Small diabetic ketones but sugars are normal

I’ve been a type 1 diabetic since I was 8 and now i’m 40 and right now I have small keytones and need to know how to get rid of them, I was in the hospital last night and was released with just a script for a virus well, I still have keytones and using Ketostix stix it comes up Small Keytones. I’ve looked on the net to find how to get them gone without having to goto the hospital again but have come up with nothing, does anyone have any ideas or has had a similar situation that might be able to help me?

I’ve been told that actually eating More carbs and covering with more insulin will reduce or eliminate ketones in urine. I don’t really worry about them or test or track them though, personally… Low levels of ketones aren’t remarkably abnormal in my opinion… And are likely to be present when a person person is eating low carb and is physically active…

If you’re concerned I’d discuss it with your doc

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What’s your blood glucose level? Do you have a fever? Are you pushing fluids? Have you phoned your endo/physician?

because its the weekend there is no one to call except to goto Emerg again. My Glucose level is 9.0 and I have bolas to correct. I am getting pains in my ab area but i’m able to goto the bathroom and i’m keeping fluids down. The blood glucose level like I said is 9.0 but I noticed on this website when other people are talking about there levels it is a higher number - like in the hundreds.

Are you replacing electrolytes — particularly potassium? Here’s a link…

How To Treat Ketoacidosis

We all realize that there is a difference between low level urine ketones and ketoacidosis right?

@Steffanie, you need to multiply or divide by 18 to convert mg/dl to mmol/l.

Blood Sugar Converter

Anytime you burn fat you generate ketones. You generate ketones overnight when you sleep. You generate ketones when you exercise. And if you follow a low carb diet you will generate ketones as you burn fat. Ketones are only a concern when you have high blood sugars and high levels of ketones.

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+1. Like Brian said. Ketones are a normal part of life. It’s only when BG is very high WITH high levels of ketones that you have a red flag.

Since @Steffanie isn’t feeling well, doesn’t seem accustomed to generating ketones, is testing for ketones with imprecise urine strips (versus blood), indicates that she has abdominal pain, and because I am not a physician (nor am I privy to her full diet and medical history), I thought it best to err on the side of caution. Thus, answering her questions and supplying her w/ information from reliable sources. @Steffanie, are you sure your blood glucose meter and test strips are fairly accurate — i.e. have you compared them with a simultaneous lab test)?

FMI:

Nutritional Ketosis and Ketoacidosis - Calories Proper/Bill Lagakos, PhD
Nutritional Ketosis and Ketoacidosis - Axel F. Sigurdsson, MD

Nutritional Ketosis and Ketoacidosis - Peter Chase, MD and David Maahs, MD, PhD/Pink Panther Book
Diabetic Emergencies – Diagnosis and Clinical Management: Diabetic Ketoacidosis in Adults
Diabetes and Dehydration: A Dangerous Combination - Richard K. Bernstein, MD, FACN, CWS

Abbott Precision Xtra

If you are concerned, I would contact your doctor. Are you in Canada (guessing since you referred to “emerg”)? Why were you in emerg last night? Some provinces (like BC) have a health number you can call to talk to a nurse, though they may just tell you to go to the hospital since they can’t diagnose over the phone. Also, if I call my endocrinologist’s office after hours or on the weekend, it often (not always) has a number for an endocrinologist on call to contact for urgent questions.

I’ve also had Type 1 for a long time and, in my experience, when I’ve been sick I tend to get ketones even when I’m only running a bit high. When we’re sick, our body often needs more insulin than it normally does, and so if we don’t increase the amount of insulin we’re taking to meet this increased need, our body starts burning ketones. This is why people with Type 1 are told to check for ketones if they are sick or have an infection of some sort. There are other reasons that people can burn ketones, like those mentioned above, but if you’re not eating a very low carbohydrate diet and haven’t been very active and have been eating and you’re feeling sick enough to be worried, I’d err on the side of caution.

I’ve always been given instructions to drink more fluids, eat or drink something with carbohydrates (unless blood sugar is very high), and take extra insulin. If you have ketones from being sick, then you often need extra insulin above and beyond what would normally be used to bring down your blood sugar. I can’t provide any specifics, though, since instructions would vary for everyone. It might be good to talk to your endocrinologist about “sick days rules” so that you have a plan for the next time you’re sick.

Hope you feel better soon.

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Per Gary Scheiner

“Ketones should be checked any time you experience an unexplained high blood sugar or feel ill. In many instances, you will not be ketotic. But sometimes you will. Just remember that detecting ketones at the earliest possible stage allows you to fix the problem and avoid prolonged periods of high blood sugar, extreme discomfort, and possible progression to the next, more dangerous stage. In most cases, ketones can be eliminated by taking extra insulin (via pen or syringe) and plenty of fluids. You should notify your doctor when ketones are present, and exercise should not be performed until the ketones clear up completely.”

“Ketones, Shmeetones.” by Gary Scheiner, MS, CDE

Let me repeat what I said earlier. If you have been fasting, such as when you are sick, your body will be burning fat (and generating ketones) to provide you energy. This happens all the time, every night when you sleep or otherwise don’t eat and this is just what your body does. The real concern with ketones is when you have a high blood sugar (like > 15 mmol/L (300 mg/dl)) and/or are severely dehydrated and then have ketones. Your blood sugar was 9 mmol/L (162 mg/dl), not a particularly elevated level. You likely were able to bolus to restore an absolutely normal blood sugar, which in itself essentially “proves” you don’t have DKA. If you bolus and cannot restore a normal blood sugar that is a red flag.

ps. Note that it is always important to stay hydrated when sick, not just water but electrolytes as well.

yes, last night I tested my meter to another meter and was the same result - normal blood sugar but still keytones

I haven’t had a high blood sugar so why am I getting keytones?

The whole idea with ketones and sick days is to prevent DKA, not treat DKA. If someone is in DKA (the acidity of their blood changes) it requires hospitalization and can’t be treated at home. Sick day guidelines for those who are prone to developing DKA don’t require high blood sugar before action is taken to get rid of ketones. It’s a good idea to develop a sick day plan with your doctor that outlines what to do when and also when to become concerned.

I don’t disagree with @Jen, but the problem is that health professionals confuse the presence of ketones as only associated with DKA when in fact the presence of ketones is a normal condition associated for normal blood sugars and fasting. Low carb diets (so called ketogenic), sleeping, fasting and exercise are all known to result in measurable amounts of ketones and those ketones do not represent an emergency unless they occur with severe dehydration and/or very high blood sugars.

This is true about some regular activities generating ketones. But sometimes it can be hard to tell the difference, and medical professionals like to err on the side of caution.

I think moderation is key. Don’t freak out and run to the hospital at any small trace of ketones, but also don’t ignore ketones and brush them off as nothing. Some people who have very tight control and eat a very low carbohydrate diet and have never been near or in DKA tend to never check for ketones, but some people have had DKA in the past and can be at risk of going into DKA over a matter of hours. I think these two situations are quite different in terms of monitoring and precautions.

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as Has been said, small ketones and up to 5 with normal BG can be a normal part of life. I would start treating with a sustained high BG over 10-13 and over 1.5 …My guess is the idea is not to get anywhere near true DKA levels which can snowball quickly, as the links have show…
http://www.healthline.com/diabetesmine/ask-dmine-dka-detective#2

this may help for sick days
https://c.ymcdn.com/sites/www.ispad.org/resource/resmgr/Docs/CPCG_2014_CHAP_13.pdf

this flow chart is good too, but it’s in euro numbers
http://www.leicestershirediabetes.org.uk/uploads//documents/Type1 Sick_day_rules_InsulinV3.pdf