I have type 1, insulin pump… i recently (3 days ago) dramatically changed my eating habits and drastically lowered my carb intake thus lowering my demand for insulin (i went from about 50-80 u per day, both basal and boluses… to about 26-36 u per day!!!)
anyway… tonight i checked my ketones and i have moderate-high ketones in my urine… which surprised me b/c my bg was only 67… i know that they come when your body burns fat for energy… or too little insulin… but is it STILL dangerous to have these even though my bg is so low AND my demand for insulin has really decrease… i am STILL eating some sugars (apples, and some fruits, BUT no starches and such)… yes for proteins also!
what can i do? can this type of ketones convert into DKA as can the high glucose ketones?
i am concerned BUT am truly feeling better w the food i am eating AND love that i need such little insulin per day… NOT to mention i am of course losing weight 
SUGGESTIONS or ino VERY much appreciated!
Melissa B
I am not totally sure that these ketones are the same ketones you see with DKA but I am no expert. When people go on the Akin’s diet or other no or very low carb diets ketones are also spilled from the lack of carbs. Make sure you are drinking lots of water to flush them out. Definitely check with your endo to make sure these are OK to be spilling. I tried an Akin’s type diet the past and within 18 hours was spilling ketones from the lack of carbs. I am no expert though.
I have read that there is a difference between ketosis and Ketoacidosis.
Almost anyone can get ketosis if he/she goes on a very low carb diet and is matablising fats as energy. The Atkins diet in the induction stage is an example of this. Those on this diet often strive to maintain ketosis to ensure weight loss.
Ketoacidosis (DKA) is a potentially life-threatening complication in people with diabetes. DKA results from an absolute shortage of insulin; in response the body switches to burning fatty acids and producing acidic ketone bodies.
Yours is most likely ketosis rather that ketoacidosis BUT PLEASE SEE YOUR DOCTOR TO MAKE SURE.
With due respect to Emmy, even a trace is not dangerous & isn’t a medical emergency.
Ketones & diabetic ketoacidosis (DKA) are two different things.
Ketones are a natural by-product of the body burning fat for energy. Ketones don’t convert into DKA. High ketones accompanied by high BG is a symptom of DKA, along with the other symptoms of extreme thirst, fatigue, vomiting, etc. With DKA, the body is starving because glucose isn’t getting into the cells.
When I changed my diet low carb (30-35 daily), of course I changed my insulin doses accordingly. If I had lowered slowly, I would have had dangerous hypos. Agree that when adjusting doses to fine tune it should be by small increments, but not when you’re eating far less carbs.
Ketone strips expire, so check the date. Expired strips won’t give accurate results. I’d buy some new ones with a different lot number & test again. Make sure you’re drinking enough water. Drink water & test again. Dehydration can result in high ketones.
ok these replies make sense… i did NOT drink enough water yesterday… so maybe one of the reasons… i just tested again (yes middle of the night… just woke up, lol…) and my ketones are back to normal…/
i DID email my endo nurse and will more than likely get back with me on monday… … i think too a combination of things… i realized i should be getting my period (don’t know if that makes a difference) , less water than usual, and perhaps not enough insulin in my basal!!!.. i will monitor closely this next day… and update after i hear back from my nurse also :
any add’l suggestions and info and still welcome
and THANK YOU for the replies so far <3 i truly do appreciate the time taken YOU ALL ROCK!!!
this was my thinking also… the dangerous hypos is WHY i changed so drastically… i have had instances in the past where i’ve been “woken” up by paramedics and i figured a couple of high days where better than NO DAYS at all… you know?
i did get new ketone strip, so that wasn’t the deal… i will monitor this day and see what happens
Periods were causing problems with me but I don’t think they caused ketosis. My control would go wild, I was often on the roller coaster a week before my period. Since I went on the pump, this don’t happen any more. Maybe it is the pump maybe I just outgrew it.
This is to really back up what Gerri has said. On a low carb diet, your body switches to using fat as energy. The way it does this is by converting fat to ketone bodies, and then your cells use the ketones for energy. Any unused ketones are excreted. When you start a low carb diet, your body will often create surges of ketones as it makes the transition to burning fat. Over time, this will normalize and your body will only generate only enough ketones to fuel your needs and you will usually see little ketones in your tests. That being said, there are some circumstances that will still cause a surge in ketones like exercise (and probably being low).
As a low carber, If your blood sugar is below 200 mg/dl, then you can be confident you are not in DKA despite any reading on your ketostix.
this is good to know… this am i woke up at 138 (i drank some milk in the middle of the night to help a low… when my ketones where gone…) BUT this am at 138 i had the moderate ketones again…
so THESE ketones are not harmful until they regularize?
Not drinking enough water will do it & most probably the cause.
If you don’t mind me asking, why are you checking for ketones? I never bother with this. The only time I’ve tested for ketones is when I was sick & BG was over 200 for hours.
Having your period, or about to get it, is unrelated to ketones.
If your readings are good between meals, your basal is fine.
Having ketones with normal or low BG is not a cause for concern.
Gerri… my bg have been fine ALL day today, my basals are keeping me regular and when i do have to bolus it does the job as well. I just feel like i have high ketones (as if my sugar was high EXCEPT it isn’t) so i check for ketones … all day today they were “small” ketones until now… my heart is pumping faster (which i’ve felt when my bg is hi and thus i checked for ketones just now and NOW they are “moderate” :(… could it just be my body trying to get used to the very low carb intake???
i have been drinking water today non-stop too 
my bg monitor is also working correctly i checked my family members…
Your post meal & in between readings are good, so don’t mess with your insulin doses.
Maybe your heart is pumping because you’re very anxious about this? I’ve never bothered to check for ketones unless ill with high BG, so I can’t tell you how often I’ve had low to moderate ketones. I’ve been on a very low carb diet for two years.
Ketones are common when losing weight & burning fat reserves for energy.
Ketones are never harmful except when they occur with highly elevated blood sugars. You can be quite confident that ketones occuring with a blood sugar of 138 mg/dl are absolutely normal.
David experienced a similar episode and I think it is very likely your body trying to adjust to your new diet.
His situation. 17 years old. Came home from school, vomiting with a mild stomach flu. Checked for ketones which showed moderate, a level that one would expect to correspond with a high BG, when in fact, BG was in range but on high side, of in range. He gave a unit of insulin to clear ketones and upped his water intake to help and all flu symptoms cleared by early evening as well. You need to seek guidance if this continues as 1 unit of insulin if you are already at 67 could be a very unsafe action to take.
We spoke to the endo as I was perplexed about how he could have moderate ketones, with an in range BG. The endo dismissed this as starvation ketones and didn’t have much more to offer. I looked up starvation ketones on the net to find:
"Large ketones are clearly a sign of problems with your diabetes. Ketones can be caused by a lack of adequate food intake. These are typically called starvation ketones. These are more prevalent when a child has a stomach flu with vomiting and diarrhea and hasn’t been able to eat appropriately. It is more common to have normal or low blood sugars with starvation ketones. These can very easily be confused with ketones from diabetic ketoacidosis (DKA). It is more common to have high blood sugars with these ketones.
Telling the difference between the two ketones can be difficult without a physician’s expertise."
I think you may have thrown your body into a bit of an upset that might take a few days to settle.
Keep us up-to-date about what you learn and how things go.
Cheryl
so my endo actually called back and said this is normal (as most already mentioned he was very happy i was doing this diet to boost some weight loss and said the ketone will be present b/c i am burning fat and using it for energy plus i have little to no carbs most of the day… so long as my bg is under control he said not to worry BUT after i am done w the initial boost and return to some GOOD carbs that my ketones should regularize or go away… he also mentioned TONS of water
he did put me at ease that i will not go into dka w these kinds of ketones rather only from high bg ketones
melissa
THANK YOU ALL for your replies and concern
Nice doc to call you on a Sunday.
Yep, perfectly normal. Glad you can relax about this.
such a great column, I’m glad you asked your question!
I had ketones (as your doctor and other friends here implied one might) when I switched to a dramatic diet, but my sugars were really good and I felt awesome, so it was a relief to know it was not harmful. I cannot stress enough the importance of hydration, really!
I hope all your worries have subsided. Well wishes, and thanks for asking a good question!
Hi there,
There is no question that you should immediately be on the phone with your Endo, I could understand that maybe there was some presence of ketones, from your blood sugars running extremely high for an extended periiod of time, and that a drastic change would not cause that , not to my knowledge, my only other suggestion would be to make sure the device you are using to monitor the ketones is calibrated properly, as that could throw the whole numbers game off…