My daughter had a site go bad this morning, so between breakfast and 12:30, she went from 115 to 359. I went to school, changed her site, gave her an injection, and she had several big glasses of water. My question is, was there any point in checking for ketones? (I didn’t.) And if she was showing them, what would be the treatment besides a dose of insulin, water, and maybe some exercise, all of which she got anyway?

I have no idea. In my 35 years, I’ve never tested for ketones and don’t know why you would need to. You did everything needed to be done anyway so why add one more stress increasing test result! My Doc said I really don’t need to unless I’m sick for a period of time.

Thanks for point that out Danny! Interesting read.

Not really. The only time to be concerned is with high BG that won’t come down. High BG with high ketones could be DKA & time to go to the ER.

Never exercise with BG over 240. Yes, lots of water & correction, of course.

Wow, I guess I am surprised at the level of non-concern. When a site goes bad, your body just totally runs insulin dry after a few hours and DKA can set in quickly. If you do end up in DKA, a “normal” correction may be woefully insuficient, DKA can cause marked insulin resistance. Knowing whether you have ketones is the difference between “correcting and forgetting” and correcting and checking your blood sugar every 15 minutes in fear that you may need a trip to the ER. Doesn’t that make sense?

ps. And don’t exercise when blood sugar is over 250, it may actually invoke an even higher blood sugar.

If my blood sugar is too high first thing I do is everything I can to get it down. I always correct and check often, just like if it’s gone low, I would do that whether I checked for ketones or not. Knowing wouldn’t change what you do, would it? If you are showing ketones, what would you do different? If I’m way high for a long time I might check (like if sick) but I’ve never, in 35 years, ever been so high for so long, that I ended up in the ER and I’ve never checked for ketones.

I’m just saying being in DKA can cause insulin resistance. She is just a child. I would have thought dumping ketones would be a trigger for hyper vigilance. It is interesting that you feel that an excursion into DKA in a child can be well managed with just a simple correct and check often. I’m not criticizing you, just noting my own misconception.

I check my daughter for ketones in a situation like this as per the instructions I was given when she was first diagnosed. If moderate or high ketones are present, I give her a correction dose + an additional 50% in a syringe. If ketones are present, insulin resistance can be an issue. Then, like you did, I change the site, get her to drink plenty of water but no exercise until the ketones are gone or her blood sugar number is below 250.

If you knew the site was bad, gave a correction via shot, and changed out the site again, checking for ketones would be a bit of a moot point - odds are good that you probably dealt with a bit of a residual high as a result of any ketones she had, but testing for them at the time wouldn’t have changed what you did.

I primarily check for ketones with an unexpected high (because I always have ketones if I am high due to a failing site) and I’m unsure of whether it’s from a bad site or something else, or when I am sick, as they can also be a fairly good indicator of not getting adequate calories and dehydration - both of which are bad when you’re sick, so it’s a good indicator to know I need to eat and drink more.

For me, checking for ketones when I suspect a bad site allows me to deal with it quickly rather than trying to puzzle it out for a few more hours before finally changing the site as a last resort. I usually catch those bad sites before I’m even 200 because I test for blood ketones.

I dont think the resistance can be calulated in DKA. I know when Ive gone without insulin it has taken long and large doses to bring me back down, but knowing if I had keytones I dont think would have helped to tell me how much additional insulin I needed.

I don’t think resistance is related to DKA either. I was diagnosed DKA with 809 BG. I’m not resistant. Perhaps going into DKA numerous times burns out any remaining functioning beta cells & this may require higher insulin doses.

I’ve been insulin-less a couple of times (forgot to take bolus, forgot to take basal before bed). Had soaring BG, naturally, but nothing that couldn’t be brought down with corrections. If I corrected a serious high over & over without success, I’d go to the ER.

Post surgery Ive hit 450 for hours, but I guess the trauma of surgery does this or so they say. No matter how much insuling I seem to take, it doesnt come down till the next day.

OUCH! Not anywhere as serious as surgery, but I injured my back & had highs for days that insulin didn’t touch. Pain & any trauma seems to do it. Thankfully, I didn’t hit 450.

You did get through the back pain ok thought, right?

Yes, trauma seems to be the ticket to high BGs. Im not totally sure how or if keytones would assist at all in any of these circumstances.

This is intereting to me. I had a bad site the other day. I went against my better judgement and changed it then fell asleep. Surprise! Woke up at 2xx, started pumping insulin to get it down, realized it wasnt working, took a shot and changed the set. All in all it was about 12 hours from 95 to 360 and back down to 95. When you test for keytones with a bad set, 1. what triggers you to test and 2. why do it make you change the site faster? Thanks!

Bet if I had painkillers my BG would have been lower! I could barely move for several days & then was fine.

I never checked for ketones.

In the five years my niece has had Type 1, she has had instances of very high blood sugar and we do check for ketones but she has only had trace and that was only once. You would have to monitor in the event ketones do not come down or if they are high you may have to go to the ER for IV fluids. Endo would give some kind of treatment plan (most likely more insulin than normal to get the ketones down). Sketchy as to the exact details, because she has never had a problem with them.

I wonder if the guidance you got on the increased correction in the presence of ketones is for a child or whether the same would apply for an adult.

I didn’t know about not exercising when high. That’s good information. She did not exercise or have PE, but they do get outside a lot at her school and often dash about between classes.

I knew her site had gone bad because her numbers are pretty predictable, and that morning she had dropped her pump while getting dressed and the tubing came loose. She does this about once every two weeks. I just reattached and reprimed, as I always have, and we’ve never had a problem. But this time when her numbers soared, I guessed that the site must have gotten pulled out a bit.

I used her pump to tell me how much insulin she should get. I did not increase her dose at all. She checked and called me hourly until her numbers were back in the 90s, which was about 3 hours.

Here’s a tip I learned from another parent. When giving a correction dose with an injection, also tell the pump to give that amount. DISCONNECT and let the insulin spill into the sink (or where ever). That way if you need to add additional insulin later, you’re less likely to over bolus because your pump will let you know how much insulin is still on board.

Here’s two of the answers from the discussion Danny references above:

I just wanted to follow up because I did ask my DR last week whether its really necessary to be checking for ketones or not when and if my blood sugar gets high. She told me it wasn’t really necessary unless I started to get abdominal pains and/or signs of DKA. She said the best thing to do is to drink a lot of water and keep checking blood tests to make sure they were coming down(of course I already knew that though! ;)).

The other person who asked her doctor said that the doctor told her it was not necessary unless she was showing other signs of DKA (nausea, vomiting, fruity breath, feeling awful, etc.)