Are we over-confident about avoiding DKA?

Your levels are a far cry from 15-25 seen in DKA. Two different animals IMO. Diet induced ketosis is generally quite benign whereas DKA can kill quickly if left untreated.

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Except in deer. I read today that feeding corn to the deer in the yard during the winter can give them acidosis and kill them. Oh no! I like my pet deer and I want to feed them something delicious. Apparently, I have to feed them guinea pig pellets. Terry4 is on the guinea pig pellet diet, lol. :stuck_out_tongue:

I went into DKA about 4 times between the ages of 17 to 20. I was running high blood sugars for a lot longer than that, but I seemed to deteriorate into a state where I needed to be hospitalized when my stress levels were high. Stress has always adversely affected my blood sugars, but I think it also speeds up the production of ketones. During that same period, I also developed pancreatitis twice and had to be hospitalized for that too. I think stress contributed to that as well.

I throw up a lot. I always have, and the cause is mostly unknown. When I throw up, I do end up with mild ketones because of combination dehydration and stress, but if I went to the hospital every time I was throwing up all night, I would spend half my life in er waiting rooms. My main prevention techniques are drinking lots of water (even when itā€™s just coming back up), and trying to keep stress levels low through a combination of apathy and venting. So, despite having ketones more than I would like, I havenā€™t had to go to the hospital for over a decade for DKA. touch wood

I like the reminder that it is important not to be complacent and to be prepared.

I am also a lazy diabetic. Sometimes I even go out without my meter (never if I am going to be driving though), simply because my blood sugars are typically so well behaved and predictable these days; I donā€™t get terribly high, and i can feel lows. This reminds me that this is not something to take lightly.

I always had to check for ketones as a kid whenever bgā€™s were high but didnā€™t ever have any. I seem to be one of the lucky ones because I havenā€™t gone into dka since diagnosis even though by all rights I probably should have.

At diagnosis though I was in DKA, hypovolemic shock, and a coma for several days. DKA is nothing to mess around with and if my bgā€™s were high and there was any reason for me to be dehydrated I would be on high alert.

DKA is however more likely to occur at lower bgā€™s when on an insulin pump and you are somehow not getting your insulin for more than a few hours (whether from occlusion, ripped out site or pump malfunction).

A number of forum members have indicated they head to ER if their ketones are over 1.5-3.0 mg/dl.

Iā€™ve been running numbers in that range and quite a bit higher (as high as 6.7) intentionally for the past 7 months. If I wake up with ketones :arrow_backward: 1.0 mg/dl I immediately change diet plan (Fat/Protein mix) for the next 2-3 days in order to raise my ketones.

Iā€™m midway thru a 72hr fast right now, my ketones yesterday when I started were only 0.7, this morning theyā€™re 1.5 (level of ketones doubled after only 36 hrs of fasting). Tomorrow morning Iā€™d expect ketones between 3.0-3.5. These levels are way below DKA thresholds, which are well in excess of 10.0.

Worrying about ketones when theyā€™re under 6 or 7 is a waste of time (and resources) UNLESS youā€™re sick / vomiting and severely dehydrated.

Anyone who eats dinner (supper) around 6pm and then sleeps most of the night is technically ā€œfastingā€. By the time you get up 12 hours later (6AM), youā€™ve already fasted for a half a day and your blood ketones are likely 0.1-0.4 mg/dl. Everyone is the same, your body begins the process of ketosis as you fast thru the night as it used the carbs / glucose / glycogen stores in the 4-8 hours immediately after eating.

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I agree. This June 2018 diaTribe column looks at ketone levels and DKA.

It was good to see them acknowledge that experts have not reached a consensus as to the specific threshold to raise the DKA alarm. Organizations that try to write standards about this kind of health issue can struggle with communicating a clear message when other qualifiers need to be assessed.

In this case, the context of any ketone level reading is important. If dehydration and nausea are absent, then ketone levels below 10.0 mmol/L are likely benign. If dehydration and nausea are present, then a lower threshold, like 3.0 mmol/L makes more sense.

Complicating this issue is the case of the SGLT2 inhibitor drugs that act to cause the kidneys to clear glucose at lower than normal levels. This class of drugs has witnessed something called euglycemic DKA or DKA with completely normal levels of blood glucose.

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I agree. But I also think that adults probably get very different education than kids, and a lot of people on this site were diagnosed as adults. And I can also see how if someone hasnā€™t checked ketones in 50 years and it hasnā€™t been a problem, they have little reason to start.

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I pray that new diabetics reading this thread arenā€™t scared to death now, regarding the likelihood that they are going to go into DKA at the slightest issue with their pump or other circumstance. Itā€™s a problem that can crop up for some, but not others, so letā€™s not predict that everyone is standing under a ā€œfalling skyā€.

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I think probably they mean in the context of high blood sugar. Or some other factor, such as having a stomach bug or taking an SGLT2 inhibitor.

My personal experience on a low-carb diet was that I rarely had ketones over 1.0, but maybe my diet wasnā€™t as low-carb as some on this site.

Conversely, Iā€™ve had ketones of 1.5-2.5 with blood sugar levels of 16-22 and feel awful and sick to my stomach when Iā€™ve had insulin delivery cut off for a couple hours. Never gone to the hospital, but if those situations had not resolved themselves, I probably would have eventually gone in.

I remember those feelings of nausea from high bgā€™s back in my ā€œbad ole daysā€ pre-pumping, pre carb-counting, pre Humalog! Oh, and pre-meter, also. And pre-Sure-Tā€™s, Iā€™d get high from occluded cannula sets on a too-regular basis.

My original post is written for long-term T1Ds like me. It is not aimed at newly diagnosed T1Ds.

I think in our community, me included, there exists a misplaced comfort taken from the fact that one has never experienced DKA, therefore they need not be concerned.

Wil Duboisā€™s tale serves a pragmatic purpose. Just because weā€™ve never had DKA does not mean it canā€™t happen to us.

I think the Chicken Little reference is not appropriate here. My original post and most of the comments have been calibrated to avoid hyperbole.

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What your intentions are and who reads this thread are two different things. I think we owe it to readers not to blow things out of proportion. You canā€™t predict or prevent who will read the thread. Can we at least agree on that? :slight_smile:

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I agree. What has been blown out of proportion in this thread?

Iā€™d start with the title. :slight_smile: The Dexcom outsourcing news has got me bummed so Iā€™m going to concentrate on that for a while.

Itā€™s not from high BGs, though. Itā€™s from high ketones/lack of insulin. I donā€™t generally feel bad from a high BG alone. But a high BG with high ketones and little to no insulin in my system feels awful.

Oh but I do. Iā€™m not used to going up to say, 275 or 300 even for an hour. I donā€™t like even being over 150. Iā€™m not anywhere near DKA when I might peak up for a bit after a meal to above-250ā€™s, but itā€™s because I am so used to lower bgā€™s. Many years ago it was the norm for me to go over 250. way over. and I wouldnā€™t feel all that bad when it was more ā€œthe normā€.
Oh, let me add one thing. back in my less controlled days decades ago, I did check for ketones now and again. then I stopped, because even when higher than I was comfortable with, Iā€™d not have ketones. SO I saw no point testing for them.

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@Jen - My own guide is to never allow my BS to rise to levels 300 - 400 mg/dl (16.7 - 22.2 mmol/L). Those BSā€™s alone would make me feel ill

@Terry4 I agree with the June 2018 diaTribe column on Ketones but they didnā€™t go far enough. Most attending physicians and Endos only spent 10 minutes of lecture time covering DKA, hence to treat them like the keepers of knowledge on the subject is rather silly.

In addition, anyone (including non-diabetics) can go into life-threatening ketoacidosis (same thing exactly as DKA except these individuals arenā€™t diabetic). Contributing factors include alcoholism, starvation and thyroid disorders. The individuals can have normal blood glucose levels, but the 2 things central to their condition is electrolyte depletion as a result of dehydration (when you starve you become dehydrated)

Iā€™m always impressed by people who say they never go high. Of course I aim to never go high, but Iā€™ve yet to do it. It doesnā€™t take much of a mistake or pump issue for me to hit the high teens or 20s.

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Trust me Jen, I know precisely what itā€™s like to go high and a lot higher than 400. Donā€™t forget I lived pre-meter days for nearly 20 years, and there have been times in my life where I was forced to ration insulin.

Iā€™m happy that I finally, after all these years, discovered a lifestyle that keeps me in range virtually all the time. Itā€™s a lot easier living this lifestyle as opposed to injecting industrial quantities of insulin followed by huge amounts of carbs to try to slow the falling BS rollercoaster.