advice needed please

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Kezz72

Kezz72

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Relationship to Diabetes
Type 1
Hi all , my son has got high keytones but he’s hypo , he’s been being treated for ibs as this last 3 months he’s been having tummy pains ,sick ,runs , he’s lost appetite due to pain and feeling sick , help any advice please
 
If it were me, I'd want him seen by a doctor tonight. Have you got an urgent care centre you can take him to or A&E? Or out of hours GP number? Failing that, call 111 but don't be fobbed off.
 
If people with diabetes don't eat and don't produce enough digestive glucose to satisfy brain requirements, the body will start absorbing body fat via the krebs/citric acid cycle to produce ketones that can more easily be converted to ATP to fuel the brain and body.
In fact the conversion of ketones to ATP gives more ATP (energy) than the conversion of glucose to ATP
 
Robert459 said:
If people with diabetes don't eat and don't produce enough digestive glucose to satisfy brain requirements, the body will start absorbing body fat via the krebs/citric acid cycle to produce ketones that can more easily be converted to ATP to fuel the brain and body.
In fact the conversion of ketones to ATP gives more ATP (energy) than the conversion of glucose to ATP
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He can’t eat as he instantly throws it back up and has runs , I’ve given him electrolytes
 
Catbanj said:
If it were me, I'd want him seen by a doctor tonight. Have you got an urgent care centre you can take him to or A&E? Or out of hours GP number? Failing that, call 111 but don't be fobbed off.
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I’ve rang and text and waiting for call
 
Sorry to hear about your son @Kezz72 :(

What levels of ketones did he have last time you checked?

Can he keep water down?

What is his BG level?

Do you have basal insulin he could have?

Glad you have called NHS 111.

Hope he gets prompt attention and recovers speedily.
 
Kezz72 said:
Hi all , my son has got high keytones but he’s hypo , he’s been being treated for ibs as this last 3 months he’s been having tummy pains ,sick ,runs , he’s lost appetite due to pain and feeling sick , help any advice please
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Has he been tested for Coeliac disease?
 
everydayupsanddowns said:
Sorry to hear about your son @Kezz72 :(

What levels of ketones did he have last time you checked?

Can he keep water down?

What is his BG level?

Do you have basal insulin he could have?

Glad you have called NHS 111.

Hope he gets prompt attention and recovers speedily.
Click to expand...
Thank you , keytones now 2.4. water yes , degludex has just been lowered , he has starvation keytones and gastropriosis ,with all the tests the last few weeks and what’s happening now its not good so it might not be ibs at all they said but gp was sent a letter for further investigation when he was admitted and nothing had been done , so all this time ,we’ve been waiting for answers and it’s now affecting his diabetes , he’s so poorly
 
Kezz72 said:
No that was my first initial response due to the dairy products not settling , there saying it could be gastropriosis due to him having diabetes for such a long time
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Unfortunately no matter what the problem is the first diagnoses is always it's your diabetes. So you have to point out to them that there is no such condition called it's your diabetes.
How long has your son had diabetes for?
 
Hello- i have a related question to this issue so was hoping @Pumper_Sue or @Robert459 you could expand on your answers a bit to help me. My 18YO daughter has T1. She has recently tended to get nauseous/vomit when stressed, then doesn't eat as she can't keep anything down, then gets fluctuating raised ketones over the next few days (not super high, 1- 1.4) which then (i presume) makes her feel sick even after the stress has passed, so she doesn't eat etc etc The whole cycle seems to take about 7 days, with her drinking masses of water to try to get rid of the ketones, till she feels up to eating properly (has happened 3 times in the last year). Her BG is well controlled throughout, even with the initial stress (4-8mmol/L) with occasional hypos treated with Glucogel.

I am baffled. Is the lack of food causing the raised ketones? I have read that as long as she is getting insulin via her pump that the ketone levels won't/can't go dangerously high- is that true? Any idea why they would be fluctuating? Any thoughts on how we can bring them down? (should she try to eat small meals at the risk of throwing them up?) The diabetes paeds team don't seem very interested unless her BG is raised, which i guess is reassuring. (?)

Clearly i will try to help her tackle this by managing her anxiety as well. However i would appreciate your help on the 'ketones while BG is low' conundrum as it has us stumped! thanks
 
If she’s not eating, they could be so-called starvation ketones. IMO, it’s best to eat something and bolus some insulin to get them down. It doesn’t have to be a lot - a piece of toast, etc, or some crackers. If she finds food difficult, maybe some soup or jelly or ice cream.

Pump users are at increased risk of DKA so I’m always wary of ketones.
 
Inka said:
If she’s not eating, they could be so-called starvation ketones. IMO, it’s best to eat something and bolus some insulin to get them down. It doesn’t have to be a lot - a piece of toast, etc, or some crackers. If she finds food difficult, maybe some soup or jelly or ice cream.

Pump users are at increased risk of DKA so I’m always wary of ketones.
Click to expand...
Thanks so much. I think it must be that. I wasn’t aware pumps put you at increased risk of DKA, useful to know.
 
CharlotteScr said:
Thanks so much. I think it must be that. I wasn’t aware pumps put you at increased risk of DKA, useful to know.
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Yes, it’s because we don’t have any long-acting insulin on board. Things can change quite quickly if you’re on a pump so I’m always very cautious. Getting some insulin and food in should help clear the ketones. Even sipping full sugar coke can help if she’s struggling to eat. I recommend little and often rather than large amounts.

There’s a medication you can get from a GP that treats nausea. I’ve been trying to remember the name but failing. One of my children had anxiety and nausea and it helped a lot - psychologically as well as physically. It might have begun with M but I’m not sure. Apologies, but hopefully your GP will know.
 
Inka said:
If she’s not eating, they could be so-called starvation ketones. IMO, it’s best to eat something and bolus some insulin to get them down. It doesn’t have to be a lot - a piece of toast, etc, or some crackers. If she finds food difficult, maybe some soup or jelly or ice cream.

Pump users are at increased risk of DKA so I’m always wary of ketones.
Click to expand...
Thanks so much. I think it must be that. I wasn’t aware pumps put you at increased risk of DKA, useful to know.
Inka said:
Yes, it’s because we don’t have any long-acting insulin on board. Things can change quite quickly if you’re on a pump so I’m always very cautious. Getting some insulin and food in should help clear the ketones. Even sipping full sugar coke can help if she’s struggling to eat. I recommend little and often rather than large amounts.

There’s a medication you can get from a GP that treats nausea. I’ve been trying to remember the name but failing. One of my children had anxiety and nausea and it helped a lot - psychologically as well as physically. It might have begun with M but I’m not sure. Apologies, but hopefully your GP will know.
Click to expand...
No that’s very helpful, thank you. I will talk to the GP. You’re right, the worry about being sick and the ketones causes anxiety as well. Thanks very much indeed for your help
 
CharlotteScr said:
Thanks so much. I think it must be that. I wasn’t aware pumps put you at increased risk of DKA, useful to know
Click to expand...
My understanding is that the reason that pump users are at higher risk of DKA is if the pump goes wrong, and we don’t do anything about it. This is because we have no long acting insulin working for us. Once the pump stops there is nothing present. Providing our pump is working effectively ketones are no more likely to develop.

To avoid this issue, we need to respond to any alarms from our pumps, and also have a back up of pens with us. I do this if I am more than an hour from home.

I hope that your daughter can get round the issues. The ketones that she is experiencing do sound like starvation ketones, so a little food or liquids with carbs in could well help to prevent the cycle.
 
Thanks so much everyone for your answers. You will hear this all the time (i hope!) but let me say how helpful it is to hear from others who empathise and want to give practical help! You really do give us relative diabetes newbies hope. Thank you.
 
CharlotteScr said:
was hoping @Pumper_Sue or @Robert459 you could expand on your answers a bit to help me. My 18YO daughter has T1. She has recently tended to get nauseous/vomit when stressed, then doesn't eat as she can't keep anything down, then gets fluctuating raised ketones over the next few days (not super high, 1- 1.4) which then (i presume) makes her feel sick even after the stress has passed, so she doesn't eat etc etc The whole cycle seems to take about 7 days, with her drinking masses of water to try to get rid of the ketones, till she feels up to eating properly (has happened 3 times in the last year). Her BG is well controlled throughout, even with the initial stress (4-8mmol/L) with occasional hypos treated with Glucogel.

I am baffled. Is the lack of food causing the raised ketones? I have read that as long as she is getting insulin via her pump that the ketone levels won't/can't go dangerously high- is that true? Any idea why they would be fluctuating? Any thoughts on how we can bring them down?
Click to expand...
Hello, we don't log on every day so may be a bit late on this. When first diagnosed (2003) T1 in hospital with DKA was disgusted with my body's loss of control. Read a lot about diabetes and cell respiration, college level, research stuff. Decided to go on a zero-carb diet to try to beat the diabetes.
.
Managed it for over a year, zero carbs, a sandwich would be two cheese slices with a chicken slice or smoked salmon inside, meals: meat, eggs, no veg or carbs. My bg level was 4-5 all the time so it works. It was hard. Ketones were high. A classic "Atkins" induction diet. We were in 'ketosis' all the time with no ill effects other than food boredom.
.
Eventually succumbed to some pizza and gave up.
Asked DM consultants what the difference was between DKA and 'Atkins', they couldn't answer.
We assume it's the low BG levels of 'Atkins' no matter what the Ketone levels were.
So, in answer to your question...

I have read that as long as she is getting insulin via her pump that the ketone levels won't/can't go dangerously high- is that true? Any idea why they would be fluctuating? Any thoughts on how we can bring them down?

Maybe, as long as her BG level is good, forget about the ketones ?

NOTE: I am not a medical professional, it is just my personal experience
...so do NOT follow my experience, but everything above is the truth.

We wish you and your daughter well x
 
Robert459 said:
Hello, we don't log on every day so may be a bit late on this. When first diagnosed (2003) T1 in hospital with DKA was disgusted with my body's loss of control. Read a lot about diabetes and cell respiration, college level, research stuff. Decided to go on a zero-carb diet to try to beat the diabetes.
.
Managed it for over a year, zero carbs, a sandwich would be two cheese slices with a chicken slice or smoked salmon inside, meals: meat, eggs, no veg or carbs. My bg level was 4-5 all the time so it works. It was hard. Ketones were high. A classic "Atkins" induction diet. We were in 'ketosis' all the time with no ill effects other than food boredom.
.
Eventually succumbed to some pizza and gave up.
Asked DM consultants what the difference was between DKA and 'Atkins', they couldn't answer.
We assume it's the low BG levels of 'Atkins' no matter what the Ketone levels were.
So, in answer to your question...

I have read that as long as she is getting insulin via her pump that the ketone levels won't/can't go dangerously high- is that true? Any idea why they would be fluctuating? Any thoughts on how we can bring them down?

Maybe, as long as her BG level is good, forget about the ketones ?

NOTE: I am not a medical professional, it is just my personal experience
...so do NOT follow my experience, but everything above is the truth.

We wish you and your daughter well x
Click to expand...
Thanks @Robert459 that's very interesting. Absolutely take your note of caution. Very useful to hear your experience and I am coming to that conclusion as well. I just want her to feel well, so will focus on that not get preoccupied with ketones while her BG is so well controlled
 
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