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Testing for Ketones

Tony 1711

Well-Known Member
Messages
505
Location
Cornwall
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Hi all, I am a T2 and normally diet controlled, however after my last hba1c results had gone back up tp 70 my gp has recommended a SGLT2 Dapagliflozin. With this I need to monitor my Ketone levels to prevent ketone acidosis. My problem is it was not explained when to test, is it the same as bg ie first thing in the morning, then before meals and 2hrs after ? I have read 3 hrs after a meal but that was on a keto diet website and not nhs.
Is there anyone else on SGLT2 and testing for ketones that can shed some light.
 
I’m actually impressed they told you to test ketones and given you the means to do so. I assume they know your diet choices. Sglt2 are usually not recommended with keto or properly low carb diets due to euglycemic DKA risks being increased so they are obviously aware of this

Have levels gone up due to not controlling it with diet (ie eating foods you know are causing the issue) or is it unexplained? How long are you diagnosed?
 
Diagnosed for about 4 years now, and at the start I managed very well on diet and exercise, however over the last year I have let it slip, I have gone back to watching my carb intake but my gp has still recommended the SGLT2, and because he knows I am back on the low carb he has given me the keto meter to keep an eye on my levels but as per my post he did not explain when to test except if I was starting to feel ill.
 
So I'm db2 and I have to take sglt2 tablet and 4 metformin but have been told not to bother checking my own bg and no one has ever mentioned ketones, should I be concerned
 
I suggest you get some ketone concentration measurements when you feel OK as on a low carb diet you may find ketone levels are higher anyway. You probably want some measurement in a fasted state (like in the morning) and after you have eaten low carb especially if it has a lot of butter which will be readily converted.

Have you been given threshold trigger levels which take into account low carb ?
 
Yes, gp has given me the ketone threshold limits and told me not to let my bg fall below 5.
I think I will take a set of ketone readings similar to the glucose readings ie morning and before meals then 3 hrs after meals just to get a baseline before I start the Dapagliflozen.
 
HEP said:
So I'm db2 and I have to take sglt2 tablet and 4 metformin but have been told not to bother checking my own bg and no one has ever mentioned ketones, should I be concerned
Click to expand...
Taking SGLT2 you do not need to monitor your bg, but if your gp has put you in the at risk group your gp would give you a ketone monitor. SGLT2 makes the excess glucose come out in your urine.
 
Tony 1711 said:
Taking SGLT2 you do not need to monitor your bg, but if your gp has put you in the at risk group your gp would give you a ketone monitor. SGLT2 makes the excess glucose come out in your urine.
Click to expand...
You may not “need” to according to the dr but it’s the single most useful thing you can do for yourself (and you’ll have to pay for it because the nhs rarely does in this situation). Testing before and 2 hrs after a meal teaches you what your body can cope with and what is too carby. Ideally you want the second reading 2mmol or less than the first. If it’s higher change the meal next time to have fewer carbs.

The risk of DKA without glucose levels being high is small indeed usually but on that class of medication (the ’flozins) it does raise it, a small amount but not completely insignificant either.
 
What limits has he provided ?
 
Less than 0.6 Normal
0.6 - 1.5 Risk of DKA
1.6 - 2.9 High risk of DKA
3 or higher very high risk of DKA, urgent medical attention required wirh admission to A & E
 
Tony 1711 said:
Less than 0.6 Normal
0.6 - 1.5 Risk of DKA
1.6 - 2.9 High risk of DKA
3 or higher very high risk of DKA, urgent medical attention required wirh admission to A & E
Click to expand...
Those look like the T1 recommendations.
A T2 on keto and not on SGLT2 inhibitors can run ketones at 5 or higher without worries.
There is a graphic but I can't find it at the moment.
I am interested because I may be going onto SGLT2 inhibitors soon.

Do you test your blood for ketones?
Urine strips are much cheaper but less accurate.
 
Maybe my gp is erring on the side of caution, I had another look and the sheet does not state what diet, just gives the levels, I will do some more research.
I have been given a meter to test my blood for ketones, just waiting for the test strips, they should be in the pharmacy today so hopefully will do a full set of readings tomorrow then start the SGLT2 on monday
 
Definitely the type 1 on a normal diet levels. So more cautious as things can get worse rapidl.
A type 2 on a keto diet will typically run between 1 and 3 ish.

I guess it depends how low carb you’re eating if the two sets of guidance are going to clash. In your shoes personally I’d be ok with 1 or 2 ish I think but be very alert to them rising more. Again some testing before you start the medication will show you what is normal for you so you can react to any levels above that, especially if in any way sick, after unusual exertion or following any additional drops in carbs.
 

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Just had a look on the nhs website and they give the same limits for T1 and T2 the only thing they say is for T2's is that your diabetic care team may give slightly higher limits
 
Well that was a complete waste of time, just been to the pharmacy to pick up the SGLT2, lancets and ketone test strips. The test strips are out of stock with the manufacturer, unable to contact my surgery till boxing day to see if they have a different manufacturers meter.
If you are offered a
GLUCOFIX moniotor which also tests for ketones, ask for a different one.
 
As a T1 who produces no insulin I get one box of ten strips per prescription (sometimes this works out as 1 per 3 months other times 1 per month) prescribed by my GP. The strips are expensive to buy, (minimum 1 UK pound per strip) and tend to have a relatively short expiry date. (If you're buying them "cheap" online I'd recommend you check the expiry date.) Maybe ask the chemist which strips/meters their T1s use before going back to your GP?

I use a caresens dual in New Zealand, which does both glucose and ketones, but you'll have more options in the UK. I personally test when I'm feeling ill (eg covid or a stomach bug ) or my blood sugar is persistently high (teens). The issue with flozins is that you can't rely on high bgs to warn you, so I personally would use "feeling ill" as a big red flag.
Here's the NHS link on DKA, which is well worth reading.

Diabetic ketoacidosis

Find out about diabetic ketoacidosis (DKA), including what the symptoms are, when to get medical help and how to prevent it.
www.nhs.uk

When you get a new script from the GP I'd push them to say how often and when you should test, as that should also influence how many strips they prescribe, and you really don't want to buy them yourself.
 
Hi EllieM,
thanks for the heads up, I have read that nhs article. To be honest I did not realise how few strips there were in the little pot, I have just checked the meter that was given to me by the gp and there are only 10 bg strips and 0 ketone strips. The primary reason for my post was to try and find information on how often to test, none of the nhs info I have read gives a testing regime like when testing for bg, it only states to test if feeling ill ????
When I can get in touch with my gp I will ask these questions but till then I think I will hold off on the medication
 
To be honest, when I'm ill I probably test once or twice a day and then after a couple of hours if my levels are actually high (1 or over). But that is just what I do, no one has given me formal advice. But though I low carb I'm not normally in ketosis so my levels are rarely above 0.6 . And I've never in 53 years of T1 had a DKA and only had blood ketone strips in the last 4 years, so I'm probably not the best person to ask.
 
NHS
West Essex Clinical Commissioning Group
KETONE TESTING
Testing for ketones is indicated to differentiate ketoacidosis from simple hyperglycaemia or in monitoring response to treatment of DKA.
Patients in the at-risk group for DKA who become unwell will need to test both capillary glucose and blood ketone levels every two hours, depending on levels, until blood ketones return tO a satisfactory level.
Blood ketone strips are more effective at detecting ketonaemia than urine ketone strips since they provide 'real time' results and test for the main types of ketones. Urine strips should only be used if there is no option of blood ketone testing e.g. type 1 diabetes patient is unable to use a blood ketone machine. There are two urine test strip options available
Just found this, so if I am reading it correctly you only start to test if feeling unwell
 
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