Ketones! grrr

this is my first post here, and i’m so glad i found you all while googling dka. i was diagnosed with type 1 about 2 1/2 years ago and have been up and down since then. i have endometriosis which has made it tricky to keep my bs low enough, but have never had moderate or high ketones, even at diagnosis when my blood sugar was 1400. several months ago i hurt my back and was put on oral steroids, which made my numbers high but not unmanagable. then i was given a steroid injection in my spine and within 3 days i was in the icu in dka. for several days i had been throwing up and feeling worse and worse and although i was having trouble controlling my blood sugar and was needing to take a lot more short acting insulin, i thought it was going ok. so when i finally dug out my ketone meter and saw it was 5.8, i was pretty freaked out.
i have been feeling better the past couple days, but yesterday i started feeling nauseaus again, so checked and my meter said the ketones were .8. by the time i went to bed it was up to 1.3. i took extra humalog and drank a ton of water. this morning i was back to feeling very lethargic and slept most of the day, barely eating, and so my blood sugar was fine at 126, but my ketones were up to 3.2!
since i’ve never had to worry about them, i don’t really know what i’m doing now. i have an appt. with my endo tomorrow and am worried she will admitt me again.
i know that in the hospital i was given dextrose along with iv insulin, but am not sure how to handle needing to take extra humalog to lower the ketones without having very high blood sugar at home. if i eat in order to take the extra insulin, how do i figure out how much to take for the ketones and how much to take just to cover what i am eating? (and if i take insulin to cover what i’m eating, will that then not get used to lower the ketones?)
sorry for these crazy questions and if i’m not making too much sense… just so confused!


It’s going to be okay, Alli. You’ve taken the first step - asking your crazy questions!

First of all, you probably realize this, but ANY ketones at all is a bad situation. If you have them, then there is a problem that needs to be addressed. Being admitted to the hospital might actually be the right course of action if your endo and you are not able to bring them down.

Secondly, steroids (oral or injected) are infamous blood sugar spikers. Most diabetics experience through-the-roof numbers when we have to take steroids. For some, it’s 2-3 days of hell. For others, maybe 5 days of slightly elevated numbers. For some, obviously, DKA. After steroids, most of us have to take a lot of extra insulin over several days and monitor carefully as we start to come down. I’m a pumper, so for me it means higher basal rates and lots of correction boluses (that feel like they do nothing).

If you have normal blood sugars but high ketones, your body is trying to tell you that something is REALLY wrong. I’m not a doctor, so take any advice here with a grain of salt. But I do understand not wanting to overdose on the humalog and have lows in the hopes of clearing the ketones. If it were me, I’d try flushing my system with lots of water. And I mean LOTS. I’d call the on-call doctor or go to the ER if the ketone levels continue to climb. You do NOT want to be DKA again. Are you sure your blood sugars are in range? Have you tried on more than one meter? Have you tried taking any humalog to reduce the ketones? I think you really need your endo’s advice on this one.

I’ll be thinking of you, but I think you’re right to be worried and confused. We’re here for you, Alli. I hope someone else can respond with something more helpful!

This is very large ketones you should actualy contact you Dr. If my son’s BG is high for more than an hour I know he get’s ketones and then he starts vomiting a lot.
The general rule for ketones are: Lots and lost of fluids, then insulin, 0,1 unit per kg body weight or 0.5U/10lb body weight - preferably rapid acting insulin (novolog / humalog) per hour until you don’t have ketones anymore.
You have to test your Bg every hour and ketones every 1 - 2 hours- if your Bg is getting too low and you still have ketones - you must drink or eat something carbohydrate to keep your BG up.
A Fanastic book to have is: Type 1 diabetes in children, adolescents and young adults by Dr Ragnar Hanas ISBN 1-85959-153-1. You can have a look it is also available to read on google books - have a look at pages 100-102 and 134 for ketones.

Alli,you have great advices.Your ketones are very high,never mind the blood glucose.You need to go to hospital just to check capillary blood gases ( wish if glucometers as they measure BG,ketone,can measure HCO3).
Normoglycemic DKA happens.You need re-evaluation and adjusting your insulin dose.Ketones should not be there at all.
With this high ketones,if you eat to raise blood glucose to add more insulin,you may start vomiting.
When treating DKA,once blood glucose is coming down to 250 mg,and acidosis is not corrected,we add dextrose to infusion to continue insulin infusion without causing hypoglycemia.
Hope you get better soon,but please do not wait if ketones are still high.


You are freeking me out here… I had always run under the idea that ketones were essentially not possible as long as you had enough insulin to cover the need for energy at the cellular level. Since they are made by fat cells being burned for energy, I thought the only way you could end up with them was to be burning calories faster than glucose could be made available via the normal glucose / insulin method. Heck, ketones are considered a desirable things for atkins folks dieting. Just not at the levels you get when you pass on a shot.

Back when I had bells palsy I spent some lengths of time where I had ketones pretty much no matter what. But, I was only able to consume about 600 calories a day, and my doseages had fallen to 1/2 R/L in the am and 1/1 R/L at night, and at those I was havening a hard time avoiding lows, so I didn’t worry about the ketones so much. I was also losing about 2 lbs a week though.

Talk to you Dr. the inversion of the numbers seems like it needs investigation.


Hi Alli.
You can have a normal BG and high ketones if you are not eating. Your body needs fuel or it will use itself. People with eating disorders who are not diabetic get them. People who restrict there carbs to low get them. They are not good for the body.
Your body needs short and long chain sugar, fats and proteins to function. Try eating a piece of string cheese or any cheese because it has some fat for you and protien, 2 crackers and a dash of salt on your tongue. The salt will help hold water in and keep you hydrated.

I get ketones because I have malabsorption issue’s and so I have become an expert if you will at clearing them does not matter if they are from a high BG or no food. I get large ones not the trace ones and I hate them too. How I do it is once I have them of course I check my BG correct if needed, eat what I said above and drink about 16 oz of propell and cover what I need to. If the ketones are from lack of food they will go away pretty fast usually within an hour. If they are from a high BG it will take a bit longer.

Hope this helps you
Be loved

Hi Alli I am a type one
Buckeyelander as well . Are you a graduate student at OSU? I have had mild and trace ketones ( from the urine stick) when I am doing low carb, I was given a corticosterioid injection for an arthritic condition in nmy shoulder about 8 years ago when I was on shots. I tested 10-15 times a day, increased my Lantus and my bolus humalog dosage ( all under the tutelage of my endo) for about 1-2 weeks. My sugars still ran high ( between 175-250), but I was able to avoid high ketones. Are there alternative treatments for your pain? Are you seeing a pain specialist as well as your endo>? They need to work together on this… I hope you feel better soon and get the answers that you need.

God Bless


Hi sohair, I was always told if I run medium or large urine ketones for more then 2 hours to just go to the er and have my blood work done. Is that what you also recommend? Is that what you mean when you ask Alli not to wait with high ketones?

Be loved

I would personally pump myself with fast acting and not eat a thing.

You need to see a doctor, now. Something isn’t right here. I would not be eating with ketones at that level.

1 Like

Could you and Andrew explain not eating to me…
Is this a YMMV thing?
For me as I understand it when I have large ketones related to high BG I get rid of them much faster if I eat about 2 oz of cheese a cracker and some salt along. The cheese gives my body some fat and protein to use instead of feeding on itself, the cracker gives a bit of simple carb to help stop the process and the salt helps keep me from dehydration. I mean 60, 80 and 160 ketones. I may be on the outside I check for ketones every morning as well as a random check non BG related in the day. I also check anytime my BG is above 240. It is rare I am caught by surprise as soon as I see a trace I change sites and adjust my insulin dose.

If I just use water and insulin it takes me almost 2-3 hours to rid them when they are mod 60 or large 80-160. When I bolus, eat and drink I can usually get rid of them within an hour which is helpful cause I don’t get to the point of being sick to my stomach. That only happens when I sleep through a bad site and wake up in trouble.

I am being curious not argumentative :O)
Be loved

You are going too text book.

Do not eat when you have high BG and Ketones. Forget the fats and proteins when high. When you see keytones or high sugars just pump yourself with fast acting and wait. Check you sugars every 30 min. DO NOT EAT ANYTHING.

What do you take for insulin? I will help you solve this problem. I think I understand the problem but I need more info.

Tell me exactly what you take for meds and what you eat during the day.

Of course, this is just my opinion. Consult your dr.

Hi Andrew this is what my docs ordered me to do. They told me by not eating anything I am not helping to slow the act of my body burning it’s own fat for fuel. I use Humalog in my pump. I only get BG related ketones when my site is bad the only way I can get rid of them fast (within an hour) is to use a combination of a small amount of food, insulin and salty water. Otherwise as I said with insulin and water alone it takes much longer to expel them for me.
I take Pancrease pills
low dose liquid erythromycin for control of systemic infections
and have a host of other meds I take when needed. I am required to eat 2800 calories a day to keep my weight.
If this works for me to clear them fast is it not reasonable to think it may help someone else? I am just thinking to have ketones is bad the longer you have them the worse it is. I do not eat with high BG and no ketones only with ketones. I have a handful of type 1 friends this has worked for them with ketones and some it has not so I am wondering why it seems to be a rule what is the medical benefit?

Again I am curious not implying anyone to be right or wrong
Be well and be loved

Something isn’t right. How much do you weigh? 2800 cals per day is a lot.

Do you exersize? Have you ever considered getting off the pump? It might not be the best solution right now?

You really need to get your sugars and ketones down. I cannot stress this enough.

Have you considered getting a second opinion from a different doc?

Oh Andrew I am sorry I did not give you all the picture I have Cystic Fibrosis I weigh right now 122 and I need to get to 135. So 2800 keeps me, more helps me gain. My sugars are great right now I only get BG related ketones when I have a bad site. Shots left me terminal at 99 pounds and almost daily pass out lows so going back to those would be my death :frowning:

I also get malabsorption large ketones that are not BG related. I don’t have BG related ketones very often and when I do the way I treat myself holds off PH problems. However it may not be for everyone. The OP could not seem to get them rid with water and insulin only so my thought was she might need to try to tweak her self treatment like I had to. I have a constant team of docs and a constant influx of new ones I am just wondering if one way is the rule and why…make sense?

Be well Andrew and be loved

There is no such thing as one way to do things.

Have you ever thought about checking into the Joslin here in Boston?

You have a lot of variables to deal with so the Joslin might be a good option. They have the best teams around.

I live in California so that would be a long drive :slight_smile:
Right now my A1C is coming down and I am holding weight so that is a win for me. Anyway I hope Alli gets better and thanks for trying to explain things to me.
Be loved you are

Andrew is right- you have what must be a very challenging set of circumstances to deal with. The effective treatment of one appears to complicate effective treatment of another.

I see you live in Huntington Beach, CA. I live in Orange County, too (and grew up in HB!). I can put you in touch with a couple of great diabetes professionals in the area. Send me a PM if you are interested and I will forward the info.

Alli check in please and tell us your ok :slight_smile:
Be loved

Oneless thank you

Trace of ketones or one+ in urine ( blood strips for ketones are expensive for most people),advice water intake, insulin bolus and rest with frequent BG monitoring.When it is more, children can go to impending DKA ,to DKA.So a visit To ER is mandatory for children.DKA is dangerous.
Ali seems to have frequent admissions since she started on steroids which raises BG.