During 20+ years of MDI, I had several readings 400+. Probably over 500 at some point. I felt sluggish, thirsty and had to use the bathroom, but besides that, not so bad.
After I started pumping, I got a bad clog while I was sleeping. I felt terrible when I woke up with a bad headache, nausea, and constant vomiting. My BG was only ~230 (high ketones), though.
When I play sports, I disconnect for about 2 hour and reconnect when I'm done. It usually works really well. A couple times, I played really hard or over 2 hours, and started feeling headache and nausea. When I test after, I am 200-250.
I have been eating LC and maintaining relatively tight control. Usually ~100mg/dl. Does this somehow make me more susceptible to DKA?
It's the pump that makes you more susceptible to getting ketones. Since it only uses rapid insulin, if you disconnect the pump or delivery gets interrupted some other way, then you have zero insulin in your system after only a few hours. That wasn't a problem when you were taking long-acting insulin.
I agree that a high with ketones feels MUCH worse than a high without ketones. I never really had ketones (unless I was sick and already feeling bad) until I got the pump. Now, if I disconnect for more than about an hour (or shorter, if I'm exercising) I get ketones pretty quickly even if my BG isn't that high.
I did try a low-carb diet for a few months a while back, where I was spilling ketones all the time (normal with a low carb diet), and I will say what made me stop that was when I got a bad set during the diet. Blood sugars weren't all that horrible, but I spilled more ketones than I've ever spilled in my life and felt horrible. I understand that on a low carb diet the ketones don't hurt you, BUT in combination with a lack of insulin I don't know if it makes the problem worse or not. I will probably try it again in the future (maybe not quite as low carb, I was eating about 50g a day and am more comfortable with about 100g per day).
When you sleep you burn fat. And this alone will generate ketones, they may not register more than trace in urine tests but you will see them in blood ketone tests. And the same thing happens in sports, when you burn fat you generate ketones and if you test right after exercise you will see ketones both in your urine and in your blood. These effects may be exaggerated with a low carb diet and having your circulating insulin drop to zero.
This makes sense. I think the ketones mess me up a lot more than the high. Although, highs do bother me a lot more, now, as well. I eat ~30-50/day, and am doing pretty well with it. I had a hard workout, last night for 2 hours, again. I stopped in the middle and took 2u Apidra. It worked really well. I was 100 before and after.
I recently read an account of woman eating LC that claims to have been hospitalized due to DKA, while low. I was curious if this was possible. She didn't provide a very detailed account of the incident, though.
I have completely fallen off the wagon lately (super busy with work/school, diabetes has totally taken a back seat), so I'm not eating low carb or exercising. But when I was eating low carb and exercising, I found I had to stop and take insulin in the middle of my workout, even if my pump wasn't disconnected, in order to not spike super high and get ketones after finishing.
I was on another forum years ago where someone mentioned going into DKA while low on a low carb diet. In those cases I don't think it's the diet, it's probably something to do with interrupted insulin delivery.
As long as my BG is where it's supposed to be, I don't pay any attention to ketones at all. It's normal to have them, for the reasons discussed above as well as others. But now you've prodded my curiosity -- I'm going to test after the next exercise session just to see.
