IF I AM RUNNING "NORMAL" ALL DAY, AND THEN I POP A 300+ i do a correction asap, will ketones show up, or does it tk an accumulation of highs before i see any difference?
Ketones show up when there is a shortage of insulin...
Diabetic ketoacidosis (DKA) is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances. DKA results from a shortage of insulin; in response the body switches to burning fatty acids and producing acidic ketone bodies that cause most of the symptoms and complications.
Note they can also show up if you skip meals and do not consume enough calories but this is not considered (DKA)
Daisy Mae,Test Yourself when high ,and find out for YOU. It varies for individals and for the situation.
This morning I discovered that I had an infusion set error and was around 300 for over 7 hours while i was asleep( Lesson learned, again: never change the set from a high and correct; Never decline from checking again to see if both the correction and the set are working!!)
After finding that dreaded high, I corrected upon arisal this a.m., and changed the set,again. Then I tested for ketones and I had moderates. Right now ; BS is 121, 5 hours after corrections, trace ketones. However, I can have one BS spike, usually from an under bolus, to maybe 240, and no ketones at all. Just depends on the situation..
I do not test for ketones every time I am high, as I usually not "spill" them unless I have been high for hours and hours. Such high ketones show that that our blood sugar was high enough to start the ketosis acidic process with the kidneys to your urine, about 3-4 hours before. So, Presence of ketones in urine are not really a reliable value of the current glucose level. If your blood sugar is in a fairly normal range, you may still "spill" ketones. They are then reflective of a high blood sugar hours befor; OR due to slight/mild ketosis from a low-carb, low cal diet.
I was never taught this of course, I was diagnosed in 1968 and maybe that knowedge was known, but it was not conveyed to the patients. We were led to think, in the pre-glucometer days, that our goal was to not "spill sugar". That was about all we had to judge "sugar levels" then. Learned about ketones more from on-line sources, and use of my CGM( when it was reliable).
Hope I explained this accurately. You have to see what it happens for you, Daisy Mae. It may not follow a set pattern for you, but you will get the idea of when to test for ketones. I have been in DKA maybe 3-4 times in 44 years, type 1: Once at diagnosis; once when I had undiagnosed pnuemonia, and two times I had mechanical and human infusion set errors; and treated the DKA at home with telephone advice from my endo.
brunetta, you are my knight in shining armor. thx so much for the in depth process regarding DKA. it helped clarify a few things, and now i will be on the look out and try and be more vigilent.
Thx, Daisy Mae
I usually don't test for ketones unless I'm running high for a good few hours. It's great to be able to ask questions here and have people answer them.
Generally, according to my son's endocrinologist, you have to be without any insulin in your system for 2 hours before you start showing ketones. And that means, if you're using short-acting insulin (Humalog or Novolog), it has to be at least 6 hours since your last successful bolus, because both of those insulins have an activity range of about 4 hours at least. YDMV, we all know that, but that's the general rule of thumb I work off of. So you're pretty much not in danger of running any ketones if you correct right away, assuming you keep pretty regular tabs on your BG (caveat, like Brunetta I tend to watch & make sure a correction is working before I let my little one go do whatever he was doing, especially if it's sleep time). And, if it's any comfort, my doc says it takes 24-48 hours of high BG + ketones to really screw with your electrolyte balance and put you in the hospital. Which is not to say you shouldn't take it seriously, because of course you should, but it is a way of letting you know that there's no need to panic, even if there IS a need to act right away.
Elizabeth, if i am on the pump, is it possible "to be without insulin" for 2 hours? are you refering to a bolus? does my basal rate count?
No, I mean, if there's no insulin in your system AT ALL, basal OR bolus. If the pump is working okay, then no, it is not possible to be without insulin for 2 hours because your basal insulin is always present, so even if you shoot high because you didn't give yourself a big enough meal bolus, or you have a cold that ups your BG, or whatever, you will have no worries with regard to ketones. But if the pump stops delivering insulin for whatever reason (you have a crimped cannula, or there's a big air bubble, or the cannula pulls out without you realizing), then yes, it is possible to go without for that long (esp. if it happens at night). Been there, done that, on all counts.
I should correct myself here and say that sometimes you can develop ketones in the presence of insulin, but that usually happens if you a) don't have enough insulin coming in to stop your body from thinking it's starving (you'd also have high BG there too) or b) you're on a restricted diet and/or exercising a lot, in which case you wouldn't have high BG and the ketones would not get high enough to make you go acidotic. Ketones aren't necessarily bad — they're a normal byproduct of burning fat, and if you're in a situation where burning fat is necessary (like, when you're exercising to lose weight) then that's fine. It's when you have excessive ketones in the absence of insulin — that is, high ketones + high blood sugar — that it becomes a problem, because it makes your system acidic. And we're supposed to be slightly alkaline.