Ketones

Yesterday my site wasn’t working and it didn’t show on my dexcom. Nausea was my first sign and I knew. I was able to eat my supper yesterday but I have been dealing with bad stomach pain. I haven’t vomitted. I am drinking lots of water. How do others deal with this?

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If my physical symptoms caused me to doubt my Dexcom reading, I would fingerstick to verify my suspicion. Drinking more water when BG is high with elevated ketones is appropriate. In any case, it will do you no harm. Did you test ketones?

Stomach pains can be caused by many underlying conditions and ruling out impending DKA with a fingerstick and a ketone check is a good idea. I would not eat if my BG and ketones were both high.

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Have you corrected and have your BG back in control?
I would also google sick day rules, for step by step treatment.

On my old pump before cgm, I would have a site fail or come out and I wouldn’t know until I felt sick and dizzy.
I didn’t need to check ketones. I just knew.
I know it was dka because I would take 20 units and it would have almost no effect. I would need to inject 40-50 units to bring it in range.
That’s almost double my entire daily dose.
The stomach pain and nausea and dizziness usually lasted an hour or so. I would generally inject w a syringe and lay down with a heat pack. One of the chemicals ones. To warm the site because it makes absorption faster.
I really don’t miss those days.
When I have a site failure I know immediately with a cascade of alarms pump and my tandem ap and my dexcom ap.
It’s been many years since I’ve dealt with dka.

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I started out this journey with type 1 with dka. I have been hospitalized one other time. Whenever I suspect ketones, I check for them and start drinking water. I give a correction with a syringe and change my site. Sometimes it is a bad site, sometimes the insulin is denatured, sometimes it is a question mark. The important thing is to act. When your bg comes down you will need to eat some carb and bolus for it. There are posts on the history of this site that are helpful. Also a few on this site have been with me virtually while I dealt with ketones and I will be forever grateful.

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I’m always surprised that it’s not normal to teach diabetics to cope with DKA anymore. It’s like they don’t trust us to manage, and just want us to run to the ER at the first sign of trouble.

I had a terrible time with DKA during puberty, but luckily had a great doctor who taught me how to tame it in my own. Insulin. You need lots of insulin. Even after your BG is back in range, if you still have ketones in your urine, you still have to treat it with more insulin. After BG was controlled, I continued with the extra insulin every hour and a tablespoon of pure coke syrup every 15 minutes to counteract the extra insulin. Looking back, though, I think the coke syrup was partial punishment. Wouldn’t want to reward a kid in a diabetic crisis with something as palatable as juice! Unfortunately, the ketones aren’t the only concern. You also have to replace electrolytes. Potassium is a big problem with ketoacidosis, and it’s a caustic nightmare to receive in the hospital. Best to avoid the problem in the first place by supplementing orally.

Of course, I also learned my “point of no return”, when I could no longer control it myself. Vomiting was my signal. If I got to that point, we had the doctor notify the ER we’d be there in 15 minutes. It was fast downward spiral from the start of vomiting. By the time we got to the ER, my lungs would be in so much pain, I refused to breathe until I passed out. Usually I could avoid that all together with the Insulin, coke syrup, and pedialyte routine, though.

I used to have a big resistance to ketones. I could ride the rollercoaster and even stay high for weeks on end with no problem. But now that I’ve learned to manage so much better, I’ve lost all my resistance. I start to feel seriously ketonic if I hit 250. We keep dehydrated coconut water powder around now for DKA. It’s high in both sugar and potassium and other electrolytes, and WAY more tolerable than the coke syrup. Haven’t had an occurrence I couldn’t manage myself since I was 13. Thank goodness, since I’m 90 minutes from a hospital now!

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I went into hospital yesterday as I still wasn’t feeling any better by 1130am despite drinking water. I didn’t eat anything except a yogurt. The last time I checked yesterday I had a medium amount of ketones and was feeling terrible but I didn’t vomit. They ran some blood tests and gave me a shot of gravel. By 4pm they said I could go home but I still wasn’t feeling better. My balance was still off and I lost my balance upon exiting emerge so they brought me back in. So the doctor came back in and reassessed me. I started to feel a bit better then they said I could go.The doctor also said that I might have been a little dehydrated. I don’t know how as I must have drank about 6 full glasses of water. Wow! What an eventful day. I need to test my supper basal. I rise quickly after eating and it will go down a bit but then it rises again at 730pm. I know this all sounds very confusing.

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Yeah, it does sound confusing! The doctor’s dehydration suggestion sounds uniformed about your actual circumstance. Communication is such a frail art, especially with doctors.

Your story seems more complicated than a case of impending DKA. I’m guessing that they checked and rechecked your blood pressure with your loss of balance. At this point, I think you’ll need to work through your case with the medical professionals.

Sorry you ended up in the hospital but that’s probably the best place to sort out your situation. You didn’t get admitted, I take it, just an emergency room visit. Is that right? I wish you the best; please keep us informed.

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I hard a rapid heart beat and it felt like my airway was closing in on me. Very scary. Today I am still not quite normal but better than yesterday. My urine tests showed a trace of ketones and my blood ketones was 0.3. It will probably take a few days before I feel like myself again.

Yes, just a visit. Yes, yesterday was quite confusing . I think I am my worst enemy. I need to probably do some basal testing. Especially my supper one.

Yes your symptoms seem bigger than dka. At least for me, after I bring myself back into range, I feel better and after a few hours I’m pretty close to feeling normal
I suppose there is a range for that,but you seems to be suffering symptoms for a long time

It was a real weird occurance. Normally I would correct and I wouldn’t have an issue. That time was different. The doctor called me yesterday for a followup. He said that my sodium levels were low. I did drink about 6 glasses of water. I seem to be doing a bit better. The doctor also wants me to get another blood test in about a week. I will followup on that.

Why is it when my blood sugar on my dexcom was showing a rise and it rose up to 10.2 and was there for 15 minutes and I was already showing ketones? I had confirmed it on my meter. Maybe it has to do with not receiving enough basal. This is really scaring me as this usually only happens when I have been high for a few hours without any iob. Your suggestions?

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I’ve maybe only had ketones a handful of times. I can definitely tell when my sugar is rising as my tongue gets a little numb, its a little harder to talk, definitely have to go to the bathroom more, and I just feel funky. I have found this happens more often when I move my pump site to a location that is a little more fatty, and doesn’t take insulin as well. I have had plenty of issues with my dexcom too. I only use it as an indication to which direction my sugar is headed. It doesn’t seem accurate enough to rely on, if your sugar varies a lot. The only times it has been accurate for me is if I am an on a steady trend, not when it is drastically changing. When my sugar is drastically changing, my dexcom has been off as much as 40mg/dL. In one instance, It was reading 65, and I was really 24, which wasn’t fun :sweat_smile:. If your body isn’t accepting insulin as well, even in sites that you know take insulin well. You may definitely have to increase your basal rate, and or carb ratio. I would consult with your endocrinologist if you believe this is the case. I’ve definitely had to increase my calcs as I’ve become less active due to changes in my life. As for not having insulin for a few hours, your sugar will definitely rise over time and stay high if your not active as you know. If your lifting, moving a lot, and other strenuous activity without insulin it can help keep your sugar from continuing an upward trend. I’ve had to do something like that when my pump failed late at night, even after I went to the ER to get needles to deliver my insulin manually as the pharmacy’s were closed.

Definitely keep up what you have been doing by drinking water, and correcting. When my sugar has been high for long periods, drinking water, rechecking every half hour to hour and correcting has helped with getting my sugar down. Doing strenuous activity as I said before helps a lot too. Just be carful about correcting to much. If you’ve ruled out your infusion site, and calcs, there could be underlying causes such as illness like a cold, or other reasons your sugar is acting up. I hope this helps

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I am testing my supper basal right now. When I bolus at supper dexcom shows it rises quickly. At 4pm it was 6.6mmol and at 6pm it is 8.0mmol. So that might explain why my sugar rises quickly after eating supper. I usually eat about 530pm. I am pretty sure a basal rate change will be needed. I will be so happy if this fixes things.

Another thing you can try, is that if your using a pump; look to see if it has an option for extending your bolus. For my pump, I can prolong my insulin delivery so if I am getting say 8Units of insulin for a high carb meal, I can setup that delivery to take place over the course of 30minutes, an hour, or longer. This can be very helpful for foods with high fiber, or foods that don’t digest quickly. That way, you can help avoid your sugar spiking later on.

Ketones will be created whenever you burn fat. It is actually normal to have a little if you are losing weight.
The real problem is when you get 3+ level. Then it sort of cascades. You become resistant to insulin.
The real problem is the change in the ph of your blood that cause keto acidosis.
Your body can not handle too much of a shift in Ph of your blood.
You know the symptoms, confusion, nausea, etc.
but then coma and death come on if you don’t correct it.
I never worry about trace or a +1 ketone. ESP if I’m fasting or not eating much.

Normally you would miss your evening meal and be clear of bolus to begin the test for overnight basal.

My suspicions were right. From 5pm until 730pm my sugar rose significantly. I had to cancel the test because I had urine ketones. I will have supper tonight and see how it goes. I am also drinking almond coconut soy milk with my breakfast. I am getting great results by doing this. I don’t really like the flavor of it but if it controls my bloodsugar then it is a small sacrifice to make.

Right. Pumping insulin by John Walsh says start the test 1-2 hours before with little or no IOB. From 5pm until 7pm I rose from 5.5 to 11.2mmol according to my dexcom. I am usually at .125 basal. I will move it to .150 and see how it goes. I always feel a little more relieved when I do basal testing as it tells me what is going on without eating.