Ketones Refresher

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The week before I started the Whole 30, I got a stomach bug.  It came on pretty suddenly.  Saturday night, my family and I went to see Disney on Ice.  When we got home that night my husband and I decided to have a bottle of wine and stay up and rent a movie.  We never do this; we always go to bed right after the kids especially since our baby wasn’t sleeping through the night (at all!).  But we thought we’d enjoy the Saturday night.  Of course our baby woke up a TON that night and Sunday morning I felt like death (complete exhaustion).  I’m not sure when the stomach bug officially hit but as the day progressed I felt worse and worse.  I went to brunch with some friends who were taking me out for my birthday and nothing on the menu looked good.  I was thinking I was just hungover/tired.  I ordered French Toast and only ate half of it before I started to feel really crappy.  I got home and ended up getting sick ALL afternoon.  I continued to get sick all night long as well.  On Monday, I was weak.  I didn’t attempt to eat anything but I did try to drink a little bit.

Tuesday morning I woke up to pee and it was really dark.  I figured that made sense since I hadn’t really eaten or drank anything in about 24 hours.  However, my blood sugars had been in the 300’s all night long despite all the bolusing I was doing.  Granted, I wasn’t bolusing as much as I should have been because I was worried about getting low and not being able to eat anything to bring it up but I was still putting insulin in and not seeing any results.  So I decided to check my ketones and they were HIGH.

Eek! High ketones!

In my recent memory (adulthood), I don’t recall having high ketones ever.  I don’t usually test but I haven’t really had a need to.  Last year, when I was pregnant, I got a stomach bug and I couldn’t keep anything down but even then, my ketones were only MEDIUM. So seeing high combined with high blood sugars really scared me.  I’ve never gone into DKA but the fear is there and especially since I was exclusively breastfeeding my baby, I didn’t want to have to deal with a hospital stay.

I called my endocrinologist but she was off and the receptionist said I could make an appointment and come in the next day.  However, I was freaking out that I needed to go to the hospital so I wasn’t happy with that answer.  The ketone instructions said that a high result combined with high blood sugars meant go to the ER.  I was hesitant to do this route because my insurance this year is crap and I didn’t want to have to pay $2,000 plus if I didn’t really need to.  Luckily, my husband called back for me and was more assertive to say that we needed to speak to a doctor.  While we waited to hear back from a doctor, I took to my support group and asked the DOC for some advice.  Thankfully, from Twitter to my Facebook groups, I had my fears calmed down some.

We finally did get a doctor to call us back and she told me just to increase my basal rate and take more insulin.  The insulin not only helps to bring my blood sugar down but was also helping the ketones.  She also said that as long as I wasn’t vomiting that I shouldn’t be too worried but to make sure my blood sugars came down over the next 6 hours.

HIGH blood sugars!!

This experience made me realize that I really don’t know much about ketones.  I’ve never had ketones that I’m aware of.  I did Google some and found some useful websites:

Healthline’s Blood Glucose Management: Checking for Ketones

Diabetes Self-Management: Getting to Know Ketones

Diabetes Self Management: Clearing Up the Confusion

Takeaways from the above websites:

  • Ketones are formed when fat is burned by energy, which is totally normal.
  • In a non-diabetic, ketones can form when carbohydrates are absent and are not a cause for concern as insulin, glucagon and other hormones regulate the hormone level.
  • Diabetics need to be concerned because sometimes the ketones can build up in their blood, most likely as a result of not enough insulin to move the carbs from the blood stream to be used as energy.
  • Ketones lower the pH of the blood, causing it to be acidic, resulting in DKA (Diabetic ketoacidosis).
  • There are two ways to test for ketones, blood and urine.  The blood test is slightly more accurate and a better reflection of what your ketones currently are.  Urine has a slight lag in time.
  • When testing with blood, here are the ranges:
    • less than 0.6mmol/liter – normal range
    • 0.6-1.5mmol/liter – moderate range
    • 1.6-3.0mmol/liter – high range
    • 3.0mmol/liter – very high range
  • Signs of DKA:
    • Excessive thirst
    • Frequent urination
    • Nausea and vomiting
    • Abdominal pain
    • Confusion
    • Weakness and fatigue
    • Shortness of breath
    • Fruity-smelling breath
  • When to check ketones:
    • When your blood sugar is higher than 250 mg/dls more than two checks in a row (I never do this!)
    • When you are sick or have an infection
    • When you are going to exercise and your blood sugar is above 250 mg/dls.
    • When you are pregnant

The above is a very generalized explanation of ketones but it helped me to realize that I didn’t necessarily need to freak out.  I wasn’t exhibiting any of the signs of DKA, just the high ketones and high blood sugar.  My urine test was in the high range but my blood test was 1.2, which is in the moderate range. I am sure if I didn’t catch it as soon as I did, it could have quickly progressed to DKA.  I followed the doctors orders and gave myself more insulin and my blood sugars slowly started to come down and I re-tested and the ketones were gone-phew!

All Gone, phew!

It was a pretty scary 24 hours as I haven’t really dealt with ketones or DKA in my recent memory.  It was also interesting timing because I was getting ready to start the Whole 30.  One interesting thing about the Whole 30 is that by eliminating carbs, you are using fat for energy and a trace of ketones is normal when doing this diet.  For a non-diabetic, a small trace of ketones isn’t too concerning while doing the diet.  In the beginning of doing the diet, I worried about ketones since my episode was so fresh in my mind.  After doing a lot of research I learned that a lot of people that do low carb diets don’t have issues with ketones.  I did have a few days where I was worried but I realized it had more to do with dehydration than low carb.

While everything turned out fine for me, it’s definitely a wake up call that I need to make sure I’m drinking enough water and that I work hard to keep my blood sugars lower.  I’ve really been struggling recently with my blood sugars and while I don’t plan to get another stomach bug anytime soon, I need to be proactive about lowering my blood sugars so I don’t have to deal with this situation again.

Before the fun started – At Disney on Ice!

Categories: T1D

4 thoughts on “Ketones Refresher

  1. Kelley, thank you for this information.After 62 years with T1, I fortunately have no experience with DKA, but then again, I never test. The one time I may have been close to the symptoms you describe was in 1969, when I got the flu. That was before blood glucose monitors were available for home use. I ended up in the hospital for two days, but never heard any staff mention DKA.

    I’m bookmarking your post as a reference. Hope I won’t have the need to check symptoms .

  2. I also have never had DKA after 43 years of T1. Of course I have not been diligent about checking Keytones. So I recently while with the flue I sent Sheryl to the store for DKA strips. Turns out I was showing a trace. But I had to be reacquainted with Keytone strips. I liked my life before the flu better.

    • Loved the poem! Yes, you reminded me how my urine strips were technically expired when I used them but they were only about a month expired so I went with it.

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