Ketones

Hello Carb101:



Absolutely NO EXERCISE!



The body cannot access the proverbial gas tank filled with her high sugar already. Exertion, makes the problem worse. It will pump out MORE (without your consent) in order to draw energy from that.



So…no exercise!!!





And for the record, checking for ketones is redundant, truly not important at that point. You might be surprised and get little/no ketones. they matter over the long term, days, weeks, not in hours…



Stuart

I got input from my daughter’s CDE, and it backs up what bsc said about potentially needing mroe insulin to correct:

The reason you want to know how the ketones are is because if they are moderate-to-large, Clara would have needed a larger dose than what you would normally give for her correction. When ketones are that high, you now have two problems: 1. not enough insulin, 2. because there isn’t enough insulin (usually an extreme insulin deficiency, such as with a bad site), the body is making ketone bodies because there is nothing to let energy into the cells. At that point, you need more insulin than normal, and just giving the regular correction dose won’t help to clear the ketones. In turn, that means that the blood sugar will also take much, much longer to come down, if at all.

Honestly, its a little concerning that people consider checking for ketones pointless; I agree, you will take corrective action all the same, but remember how much crazy damage you are doing to the body every time you have ketosis/pre-ketosis. I just feel it is REALLY important to keep track of instances of when ketones are present, and to use these times to learn the most effective ways to deal with them, and why they occurred at all.
Good topic, thank you.

I’m not talking about a child, I’m talking about my experience. You may have to do things totally different for a child, I don’t know. Doesn’t it take a extreme high over a long period for ketones to set in?

I got another email from my CDE. I asked her if it was realistic that Clara could have developed ketones in the 5 hours that I estimate her site was pulled out. She answered “you can be in the hospital within 6 hours from a total deficiency of insulin (i.e.: bad pump site that goes undetected).” Interesting food for thought.

Whenever my son gets a high reading, whether he is ill, or whenever, he tests for ketones. He often will have trace, but on occasion he has mod. to large ketones. THe CDE gave us a protocol that lists corrections via syringe based on his blood glucose. We have always been able to get him back within normal range with this method.

I test when I suspect I am high for a reason that is not my fault (i.e. not related to food). Sometimes I test because I “feel” like I have ketones in my system (dull headache, nausea) even when my BG Is not that high. It usually does result in me changing out a site faster than I would have without testing - it makes the whole process last maybe 3-4 hours to bring down one of those highs, rather than the 12 hours it took you. I’d rather not feel lousy for that extra 8-9 hours if I can help it :slight_smile:

I have countless episodes documented where I will have ketones well before my BG reaches 200. So for me it isn’t always just a “I’m high, I should check” but “why am I high?” that leads to suspecting a bad site.

I have been plagued with bad sites over this past year, as I’ve been trying to figure out just what it is that my skin reacts to - going so far as to try pumping u500 insulin to see if the decrease in volume helps any (it didn’t really). So really, I just accept at this point that it’s a good stretch when I have a site reach 48 hours without trouble… and if I suspect a bad site sooner, at least I have a tool available to diagnose that faster than “waiting it out”.

I do test ketones. I test when I am high because if it is still not coming down then the Endo gets A call and she will ask about my bg numbers as well as for ketone test results. I always have to dose more insulin if I have mod. or high ketones if I give the reg. correction factor but have those mod. ketones then my bg just will not come down no matter what I do till it gets hit with the proper dose. Now this is what works for me. I have had very little highs over my 16 yrs of diabetes that has had mod to high ketones.

DKA is potentially much more serious in children than it is in adults. It sounds like your daughter clearly had no DKA symptoms, so treating as you did (fast acting insulin and water) was the right thing to do. But a urine test for high ketones would have made it even more certain that it was just high BG and not the start of DKA - thus the recommendation to do the test. If she had had high urine ketones, taking her out of school so you could watch her BG and make sure it came down would probably have been recommended - especially since as your Dr. noted the amount of insulin needed to get back to normal when BG is really high is harder to predict.

See this paper for a description of why extra concern is called for in children: LINK HERE “A child is not a miniature adult is most appropriate when considering DKA…”.

i always check ketones when above 250. granted most of the time its none, but there have been times i was 300 and had large ketones. i think it was important for me to know those few times that i had tons of ketones.

but with me, idk how long i was high cause im hypoglycemic unaware. i have no idea what my blood sugar is most of the time because i cant feel it.

Thanks for the reply. How long have you been pumping? Also, I think the trick is keytones, before you hit 200. I wasnt aware that happened. Although, YDMV so…

Don’t be done with diabetes because it won’t be done with you !!!

we were told anything over 15 to check for keytones. luckily, we have never found any, but i think a high number with no keytones, no panic, just correct, but with keytones i would panic, correct and keep checking til the BG was back in normal range.

aw mileyfan, don’t think that way. nothing can stop you from doing what you want!

I’m a T1 for 51 years in good health.



I have never tested for Ketones. My old and current docs always said don’t worry about it unless you have high BGs for an extended period of time. The extended period to me means more than 12 hours, which I’ve never experienced yet.



I would like to know if the strips could be used to test for Coke vs. Diet Coke since sometimes when I eat out I can’t really identify it and i don’t trust the drink “hooker uppers” and have gotten highs from “diet cokes” before.



Anyone here ever tried it? Now in my opinion that would be a good use for the strips.

I have tested soft drinks with a BG meter. regular (which was suppossed to be diet- fountain drink) read HI and the diet (in a can to double check if the test on the other drink had really worked) read 1 point something (mmol)

I have found that if I actually have ketones, I know it by the nausea and massive headache. Of course, your mileage may vary… However, if she was checking her blood sugar frequently, you would have picked up if she was spilling ketones as the highs are harder to bring back down. Also, the suggestion that I was given was to drink lots of water and keep checking my numbers to make sure I’m coming down.

Out of curiosity, how old is your daughter? This could be the start of many unexplained highs…

Glad I’m not the only one, 35 years and never tested. Testing Coke - great idea!