at the moment trying to lose more weight. I can lose and put on a few kgs weekly!

I generally only eat 2 times a day and sometimes won't eat all day until 8pm dinner by which time I'm starving and probably eat too much (they think the Trulicity is causing loss of appetite and affecting my eating routines).
I've been keeping my levels pretty good in the last month but a similar thing happened after last weeks hockey game and I ended up having a hypo down to 3 on the Saturday night and another hypo on the Sunday and Monday nights (All hypos happened when my glucose levels were over 7 before dinner and dropped to hypo while I was eating).
When I reduce my carbs I go low and if I eat carbs (even small amounts), my glucose goes high.
I've been under my GP before covid but since beginning of covid I'm now under diabetic clinic in my local hospital which has been brilliant. I've learnt more in the last few years about managing diabetes compared to 13 years under the gp.
I've been telling the doctors for years that I feel like I've been having liver dumps.
I was tested for LADA a couple of years ago and they said I was type 2.
Click to expand...
I’m not an insulin user but if you dose, then eat and then hypo doesn’t that mean there’s an issue with the amount or timing of the insulin? Is it fixed doses or do you basal/bolus and self adjust?

I’m still curious how they ruled out LADA? You really don’t fit the type 2 pattern.
 
HSSS said:
I’m not an insulin user but if you dose, then eat and then hypo doesn’t that mean there’s an issue with the amount or timing of the insulin? Is it fixed doses or do you basal/bolus and self adjust?

I’m still curious how they ruled out LADA? You really don’t fit the type 2 pattern.
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Now days they use a c-peptide test. If your body is producing large amounts of insulin and it is not effective then it is type 2. With high levels insulin resistance some type 2 diabetics need insulin.

You may have seen in the news articles the Exeter University Medical team: Simple, cheap C-Peptide helps patients get the right diabetes diagnosis and treatment.

Featured news - Simple, cheap C-Peptide helps patients get the right diabetes diagnosis and treatment - University of Exeter

news-archive.exeter.ac.uk news-archive.exeter.ac.uk

This is the c-peptide criteria they were using: https://www.exeterlaboratory.com/test/c-peptide-plasma/
 
ert said:
Now days they use a c-peptide test. If your body is producing large amounts of insulin and it is not effective then it is type 2. With high levels insulin resistance some type 2 diabetics need insulin.

You may have seen in the news articles the Exeter University Medical team: Simple, cheap C-Peptide helps patients get the right diabetes diagnosis and treatment.

Featured news - Simple, cheap C-Peptide helps patients get the right diabetes diagnosis and treatment - University of Exeter

news-archive.exeter.ac.uk news-archive.exeter.ac.uk

This is the c-peptide criteria they were using: https://www.exeterlaboratory.com/test/c-peptide-plasma/
Click to expand...
I know what they should do. I was asking what they did do. Not always the same thing.

Also whilst c peptide is very clear in some cases in others it’s a bit ambiguous and the whole picture needs to be considered.

Antibody testing is also usually done. Although sometimes they only test for one type (GAD) rather than all of them. Unfortunately even this is not always positive even in true type 1. Although a positive result is a very strong indication as one a few rare situations would give a positive when it isn’t type 1 and the clinical picture should rule those in or out in almost all cases.
 
HSSS said:
I know what they should do. I was asking what they did do. Not always the same thing.

Also whilst c peptide is very clear in some cases in others it’s a bit ambiguous and the whole picture needs to be considered.

Antibody testing is also usually done. Although sometimes they only test for one type (GAD) rather than all of them. Unfortunately even this is not always positive even in true type 1. Although a positive result is a very strong indication as one a few rare situations would give a positive when it isn’t type 1 and the clinical picture should rule those in or out in almost all cases.
Click to expand...
The c-peptide may need to be monitored over time if the patient is in their honeymoon period. But if you look at the Exeter notes by 3-5 years, they are still producing insulin, they are not classifying the condition as type 1. Some diabetic patients are have the same treatment as a type 1 patient and may be registered as such for practical purposes. This does not mean if Exeter University team were ask to classify patients like they did in Scotland, they would agree with this classification.

They seem quite confident that Steve is type 2, which suggests it is clear cut.
 
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ert said:
The c-peptide may need to be monitored over time if the patient is in their honeymoon period. But if you look at the Exeter notes by 3-5 years, they are still producing insulin, they are not classifying the condition as type 1. Some diabetic patients are have the same treatment as a type 1 patient and may be registered as such for practical purposes. This does not mean if Exeter University team were ask to classify patients like they did in Scotland, they would agree with this classification.

They seem quite confident that Steve is type 2, which suggests it is clear cut.
Click to expand...
Err we don’t know what investigations or results Steve had so I’m not sure how you can be so confident. You may be right but we in here simply don’t know.

Have you not read some of the ludicrous or doubtful assumptions about type or testing some type 1 have had in their journeys? Again what should happen isn’t always what does happen.
 
ert said:
When are ketones an issue? If you are ill, dehydrated and have blood sugars above 13 mmol/L for an extended period of time then you should follow sick day rules. (mod edit to delete T1 DAFNE dosing advice)
Click to expand...
Genuine question, as I haven't done the DAFNE course. Do DAFNE sick day rules apply to insulin dependent T2s?
 
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