Nutritional ketosis v’s DKA

[Sara77b]

Hi,
Could anyone explain if there’s a difference between the keytones detected in your urine when you’re on a keto diet v’s the keytones when you’re in DKA. Is there a difference? Does the human body, in particular a diabetics body, distinguish between the two?
Thanks

 

[TheSecretCarbAddict]

The ketones are one and the same, but that it is the level of ketones in your blood that differentiates dietary ketosis from DKA.

 

[Sara77b]

The ketones are one and the same, but that it is the level of ketones in your blood that differentiates dietary ketosis from DKA.

The dr dip tested my urine today and as it showed what he said were mid range keytones I had to go to the hospital! He’d just finger pricked me and it was 5.2 (very good for me and it’s so good because ive popped myself onto a keto diet). He’s completely confused me and said I shouldn’t be doing keto as a diabetic. My understanding of ketosis is that if your finger prick is high then worry about your keytones and if your finger prick is low then all is well

 

[ianf0ster]

Your understanding is the same as mine. Though there seem to be some people who disagree.
DKA is usually a potential problem for Type 1's rather than Type 2's, however I note that you are on Insulin like a Type 1 would be.

Fortunately there are quite a few Type 1's who thrive on a keto diet, use keto to have super BG control and don't suffer from either Hypos or DKA.
These include Dr Bernstein in the USA and Dr Ian Lake in the UK.

 

[Sara77b]

Your understanding is the same as mine. Though there seem to be some people who disagree.
DKA is usually a potential problem for Type 1's rather than Type 2's, however I note that you are on Insulin like a Type 1 would be.

Fortunately there are quite a few Type 1's who thrive on a keto diet, use keto to have super BG control and don't suffer from either Hypos or DKA.
These include Dr Bernstein in the USA and Dr Ian Lake in

 

[Sara77b]

Thanks for your reply.
Keto really works for me. Im slim, but inevitably afew extra pounds appear every now and again. Todays gp really confused me and told me to get myself out of ketosis and resume my normal diet. Ive got afew pounds to shed and being on insulin makes that very difficult (especially when I suspect its the insulin causing the weight gain)

 

[JoKalsbeek]

Hi,
Could anyone explain if there’s a difference between the keytones detected in your urine when you’re on a keto diet v’s the keytones when you’re in DKA. Is there a difference? Does the human body, in particular a diabetics body, distinguish between the two?
Thanks

Ketones show up when your body uses fats for fuel, it's a bit of a by-product. When you're in nutritional ketosis, you're just burning fat because carbs aren't available, and you have to run on something. If that's the case, blood sugars are usually in a healthy normal range, and it's perfectly fine.

However, when you are having high blood sugars and ketones present, it means your body is burning fats because it's too high on glucose which you can't use (too little insulin, too much insulin insensitivity, you name it). You're basically burning yourself up, while blood sugars are high. The ketones get stacked and you end up with a toxic amount, and you become severely ill. This is more likely to happen in a T1, but for some T2's it can happen when they're on certain medications or there's some perfect storm or other; not a daily occurrence, but it's not impossible.

So they are the same ketones, the question is just what's causing them, and whether they're there in combination with high blood sugars. If because of a diet that's going perfectly well and keeping numbers down, yay. If it's because your body's high in glucose (due to diabetes, or it running unusually rampant due to an infection, medication or something), then it's problematic and even dangerous.

The thing is, some docs don't know the difference from one ketone-cause to the next.

Mind you, I had a lot of bladder issues over the years (infections, kidneystones etc), so I had my urine checked regularly. For the first 7 years of that, I'd get a panicky call from the assistants, saying there were ketones in my urine. I'd explain I'd be worried if they weren't there. And in my 8th year as a diabetic I've finally had a brand new assistant on the phone, who wasn't freaking out over my imminent death, but just went "There's ketones present, but you're on a special diet, right?". Sooner or later they will get clued in, even at the GP's practice.

Hope that helps!
Jo

 

[searley]

In dka the keystones will continue to increase and get toxic.. in diet they don’t they stay relatively low as the body is still getting energy from the food you do have

 

[Sara77b]

In dka the keystones will continue to increase and get toxic.. in diet they don’t they stay relatively low as the body is still getting energy from the food you do have

Thankyou for your reply.
The gp kept saying ‘its not that linear’ but I translated that into him not knowing and left feeling incredibly confused

 

[lovinglife]

A couple of posts have been moved by mods to a new thread here

3 years T2 recent menopause & stopped HRT - levels shot up

Hi all, I’ve been diabetic for about 3 years now and I don’t have a diabetic nurse. I’m on alogliptin. I’ve started menopause and I recently stopped hrt. Since then my levels have shot up i’m eating more healthy and I’ve lost a little bit of weight. I do struggle with the eating side I’m still...

www.diabetes.co.uk

 

[AndBreathe]

@Sara77b - It would be really helpful if you could confirm which medications you take to help manage your diabetes. I can see you use insulin, but I can't see if you use anything else.

For most folks (including T2s) the presence of ketone, with normal or lower blood glucose is fine. Ketones plus high blood glucose tends to be a red flag. That can symbolise DKA, which nobody wants.

If you happen to take Empagiflozin or one of it's type (mainly ending in flozin), it is possible to develop DKA with normal blood glucose, to care over diet is really important for those folks.

Many GPs are unfamiliar with dietary ketosis and discourage ketosis of any kind. For someone using insulin, it is really important you are confident in adjusting your insulin doses when using a keto diet, and your insulin requirements are likely to reduce as your numbers come down too.

 

[Sara77b]

@Sara77b - It would be really helpful if you could confirm which medications you take to help manage your diabetes. I can see you use insulin, but I can't see if you use anything else.

For most folks (including T2s) the presence of ketone, with normal or lower blood glucose is fine. Ketones plus high blood glucose tends to be a red flag. That can symbolise DKA, which nobody wants.

If you happen to take Empagiflozin or one of it's type (mainly ending in flozin), it is possible to develop DKA with normal blood glucose, to care over diet is really important for those folks.

Many GPs are unfamiliar with dietary ketosis and discourage ketosis of any kind. For someone using insulin, it is really important you are confident in adjusting your insulin doses when using a keto diet, and your insulin requirements are likely to reduce as your numbers come down too.

Until yesterday I’ve been using a long acting insulin and nothing else. I’ve used the array of flozins years ago and understand that they can bring on DKA even with decent glucose levels.
Yesterday I said goodbye to insulin as I refuse to keep slowly gaining weight on my usually very slim frame and not being able to lose it. I’ve been put back on Sitaglyptin to see what happens.

 

[Melgar]

I am not on a keto diet, and I produce ketones In my urine. They range from 0.5 to 1.5. My blood sugars are definitely raised but not high . No glucose in my urine. I do a lot of exercise to keep my blood sugars down. But I was very concerned and went to my Dr . He told me as long as my sugars are not high and I have no glucose in my urine then it’s nothing to worry about. I went home and researched it. In general your body is working at optimum if you are producing low levels of ketones. I have the research on that somewhere. If you are interested I can dig out the research. The worry of course is the amount of ketones which coupled with high blood sugars means your blood is too acidic and life threatening if not treated.

 

[Resurgam]

The dr dip tested my urine today and as it showed what he said were mid range keytones I had to go to the hospital! He’d just finger pricked me and it was 5.2 (very good for me and it’s so good because ive popped myself onto a keto diet). He’s completely confused me and said I shouldn’t be doing keto as a diabetic. My understanding of ketosis is that if your finger prick is high then worry about your keytones and if your finger prick is low then all is well

If it wasn't so sad it would be funny.

I hope that your new regime proves satisfactory.

 

[EllieM]

Quite an interesting article about EDKA here (DKA with normal blood sugars)

Euglycemic Diabetic Ketoacidosis - StatPearls - NCBI Bookshelf