Consistently high blood glucose but low ketones?

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Lauren95

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Type 1
Hi everyone,

I already posted a bit about this on the newbies forum, but I thought I'd make a specific thread as I have more questions. I have just been diagnosed with diabetes (type 1 LADA) and have been getting consistently high blood glucose levels - my personal record is now 27.5 as of last night, however my ketones have never gone above 0.2. Has anyone else encountered this? I've tried looking online elsewhere and can't find any solid information as to why this is happening. I'm glad I'm not getting high ketones, but I don't understand why they aren't rising with the BG too?

Secondly, I just started gliclazide today properly to help control the sugar spikes. Maybe it is just too early for it to work well or something, but after lunch today I still got up to 16.9 and am not feeling well at all still. Is it worth contacting the diabetes nurse at the hospital about? She said to phone if I get high teen/20s levels when we were talking before I started the gliclazide, and I still have only 0.1 ketones so I don't know if it's worth phoning?

On a related note, can stress elevate BG to a significant extent? I've been super stressed about my upcoming university exams and I wondered if this could be contributing to the fact that I appear to be getting worse as the weeks go on?

Many thanks in advance 🙂
 
Yes, stress can certainly elevate levels! 😱 Some people do actually drop low, but most people find stress to be a real problem in causing high levels (stress hormones cause the liver to release extra glucose).

I would contact the nurse as well about the blood sugar levels, you must feel horrible at those levels. I'm no expert, but what may be happening is that, even though your levels are high, indicating insufficient insulin circulating, you have enough to manage the processing of ketones from your body. I've had high ketones on two occasions, and on both occasions it was because I was very ill and not eating - my body had no source of energy other than my fat and muscle tissue. As soon as I was able to manage eeven small amounts of carbohydrate my ketones reduced significantly. Since you are eating it looks like your body is just about managing without having to burn fat.

I think you would be better off on insulin really, even if it's only to give 'correction' doses for high blood sugar levels, or maybe a basal insulin that would bring your general levels down so they are not already starting from a high place then climbing higher.
 
I agree fully with your response Alan - and I've though as per your last paragraph ever since Lauren's first post.

(Shame me and you can't prescribe! LOL)
 
Yes, absolutely, I completely agree with Alan too.

I don't get high ketones with spikes - in fact, I've never had anything other than neg. ketones since I was first diagnosed (by being rushed to hospital with diabetes ketoacidosis). But I do get really sleepy and feel awful and need to have insulin to deal with them. And about five minutes after having a correction dose of insulin I feel absolutely fine.
 
Hi, sorry to here your not great and high bloods. Do take insulin like through pen or pump? If so I have some advice due to this happening to me too a couple of months ago.
 
Hi guys, thanks for the replies. To clarify, the night before last when I was 27.5 I went to the out of hours clinic in the infirmary and as I was just starting to go down again on my own, they gave me aspirin and sent me home to bed. Last night as I was still in the 20s - despite having started gliclazide that morning and having taken an extra dose with dinner, as the nurse suggested when I phoned (as pre-dinner I was still 13.8). At the out of hours last night they didn't really do much again, which was concerning to me as I'd already maxed out the gliclazide. They just gave me some aspirin again to stop me feeling quite so bad (didn't work particularly well) and had me wait for a while so they could see if I was still rising etc. Eventually, about an hour after I peaked, and about 4 hours after I'd taken the second gliclazide I started going down on my own so they sent me home again. It's quite frustrating to be told that if I get high bg I should phone the nurse and then they tell me to go in to the hospital, only for me to wait a bit and then be sent home. I can't help feeling that I should be on insulin or something already, as I'm feeling consistently rough and spiking after every meal - even low carb meals (had Japanese for dinner yesterday that was mostly vegetables and pork so I thought I would be okay) and this is despite taking the gliclazide as instructed. My first exam is tomorrow and I honestly don't know how I'm going to cope as either I'm going to try and not eat anything and potentially risk a hypo (or just be hungry the entire exam), or I'll eat but then feel crap and not be able to concentrate as I doubt I won't spike again... doesn't help that exam is 9-12:30 and as this has happened so fast I haven't had a chance to submit all the paperwork to get exam adjustments to be able to bring food etc in, so I won't be able to do anything if I decide not to eat and then go to the low extreme (which I kind of doubt I will, but who knows, the nurse kept emphasising the risk of hypos if I don't eat regularly with gliclazide so....) Sorry for the long rambling rant, just very frustrated and anxious feeling right now :(
 
Milsey moo said:
Hi, sorry to here your not great and high bloods. Do take insulin like through pen or pump? If so I have some advice due to this happening to me too a couple of months ago.
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I don't take insulin yet, I'm only on gliclazide, which is a pill supposed to stimulate me to produce more insulin myself, as I should have some beta cells left to do the job, just not as many as non-diabetics
 
I really feel for you, especially with doing exams. The problem with the out of hours clinic, is they will only be interested in making sure you are not at risk at that time. They will not be looking at the bigger picture with regard to your diabetes. I remember my gp sending me to casualty as I had high ketones for 2 days in my urine. But A&E weren't interested as I wasn't in DKA and just sent me home. I had to get referred to the Disbetes specialists in the hospital, which I really think would be best for you. Can you find any contact numbers on your hospital website?
I can remember how rubbish I felt with high blood sugars, perhaps you can contact whoever you are doing exams through (college, uni etc) and see what support they can offer?
Best of luck
 
stephknits said:
I really feel for you, especially with doing exams. The problem with the out of hours clinic, is they will only be interested in making sure you are not at risk at that time. They will not be looking at the bigger picture with regard to your diabetes. I remember my gp sending me to casualty as I had high ketones for 2 days in my urine. But A&E weren't interested as I wasn't in DKA and just sent me home. I had to get referred to the Disbetes specialists in the hospital, which I really think would be best for you. Can you find any contact numbers on your hospital website?
I can remember how rubbish I felt with high blood sugars, perhaps you can contact whoever you are doing exams through (college, uni etc) and see what support they can offer?
Best of luck
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I have actually already made an appointment with my tutor but as he's been away this week, the soonest he could see me is tomorrow, after my first exam, so we'll see how tomorrow goes.. :/ As for the specialists, I do have a phone appointment with the proper diabetes nurse on Tuesday, but it's a bit annoying that there's only the nurses from nhs24 that are available during the weekend, and as they don't know me, their only advice is just go to out of hours it seems.
 
Hi guys, just to let you know, I had an appointment yesterday, and as my levels have been so erratic even with gliclazide, they've decided to put me on insulin. So far it's just Lantus basal insulin, and 4 units in the evening. I took it for the first time last night (and when I say I took it, I mean I had to get my flatmate to do it for me because I chickened out!!) and I woke up at 7.8! The previous few days I've been 10-12 so I'd say it appears to be working so far! 🙂 I also have Novorapid, but I'm not taking it yet. They gave it to me as they think I'll probably end up needing it soon and it was easier to just prescribe it then. Oh and one more thing, they've changed my official diagnosis from LADA to normal type 1! On a previous thread I said that I had been positive for one antibody test and negative for the other, when I was in yesterday the nurse told me that actually I had been positive for both, they'd just messed up apparently? Slightly concerning, but it does explain why the past few weeks I've been kind of spiralling out of control and getting rapidly worse! So thank you all for the support so far! 🙂
 
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Glad you're now sorted out, Lauren.🙂
 
Oh - that's great Lauren! - well not great cos having D in the first place isn't brilliant LOL - but when you clearly weren't getting the right medication for it, it always worries me no end.

You know it flipping baffles me - Crikey - all those years ago I was 22 and married with my own home so no kiddie, but I went to my GP, he said he was 99.9% certain it was T1, sent me to hospital and that was that - there was never any suggestion that it wouldn't be Type 1. So how the hell can there be now - when someone is that young?
 
trophywench said:
Oh - that's great Lauren! - well not great cos having D in the first place isn't brilliant LOL - but when you clearly weren't getting the right medication for it, it always worries me no end.

You know it flipping baffles me - Crikey - all those years ago I was 22 and married with my own home so no kiddie, but I went to my GP, he said he was 99.9% certain it was T1, sent me to hospital and that was that - there was never any suggestion that it wouldn't be Type 1. So how the hell can there be now - when someone is that young?
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I think there was some doubt in the beginning as I never have gone into DKA (or had high ketones even) which is apparently how most t1s are first diagnosed, so they thought it was maybe just progressing super slowly. That coupled with the fact that they originally misinterpreted my antibodies test as only being positive for one, not both, meant it could have progressed slower and fallen more under the category of LADA, though having done more research now I think I agree with what someone said above, that maybe LADA isn't that useful a label as it's all autoimmune type 1, just sometimes it comes on slower.

Also, I've been around 7-9 all day, which is sooooo much better than going between teens and 20s, so being on basal insulin seems to be really working for me!! I feel like I'm so much more lively today than I have been the past few weeks, and I'm not having as much trouble concentrating on revision anymore :D :D
 
Great news Lauren, I remember that feeling when I finally went on insulin, like coming out of a fog into sunshine again. Best of luck with exams
 
Really good to hear you have a proper diagnosis and have been given the right treatment Lauren 🙂 Let us know if you have any questions, I hope it goes well and you feel much better 🙂
 
Lauren95 said:
Hi everyone,

I already posted a bit about this on the newbies forum, but I thought I'd make a specific thread as I have more questions. I have just been diagnosed with diabetes (type 1 LADA) and have been getting consistently high blood glucose levels - my personal record is now 27.5 as of last night, however my ketones have never gone above 0.2. Has anyone else encountered this? I've tried looking online elsewhere and can't find any solid information as to why this is happening. I'm glad I'm not getting high ketones, but I don't understand why they aren't rising with the BG too?

🙂
Click to expand...

Just from my own experience....
I had BG levels of 31+ (it just showed as high on my meter) and no keytones using dip sticks.
I went to A+E and they admitted me straight away and put me on a sliding scale to get the BG under control, I believe being too high can be dangerous too.
 
Well ketone dipsticks only tell you what was in your bladder 2 hours ago - they always were pretty useless and still are.

I wasn't in DKA but I was always thirsty always drinking therefore always peeing, had suddenly lost weight even though I was skinny anyway, and suffering from palpitations. And boy - was I tired. Went to the surgery on the way home from work. GP listened to me and asked if I could go along to the nurses room to donate a pee sample. She tested it for glucose and whatever else they had dipsticks for in those days - and that was that - he'd already rung the hospital before I got back in his room. He told me what was up and that I would need to go to hospital - I needn't go tonight, I could go at 9am in the morning.

Could they test for ketones easily or, like blood glucose, was that one of the many things they had to take the daily armfuls of blood for, back then? Bloody vampires - every morning, every evening. For a fortnight!

I'd not seen a druggie then (well I haven't now but I've seen pictures LOL) but one way and another I should think all new T1s resembled human pincushions from their lower inner arms!
 
Okay, so last night was when I took the Lantus for the first time, but I completely chickened out and got my flatmate to inject if for me (slightly embarrassing that I couldn't muster the mustard to do it myself but I'd never even felt what an insulin needle would feel like in me before! I thought it would be very painful!). However the time just came to do it again, and it's probably a very routine thing for most of you guys now, but I'm actually inordinately impressed at and proud of myself because I DID IT ON MY OWN. I don't know if this is a big thing for most people but I feel like it is right now, so yay! I mostly didn't chicken out this time only because I'm still at the library and not at home, and my friends here were also too scaredy to do it for me, but now I know it really isn't as bad as I was thinking it would be at all, and I'm just super happy because it's taken a load off my mind that I didn't even realise was there as it's something I'm going to have to do the rest of my life! Sorry for the ramble, I'm just very happy now 🙂
 
Lauren95 said:
Okay, so last night was when I took the Lantus for the first time, but I completely chickened out and got my flatmate to inject if for me (slightly embarrassing that I couldn't muster the mustard to do it myself but I'd never even felt what an insulin needle would feel like in me before! I thought it would be very painful!). However the time just came to do it again, and it's probably a very routine thing for most of you guys now, but I'm actually inordinately impressed at and proud of myself because I DID IT ON MY OWN. I don't know if this is a big thing for most people but I feel like it is right now, so yay! I mostly didn't chicken out this time only because I'm still at the library and not at home, and my friends here were also too scaredy to do it for me, but now I know it really isn't as bad as I was thinking it would be at all, and I'm just super happy because it's taken a load off my mind that I didn't even realise was there as it's something I'm going to have to do the rest of my life! Sorry for the ramble, I'm just very happy now 🙂
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Excellent - well done Lauren! 🙂 It is a big thing, doing your first one - mostly fear of the unknown, but once you've got that over with you realise that you were imagining all sorts of horrors that don't exist 🙂 Lantus can sting a bit, but it's not as bad as stubbing your toe or stepping on a lego brick in bare feet 😱
 
I know exactly how you feel Lauren! The first time I had to inject myself it took me half an hour to get up the courage to do it & I cried for a good 20 minutes afterwards. 4 months later - I feel like a pincushion but I'm used to it, it only takes a few seconds & it's done & you can get on with your life... Til the next time!
 
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