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Ketones

Okulu

Well-Known Member
Messages
78
Type of diabetes
Type 1
Just after some really quick advice. I have 1.0 ketones (tested on blood meter) but blood glucose is 8.1 and has been 'perfect' all day. I've corrected (using pump suggestions), am drinking lots, and am just about to eat 40g of carbs (for which I have also injected with a 1u:8g ratio) but what else should I do? Extra insulin? Panic!?

Thanks in advance...
 
What do you normally eat? Ketones at 1mmol/l isn't usually anything to worry about as it signifies either burning fat or that you were high earlier in the day. As long as BG remains okay there's nothing else to do.
 
OK, that's good to know, thanks. In 18 years, I've never been ketotic before and so is a bit of a shock!
Not been high today at all, but thinking about it, I've only eaten 68g of carbs today and I've cycled 8 miles (although I usually only eat 100-130g carbs a day anyway)...would that have caused it, do you think?
 
Contrary to popular belief, DKA doesn't occur until much higher levels of ketones. We need to distinguish Ketosis with diabetic ketoacidosis (DKA). Ketosis is a highly natural state to be in, shown in our history as hunter-gatherers. optimal-ketosis-range-2.jpg
 
Tim's answer about a level of 1 is fine. I suspect it may be exercise induced but to be on the safe side you do need to make sure. (you could be going down with a bug )
Keep a check on both glucose and ketones to make sure that the ketones go away and certainly aren't rising (obviously take appropriate insulin )


Being worried at much lower levels than those suggested on the graph above hasn't much to do with popular belief quite the opposite. (where did the graph come from?)
People with T1 do not have the feedback loop that people with insulin have and therefore ketones can increase very rapidly
This is from the 2014 guidelines for DKA from the International Society for Pediatric and Adolescent Diabetes
Definition of diabetic ketoacidosis (DKA)
The biochemical criteria for the diagnosis of DKA
are (17):
• Hyperglycemia [BG>11 mmol/L (≈200 mg/dL)]
• Venous pH<7.3 or bicarbonate<15 mmol/L
• Ketonemia* and ketonuria
*Although not universally available, blood β-hydroxybutyrate (BOHB) concentration should be
measured whenever possible; a level≥3 mmol/L is indicative of DKA (18).

Urine ketones are typically≥2+(‘moderate or large’) positive. Partially treated children and children who have consumed little or no carbohydrate may rarely have only modestly elevated BG concentrations, referred to as ‘euglycemic ketoacidosis’ (19, 20).


If you also check the research on this done with adults you will find similar reported levels. http://www.ncbi.nlm.nih.gov/pubmed/15660743 (several other similar studies in sidebar)



 
The diagram is from Phinney and Volek, @phoenix. They have done a great deal of work on managing ketones - though yes, of course, one has to be alert and careful with ketones. IN the presence of high blood sugar, that is.
 
Tim's answer about a level of 1 is fine. I suspect it may be exercise induced but to be on the safe side you do need to make sure. (you could be going down with a bug )
Keep a check on both glucose and ketones to make sure that the ketones go away and certainly aren't rising (obviously take appropriate insulin )


Being worried at much lower levels than those suggested on the graph above hasn't much to do with popular belief quite the opposite. (where did the graph come from?)
People with T1 do not have the feedback loop that people with insulin have and therefore ketones can increase very rapidly
This is from the 2014 guidelines for DKA from the International Society for Pediatric and Adolescent Diabetes
Definition of diabetic ketoacidosis (DKA)
The biochemical criteria for the diagnosis of DKA
are (17):
• Hyperglycemia [BG>11 mmol/L (≈200 mg/dL)]
• Venous pH<7.3 or bicarbonate<15 mmol/L
• Ketonemia* and ketonuria
*Although not universally available, blood β-hydroxybutyrate (BOHB) concentration should be
measured whenever possible; a level≥3 mmol/L is indicative of DKA (18).

Urine ketones are typically≥2+(‘moderate or large’) positive. Partially treated children and children who have consumed little or no carbohydrate may rarely have only modestly elevated BG concentrations, referred to as ‘euglycemic ketoacidosis’ (19, 20).


If you also check the research on this done with adults you will find similar reported levels. http://www.ncbi.nlm.nih.gov/pubmed/15660743 (several other similar studies in sidebar)

Thanks for such a detailed reply (sorry, only just seen it!). I was fine after eating some carbs. But I'm going to keep an eye on it this week to see what happens after exercise (I cycle 6 miles everyday), as I often feel slightly ketotic after my cycle, although I've never checked before...

Just out of interest though, I was wondering what you meant exactly when you said "People with T1 do not have the feedback loop that people with insulin have and therefore ketones can increase very rapidly" - what feedback loop are you referring to? And are you talking in relation to hyperglycaemia only, or in terms of starvation ketosis?

Thanks in advance!
 
It's insulin that stops the production of ketones. If you don't have sufficient then they will rise. We need more insulin in times of stress (though whatever reason) and even if we've injected a normal amount, it may not have enough to stop the increase . The resulting increase can be very fast, particularly in children and adolescents . When pumps were first introduced there was an increase in DKA . If there was a pump problem DKA could develop in some cases within a few hours . Nowadays education and testing regimes are much better and the number of events has decreased because people are (or should be) trained on what to do.
 
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