I found this textbook chapter on ketone testing published by the University of Colorado, Denver. I believe this is the location of the respected Barbara Davis Center for Diabetes.
Here’s one of the tables in the book:
Unless that test is denominated in another number system for measuring ketones, I would be worried about a characterization of “< 5.” This system shows anything over 3.0 mmol/L to be urgent.
This document is only five pages long and seems targeted at an easy to read patient level.
Edited to add: This is a test strip package insert from the Abbott Precision Xtra home blood ketone tester:
How is your husband today. I am quite alarmed and concerned to hear about him staying so high and feeling so bad. You must be so worried. Can you give him your rapid acting insulin to bring him down? Can you further increase the basal dose he’s been given.
I really think the current situation totally warrants you going rogue and just treating him with what you have on hand. This is his and your life at stake. There seems to be some major incompetence going on with the so called ‘medical professionals’ you have been seeing.
He saw the doctor again today and she’s upping his Tresiba to 110. Still refuses to prescribe fast acting.
It seems to me that even silly amounts of basal won’t keep him where he belongs, because any time he eats, it just skyrockets up and stays there.
Once he gets fast acting insulin, I assume that we should be ready to bring his basal down quickly? Right now he’s so high all the time that if his basal brings his numbers down 150 points at night, it’s not a problem but once he’s in a normal range, it will be waaaaaay too much.
Still no luck getting an endo to see him in any reasonable amount of time… I continue looking though and am bugging the CDE at my endo’s practice to see if she has any pull or thoughts on how to work the system.
I never thought I was the type of person to not eat when stressed, but I guess I am. So on the bright side, my TDD is down nearly 50% since I’m all basal baby! My stockpile is growing nicely, I think we’ll need it.
I’m shocked that a doctor is so clueless. Basal is NOT SUPPOSED TO BRING BG DOWN. That’s why it’s called “B-A-S-A-L!” _RAPID/BOLUS insulin is for that purpose and no amount of basal will substitute for that.
When can your husband see ANY new doctor? I can’t believe there are two that are THAT clueless!
This is the second doctor. When I had this “discussion” with the first GP, I got a very nasty reply. This doctor is my GP, who first prescribed me both basal and bolus, so I hoped that she would do the same for him.
I don’t know how to screen for a doctor who will prescribe fast acting. When I call and talk to the office/nurse they say that we would just have to come in, have him start as our doctor, and then see what he thinks.
All the nurses at the ER were saying behind the curtain that this is crazy. But when the ER doctor saw him, he refused to prescribe insulin because that’s up to my husband’s GP. Basically he wouldn’t do anything that would go against or make his doctor look bad.
I totally get how insulin works. After watching me for a year, my husband gets it to. But I am at a loss for how to find a doctor who does get it, and will give us an appointment in less than 3 months.
My next endo appointment is in 1.5 months, maybe he can take that? My husband isn’t willing to go against doctors orders and take insulin without the prescription.
I only had BG going into the 200’s after meals and went to Wal-Mart and started using Novolin R without a script. I then told my doctor what I was doing and he was fine with it. A lot of doctors don’t want to take the time to work through insulin doses with their patients. I just did it myself since I wanted to take charge of my own health. You don’t have to tell the doc what you’re doing. The most important thing is to get your hubby’s BG levels down as fast as you can. Don’t want on the doctors to help you when you know what needs to be done. That is my advice to you.
I have to say, most GPs don’t feel comfortable or competent to initiate insulin therapy. To them it presents a serious risk and liability. After all a patient can have a hypo and suffer serious harm. And who made the “decision” to initiate insulin. That is right the GP. The GP is the one who has to carry malpractice insurance. And if a GP feels any apprehension about whether to initiate insulin they will protect themselves.
Unfortunately this leaves us patients in a quandary. Do we wait and suffer ongoing harm waiting for someone in the health system to finally go out on a limb to help us? Or do we make the decision ourselves. I claim that these sorts of decisions should not be made for us. This is about our lives and we should be able to make our own well-informed decisions. I had a number of doctors refuse my request for insulin. I decided to learn all about how to safely use insulin and make the decision myself. It is going on seven years ago that I made my decision. You can read about it in my post from December 2010 called “Taking Control and Starting Insulin.”
I would also add that when I returned to see my GP three months later and declared that I had started insulin on my own, he complimented me on my dramatically improved control and suggested that maybe I would do better on a modern insulin rather than R and NPH. Apparently he was fine that I was on insulin so long as he didn’t have to make the medical decision to initiate insulin therapy.
Most endos line up their patients to see them every three months and are fully booked for three months. My favorite trick to get in to see an endo is to ask to be put on the “waiting list” or to be called if there is any opening. Patients cancel. It happens. You might get in tomorrow.
I can’t second Brian’s words strongly enough. Like him, I taught myself how to use insulin correctly. I can’t prove this, but I suspect the only reason my GP was willing to prescribe it was because I could prove that I was already using it competently.
With post prandial readings regularly in the 300s, what gets me about your husband’s doctors is, not only is the need for insulin glaringly obvious, but he lives with someone who already knows how to use it properly. What more do they need? Flaming letters in the sky and a celestial voice saying “do this”???
It’s late here, too many answers I’m not up to reading - I’m sure they’re all great as this is a VERY helpful site.
Just want to say -I was Dx’ed 2.3 yrs ago when my Husband came home unexpectedly and called ambulance @ 1 in afternoon coz he ‘had a bad feeling’- 1st time in 42 yrs. I have no recollection of the 1st 4-5 days. The last thing I remembered before I slumped over was saying “Thank God You’re Here”. Just to point out - numbers can be misconceiving.
I had severe DKA & Sepsis, even though my bs was only 572 (I’ve taken care of people much higher. My HgA1C was only 11. Again, I’ve seen worse). Dr told Husband it may be too late to save me - my labs were incompatible with life. (I think I only surved b/c I was drinking baking soda fot the nausea & vomiting, which counteracts acidosis to a certain degree).
Demand whatever you think he needs! No one knows us better than ourselves and our spouses!
Husband saw the endo yesterday (there was a cancellation). She’s taken him on and I am no longer responsible (which was becoming a strain on the relationship). He has a direct line to the doctor and they will tweak things day by day until things are figured out.
So glad you finally got your husband hooked up with a doctor who will take care of things!! Woo! on the 116 fasting!!
(Meant to ask you @daytona, about your endo… Was needing a new endo, as mine is retiring - though, I live north side and work MUCH farther north, so UofC isn’t exactly convenient… Meanwhile, had an excellent appointment with a new endo in Lake Forest, so I might be good to go!)
Wow I hope he gets what he needs. From what I understand is that once your BloodSugars are above 1bout 170 to 180 you begin to damage your body. So think of blindness, kidney damage, neuropathy - Permanent damage that can’t be reversed. I can’t believe you had doctors so slowly lowering his Blood sugar and not worrying of the the high values.
Not to go into how I got to the point of seeing my GP - But when I saw him Was almost 500. HE diagnosed me as Type1. The next day I meat with a Diabetes Nurse (CDME I think or something like that) and she trained me on Basal and Bolus. Took my my weight and we figured out a Long acting and Fast acting set of values to use. In the first week I got it down from the high 400’s to the mid 200’s. We tweaked it again and the following week I was down to a Pre-meal blood sugar of 105 and a 2 hour after (Calculating my carbs and taking the units of Fast Acting Insulin 15 minutes before I eat) to about 135-150. And 4 hours later around 115.
Then I taught myself what Type1 was. And truly how to think about my food choices. How fats affect. How vegetables and fruits affect. And I’ve had almost every year since and A1C of 5.5 to 5.8. It’s a lot of work. I was diagnosed at 43. I’m now 50. And my wife wants me around till at least 100. So taking care of this is a top priority.
So I truly hope - truly - that you get someone that believes in tight control. And doesn’t label him Type1 or Type2 or whatever. But get it under control first and fast. Then lets worry what it actually is. He could have been Type2 for so long that he damaged his Pancreas to only produce 10% of what he needs. He could be LADA and have a sort what looks like Type2 but is really a slow onset of Type1. He could be MODY with a genetic abnormality that only recently started getting worse. And he still could be Type1 but not show the genetic markers for it…
So one thing is to test to see how much Insulin he’s really producing. That will tell a story there. Making a lot, some or none at all.
You don’t have to buy it. Make your own, it’s 5 ml of sodium or salt, 5 ml potassium in one litre of water. It’s what they give to people with diarrhea and/or vomiting.
I can see doc’s not wanting to fool with Insulin therapy. I have the same issue with being on blood thinners. Some GP’s will not take me because I am a liability and too time consuming. I bought a home monitor to help alleviate the burden on my doc. I initiated insulin therapy on my own very slowly and very carefully. I always had plenty of sugar on hand to correct any lows. And it also helps being insulin resistant. It’s hard to crash from the insulin when you can take 50 units at a time and it barely helps. That’s how it was in the beginning for me. My doc finally agreed to prescribe me insulin after I showed him I can use it responsibly and that it had significantly lowered my A1C. Anyhow I hope you got it all worked out.
My stockpile is growing nicely, I think we’ll need it.