Why do I have ketones?

So something strange happened to me yesterday. The day started out normal, I woke up with a BG of 157, I gave a bolus to bring me down to a good number. I took my morning pills (Metformin, birth control, low dose aspirin, metoprolol…and a new drug I just started called Cymbalta) with a glass of water. I ate eggs and sausage for breakfast, a larger breakfast than I normally eat, but not huge. I did a mid-morning workout -a short ten minute ride on my bike. Lunch was very small because I wasn’t hungry and had zero appetite, but my BG felt as if it was dropping (even though the meter said 97 and holding steady) so I forced myself to drink a cup of coffee with a bit of vanilla cream and a slice of pepper jack cheese. I felt much better immediately after I ate.

Later in the day, around 4ish, I began to feel nausea but I ignored it. My BG was at 116 at this time. Around 5:30 I ate a decent meal comprised of low carbs, lots of veggies and some meat and cheese. This made the nausea go away and all was good for several hours.

I noted that I was eating more protein today than I usually do.

I checked my BG a couple of times throughout the evening, it held steady at around 118 until I ate a Snow Ball (a cake type treat), I bolused for it of course but my BG still spiked as high as 213 so I corrected.

Around 9:30 I began to feel nausea again. By 11:00 my BG was still high at 197. I corrected again but took into consideration that I still had insulin on board so I took less.

Around 11:30 I checked for ketones because the symptoms I was feeling reminded me more of DKA than a stomach bug or flu. The test indicated I had moderate ketones (over 40 mg/dl).

I vomited.

After the puking I felt much better. I drank a large glass of water and then went to bed. My BG at this time had dropped down to 159.

I don’t understand why I would get sick with ketones when my BG’s have been very good this past week (primarily in the 80-140 zone).

Things I’ve changed this week are that I’m doing much more exercise, to the point were my muscles have been sore, I take a higher dose of Metformin (2K mg, up from 1500 mg), and I started Cymbalta. I had to stop taking Farxiga (last pill was on Friday morning). I did slack on my water intake yesterday. And I just got a flu vaccine and tetanus shot on Friday morning.

The only times I’ve ever experienced DKA was when my BG was massively high over an extended time and I had a virus. I know it’s possible to have moderate to high ketones with normal BG, but I’d like to figure out how this happened so I can prevent it from happening again.

I figured out that it is the Cymbalta that is causing my nausea. But that still doesn’t answer why I had ketones. Last I checked the ketones are now down to small so no worries, but I’d still like to know what caused the rise.

Ketones are your bodies way for energy, and your description sounds like you have something (sick, or infecton.) so in instances like this your body needs more energy than what it is getting. Hello Ketones. Ketones usually show up when you are sick. even if your blood sugar is good. It is your bodies way of saying extra energy. I am not a doctor, but this is something I learned. even if it is a side effect of a medication, your body still thinks its sick.

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I seem to get ketones very easily if I’m taking even a tiny bit less insulin than I need. If I have a bad pump site and insulin is cut off completely then ketones and blood sugar go high very quickly, and same if I try to exercise while disconnected from my pump (can’t do it without ending up with high blood sugar and very high ketones an hour later). But I once had ketones for days and my blood sugar wasn’t that high, but they went away when I put my basal rate up a tiny amount. Same thing when I’m sick, I can get ketones the entire time even if my blood sugar isn’t running that high and I’m eating. Of course, there’s also the ketones that you’ll get if you don’t eat or eat very low amounts of carbohydrates.

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i found out if i take a bit less insulin than I need i get them.

So ketones can happen naturally for anyone. When you sleep overnight and are fasting you can have trace levels of ketones. When you exercise you can get a spike in ketones as you burn fat. And ketones don’t just disappear. If you test ketones with ketostix it will depend on how long the urine has sat around (possibly hours). And even a ketone meter isn’t immediate as excess ketones are excreted over time.

It is also possible that medications are involved. I wouldn’t have throught of Cymbalta, but I immedately thought Farxiga as it can cause dehydration which can be the cause of your nausea and increase the risk of ketones and DKA. And the same thing if you are on a diuretic. In fact the FDA has been collecting data and having studies done of so called “normal” blood sugar DKA with the SGLT2 drugs like Farxiga.

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Take your Cymbalta in the middle of a meal and you shouldn’t have any nausea after a few days. It’s worth the short-term trouble!

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I was wondering if the increase in exercise had maybe caused the ketones. I doubled my exercise this week and was really working hard at pushing myself with it.

Ketones are part of your body’s natural way of using fats for energy; your liver converts fats to ketones so that the rest of your body can use them. However, when your body runs short of insulin, your liver converts too much fat to ketones, and you get the various side effects of having too much ketones.

  1. As several people have stated, cells can use both glucose and ketones as an energy source. The body produces ketones by metabolizing fat.
  2. From your post, it looks like you didn’t eat any carbs until dinner, which means that your mid-morning exercise plus your regular daily activities were fueled by ketones.
  3. If you ate carbs before exercising on previous days, then your body would not have produced as many ketones as it did on this day.
  4. Doubling your exercise would likely increase the amount of ketones your body produced.
  5. Cells use the same receptor to move both glucose and ketones from the bloodstream into the cell. This means that your body needs insulin to use ketones just as much as to use glucose.
  6. Since you are taking metformin and no insulin, I assume you have T2D which means you are insulin resistant which means your body doesn’t move ketones from the bloodstream to the cells very efficiently.
  7. Metformin reduces blood sugar by suppressing the liver’s glucose production. It has no impact on how much insulin you produce or how effective your insulin is.

All these things together can account for the build up of ketones over the course of the day. Brian also makes a good point about urine ketones being several hours behind blood ketones which may account for them still measuring at moderate at 11:30 pm.

I am type 1, I do use insulin. I am on Metformin because I am insulin resistant.