Help... hi ketones

The past month has been crazy... my son's.blood sugars will be in the.normal levels for days... everything is going well.. Then all of a sudden... BAM!!! His bloodsuger is in the high 300's or 400's.. He doesnt feel ill, but has a large.amount of keytones... The school will call me to. Come pick him up & would rather him not go keytones... So my son has missed 3-4 days in several weeks due to.havein high keytones... Ive.called his.nurse each time, i do not understand why each week this happens... im doing everything im supposed hes eating healthy, gets plenty of excercise... im even alternateing his sites.. my son can not keep missing days of school w/o.a.drs. exuse... and we can not go to his endrocronoligist every time.... they are 3 hours away.... has any one dealt w/ this.before? Please.... any input will b greatly appreciated...

Is he on a pump, or getting shots?

Regardless of which kind of therapy he has, if he has ketones, it means he's not getting insulin. I just now PM'd you with some information that may help.

OK, I just saw on your profile that he's on shots. Presumably you have a long-acting insulin like Lantus or Levemir that he takes once a day, plus a short-acting insulin like Novolog or Humalog that he takes for meals — is this the case?

So here's the thing: if he's getting a shot of long-acting insulin every day, he should not be showing ketones. The long-acting insulin ought to be enough to prevent that from starting, and definitely it's enough to prevent high ketones. So you have one of two things happening: (1) either the insulin isn't getting into his system [meaning, he's forgetting the shot OR he's using a site with a lot of scarring] or (2) his metabolism is somehow super-speedy at clearing the long-acting insulin out of his system so that instead of lasting 24 hours, it lasts 17, or 20, or something. I am inclined to think that it's more likely the first problem than the second, because if it were a metabolic issue, his short-acting insulin would still work to prevent the ketones developing.

Do you give him his shots, or does he do it? If he's doing it, you may need to supervise him more closely; kids do forget from time to time, and even when they don't forget, they often don't understand how important it is to be consistent on a day to day basis. Even my seven year old, who has been doing diabetes since before he could talk, complains when I tell him it's not OK for him to go to bed without checking blood sugar. Diabetes gets old REAL fast when you're a kid. Well, when you're an adult, too :)

Make sure he is not sneaking food that is not on his diet, like candy bar.

Hi crys,

What does the nurse say when you call? Who is measuring the ketones and how?? When the 300 or 400 bg is present, is that the only time the ketones are measured??? Does your son like his school, and how old is he????

Sorry for all the questions. I would do some investigating to learn

a) when these BAM!!!! high bg's happen and find out why.
b) how quickly do corrections resolve the bg, and do they resolve the ketones also.
c) what exactly did your sone eat/do/etc.

And I would make an appointment with his doctor. You may be doing everything you are supposed to do but is your son?

Mark, sneaking food might account for the high BGs but it would not cause ketones. If he has ketones, it means one thing: he isn't getting insulin. Not just short acting insulin for food, but long acting insulin. So either there's an issue with him forgetting shots, or there's an issue with the insulin not lasting as long as it should. Those are the only possibilities.

Okay, I will defer to your years of experience.

I think if he is sneaking food and not bolusing for it, that would drive up his blood sugar high enough and if there were no corrections, it would stay high long enough to cause ketones. I guess, that is, in effect, the same as not getting insulin. It is my understanding that any severe and persistent highs can lead to production of ketones.

Yes yes… im certain hes sneeky… lol. But it does make sense that.hes not.gettin enough insulin… the.bCk of his arms are solid… so.ive told him no arm shots for 2 weeks… and his nurse just increased his lantus . I’ll have to do all through night bs checks, hhes gonna hate that… but its got 2 be.done… iand i am.goin back to the school n the a.m. and will go phsyco on these clowns… i measure his.keytones w/ the.lil test stick… i thank all of you so very very much for your help and support…

Thanks for your input, Zoe.

No, that's not how it works. Ketones occur when the body thinks it doesn't have enough energy (glucose) to meet its needs and starts burning fat. The breakdown of the fat produces the glucose needed for the cells to use, but the ketones are the byproduct of that breakdown. If you're an athlete running a marathon, you're producing ketones because you're using more energy than you can get from the food you ate an hour or more before you ran. The difference is, that doesn't make you acidotic because you have the insulin in your system to utilize that glucose and that satisfies the cells' need for energy, so the trigger to burn fat ends once the exercise does.

In a diabetic, though, that signal occurs when the cells can't access the glucose that's already there because there isn't any insulin. Insulin is like the gateway that glucose uses to cross into cells. No insulin means no glucose transport. So even in the midst of tons and tons of glucose to use as energy sources, the cells are starving and they put out the call to start burning fat — which only drives the blood glucose level higher, and produces ketones. Unless you then inject insulin, that call continues unceasingly, because no matter how much fat is burned, the glucose isn't getting into the cells without insulin, and the cells are still starving.

But here is the thing: if there is even as little as 10% of what the body truly needs insulin-wise, then the cells will not tell the body to start burning fat. You have to be pretty much completely without insulin to develop high ketones, and it does not take very much to shut ketogenesis off. So if you sneak food and don't bolus for it, you'll get high blood sugar — BUT, as long as you've taken your long-acting insulin, the basal will prevent you from developing ketones. This is why people can undergo periods of fasting or famine, like when you're too sick to eat when you have the flu, but still not die of ketoacidosis. As long as you have your basal insulin, you won't develop DKA. This is also why people on pumps are more prone to DKA than people using shots — because if the pump fails, that means there's no basal insulin [and it takes only about 2 hours without insulin for the ketones to start], whereas all you need to have 24 hours worth of background insulin is one shot of Lantus or Levemir a day. Yeah, you might have sky-high blood sugar, but you won't get DKA (unless, of course, you don't give yourself ENOUGH Lantus/Levemir to meet the minimum needs, but that's another issue).

So, in a nutshell, whether he's sneaking food or not isn't the problem here. Sneaking food won't cause ketones. Having inadequate insulin is the only thing that will do that.

Rotating sites is key. Scar tissue doesn't absorb insulin well. He may prefer his arms because it doesn't hurt as much, but that's not going to be much help if he winds up in hospital! I hope you get this sorted out, ketoacidosis is not something you want to deal with if you can avoid it.

Oh, oops. Other possibility is that the insulin may have expired. Did you check the use-by date? Has it been open more than a month?

no, one can certainly get ketones from BG's high from wrong bolus, if one doesn't take enough bolus to cover meals and it doesn't come down, and it won't without more insulin, of course one can get ketones. And if one is continually high from not enough bolus, ketones can start. Doesn't matter if it's basal or bolus, if blood sugars are high, stay high and continue to be high, ketones can occur. I've had ketones on MDI, levemir, and it wasn't my levemir.