Ketones

I don’t recall ever having ketones before…at least not in a long, long time.

Its oscillating back a forth a bit the last couple days between negative, trace, and small amounts. Blood sugar pretty normal - less than 180.

How do I get rid of these little buggers? Can I just keep drinking a lot of gatorade zero? Have I messed up my blood chemistry and need to go into the clinic? Not the ER, right?

Stupid ketones!

I don’t feel great. Is it the ketones make me feel bad?

If I eat food, will the ketones go away?

You can purge ketones on your own, you shouldn’t need a hospital unless you reach a “point of no return”. For me, that point is vomiting. If I reach that point, it goes downhill fast. That’s why I was worried about your other posts! But it’s different if the vomiting is from illness, not the ketones. High ketones + vomiting = hospital. Vomiting + low/no ketones = normal sick day regime, unless it worsens. And yes, most likely hospital. DKA is critical and life threatening, not something your run of the mill clinic is able to handle.

It seems like they stopped teaching diabetics to manage ketones on our own in the last few decades. You need insulin to purge the ketones. LOTS of insulin. It’s not just about delivering enough insulin to manage BG anymore, but rather you continue to deliver excess insulin after your BG comes down until the ketones are out of your system, and manage the extra insulin with increased carbs to keep your BG up. Ketoacidosis is really hard on electrolytes, too, especially potassium. For all of us who have been hospitalized with DKA, that’s what is in the IV bag to make it burn like the fires of hell. IV potassium is really caustic. You don’t want that, so best to supplement electrolytes early and often.

When I was a child, the routine was 2 units of humulin-R and a tablespoon of Coke syrup every 15 minutes until urine ketones were down to “trace”, and as much Pedialyte as I could handle in between syrup/insulin doses. The coke syrup was available in the pharmacy, and the same stuff they dilute to make the beverage, but full strength for this purpose. It was foul stuff and more torturous than the DKA! I think it was intentional so they weren’t rewarding the irresponsible child with tasty sugary treats when I got sick.

Now I prefer coconut water to treat ketones, since it’s both high in sugar and potassium. I basically sugar surf. I set my pump to my 150% sick day profile, but that doesn’t count as excess insulin, that’s just the insulin I need to manage BG when I’m ill, have ketones, or are otherwise insulin resistant. Then I use the extended bolus feature, and deliver quite a large bolus, extended over 2 hours (because that’s all my pump allows anymore). I keep a bottle of coconut water with me throughout that time and drink as much as I need as often as I need it to keep my sugar up.

I like the dehydrated coconut water powder. I can mix it up a little more potent for sick days than I would for normal drinking. Plus it’s shelf stable and doesn’t take up a lot of space. This is the one I buy:

Wilderness Poets Coconut Water Powder - Freeze Dried - Instant Mix (32 Ounce) https://a.co/d/eAp3ynO

It looks like a lot of money, but I get it on subscribe and save and it works out to be $3.35 per liter. That’s less than the grocery store (~3.79/L), and way more convenient.

The big thing to remember is that insulin is dangerous! You have to have to fast acting carb at the ready, and you need to have an emergency plan in place… Even if that’s glucagon, friends or family to check on you, or 911. You can’t just deliver excess insulin irresponsibly.

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If you have been avoiding/limiting carbs, and eating mostly fat/protein, then trace/low ketones are normal.

But if you have been eating more carbs, and have ketones, you need more insulin.

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I ate a banana yesterday to try and help with the potassium. Yesterday was the first day of food. I just ate a sandwich. Not sure what will happen. I took 20 units.

I put on a new pod yesterday with 200 units and it is almost gone. If I eat anything, even just a bite of something, I have been taking 10 units to be on the safe side.

Pedialyte is discusting. Been trying to drink some here and there - I’ve had 1/2 a liter. Drinking TONS of Gatorade zero. I feel pretty lightheaded and ‘off’ when I stand up and get tired easily.

Thanks you guys! This was definitely DKA. It came on real quick, overnight, I think.

I need to rebuild my teck stack and way of doing things. My Doc was like, “you need to run that dexcom.” She’s right. I ordered a new receiver. That’s the right thing to do.

I know that what I’m doing is dangerous and not the right way to do things. Maybe its just time for another receiver.

There is a difference between having ketones and being in dka.
Ketones are a byproduct of metabolizing fat and protein so if you are fasting or eating less, you will burn fat and produce ketones. It’s normal.

When you get into the moderate to high that’s 3+ or greater you run a strong risk of being dka. Usually though if you are taking long acting insulin you won’t enter dka.

For me dka symptoms start about an hour after, I lose my set or it’s clogged. But now I have cgm it hasn’t happened since because I get an alarm pretty fast when my sugar goes up.

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Can you explain? Have you been intentionally fasting without food? Or doing a liquid only diet? Have you been sick?

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When I checked my sugar, it was 100 early saturday morning (around 3am). I was not sick. I had became confused and crawled to the kitchen for a snack. I had a granola bar and 3/4 can of squirt. My BG seemed normal, but I did not feel normal, so I had a snack anyway.

Starting saturday, I couldn’t eat. I couldn’t hold fluids. I pretty much just laid in my own vomit. At first I was able to distinguish between glasses of vomit and glasses of water, but at some point they became confused. At some point I no longer cared which was which. I could barley make it to the bathroom to empty the vomit cups. I was throwing up 44 ounces many, many times throughout the day. Whenever I drank fluids, I threw up, but I was too thirsty to NOT drink. Opportunities to drink water were like a dream come true, even though the vomit was inevitable and inescapable.

My blood sugar was over 500 for some period that began early Saturday morning. I changed pump and took MI. Those did not help and I was too weak to do much else. I wondered if I had the flu. I tried to drink some theraflu, but promptly threw it up. I calIed and got a ride to the 24 hr pharmacy and got a new bottle of insulin early sunday morning and started fighting it down. Early Monday morning I hit 180, then 160, then 90. On Sunday and Monday, ketones danced around between none, trace, and small readings.

Everything ok now, except that my mouth is one giant sore from throwing up so much. My teeth hurt, my gums hurt. I’m taking advil so I can eat and resume daily activities. Even my ears hurt from throwing up so much. Those are the lasting repercussions of this hell weekend. I wished I was dead.

I believe this was a result of taking bad/ineffective insulin. I believe that I had a ‘stockpile’ of insulin from covid that simply aged out. My pharmacist gave me a Santa Claus bag full of insulin to tide me over during covid. I just kept reaching into the Santa Claus bag and grabbing more whenever I needed it - that was Lisipro for my pump. I think it aged out.

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Well, it sounds to me like you were in DKA and managed to pull yourself out of it. Not a good maneuver! You have been very lucky.

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I’ve had dka 3-4 times and although I felt horrible, it was never like that. Then again I was pretty young. I don’t know how I would fare now that I’m in my 50s.
I know the feeling of dka. It’s unmistakable when it starts.

I take 10 units of lantus along w my pump and I do that for better control and to keep my sites from failing, but it is also a protection against dka.

It’s very difficult to move into dka while you have some long acting insulin onboard even if your sugars are high.

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Ketones don’t pop up much for me. Thank goodness! After my DKA, coma diagnosis, I never, ever want to feel like that again.

Doing a clinical trial, I learned a new thing about ketones. I was always told more insulin and fluids with electrolytes. And usually when spilling ketones, you just don’t feel like eating. But I was told, a small amount of carbs with insulin will help. Didn’t believe it , but did have to do a small snack mid morning with insulin to help keep the ketones down during this trial. It sucked because eating more is not what most of want to do but it did help keep me feeling better but didn’t help with weight.

But for those spilling small ketones, might want to think about insulin with small amount of carbs, not just fluids.

So very glad you are feeling better. I am like you and feel like crap, even with a small amount of ketones.

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I figure I’ll just make rounds every day after work - swing by the clinic office and the pharmacy and see if anybody can get me an RX for Lisipro, a new Dex receiver, and some kinda basal since you guys are calling that out specifically.

I need the Lisipro Rx most desperately to keep the pump running. Been working on that since 6am Sunday, so it should go through soon.

Mouth pain still excruciating. I would have thought that the open sores in my mouth would heal quickly. Never, ever let this happen to you. I forget how painful it is.

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Can you try using Regular, which is available without RX? Many folks, including me started pumping with old fashioned Regular!!

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Yes! Backup will be NPH and R if I’m unable to fill. Thanks for the reminder. I’ve never pumped with R before, but I’m willing to try.

Are the clinics more broken than usual…like everything else - short staffed and unable to do get biz done? I’m gonna try to call primary care today to see what he can do. He’s in a smaller clinic where the requests might actually get through to him.

I’m living in a house of cards, lol. :sweat_smile:

My local CVS pharmacy used to have 3 pharmacists and 3 technicians during peak times, now it’s 1 & 1 with a mid day closing.

A nurse on the call line at my clinic said she’s getting a lot of calls because people can’t get Rx’s filled from the Docs. A guy at work borrowed me a bottle of lisipro.

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@MM1’s point is extremely important:

I haven’t been measuring ketones for a while now - since I started AndroidAPS. My previous ketone levels were typically around or under 0.3mM (using an Abbott Precision Xtra meter). If I had gone above 1mg/dL I would have started panicking; I would have suspected a failed pump (bent catheter etc.)

So I just tested my ketones; 1.1mM!

Duh. I’ve basically been at 100mg/dL all day (it’s now 4PM). AndroidAPS/Statistics reports my 7 day TIR(70-140) as 74% with 24% high, but my 7 day TIR(70-180) is 93% with 5% high (the 30 day figures are better; my current G6 sensor seems to be a bit wonky).

What I think is happening here is that I went to OMAD and that is resulting in more ketosis. No problem; well, none that has been identified by medical science.

UPDATE: I continued testing my ketones (so from 4PM to 6:41PM my time). The 1.1mM figure is immediately before my OMAD. Immediately after I was at 0.9mM (30m later), after 60m I was at 0.8mM and now, after 2 hours, I’m at 0.6mM.

Meanwhile my BG from the G6 has spiked, from a preprandial 95mg/dL or so, through a 40g meal with a 3.4IU pre-bolus (delivered 20m before the meal) to 130mg/dL at this moment.

The ketones are entirely due to an absence of alternative sources of glucose; straight forward ketosis.

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@mohe0001 Next time you can’t tell what you are drinking it’s time to call an ambulance or get someone to take you to the hospital. Continual vomiting with confusion is so dangerous. At that point can you really trust yourself to judge how you are doing? Hopefully there is not a next time, but if there is, next time get to the hospital or call 911.

You should be able to just call Dexcom and tell them your receiver is broken. I have before and they just send a replacement.

I just saw this and I hope you are finally feeling better and have everything sorted out insulin wise. Hugs.

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Thanks, Marie. I think all my Rx should have gone through and be waiting for me at the pharmacy today. I called them everyday and it took about a week, so I need to stay on top of this stuff. Before covid, I think things were running much smoother.

@John_Bowler , I have tons of ketone strips, so I’ll continue to test mine and just see if anything shows up at baseline so I know better how ketones works. That’s interesting.

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Are you using US urine strips? I’m using a blood ketone meter, hence the mM (mmol/L) units and the small numbers. The urine strips available in the US are poorly documented and converting between the units they quote and mM is difficult (because the US strips don’t document exactly what chemical they are measuring).

My current numbers are consistent with a “keto” diet; I just measured 2.1mM, did a double check, got 1.8mM and then sanity checked my wife, 0.4mM. The problem we all face is that the documentation for T1s is minimal; even the CDC doesn’t actually give numbers! FWIW my BG is 91mg/dL by a finger stick - divide by 18 to get mM, that works (we know it’s measuring glucose, molecular weight 180g/mol).

I feel that getting to the bottom of this is important. We can do that by documenting numbers associated both with routine diets and with DKA.