Ketone levels

[Annette Arundell]

I have been diabetic for 15 years , but I am really worried as a type 1 diabetic I wake in the middle range of ketones every morning? I have ketones all the time throughout the day, I have spoken to consultant and DN, but they tell me not to keep testing, which is a strange thing as I am in the numbers to check every 2 hours every morning, and it does affect me, I feel nausea, and my pulse high, I've woken up last 3 mornings like this then they come down , then rise again in afternoon, I am taking regular insulin. When i wake in morning blood glucose is normal, then an hour later when I get up before breakfast it rises to around 12, and ketones between 1 & 1.1 every morning, I cant think why they would rise when I'm in bed. can any one shed light on this please as my diabetic team cant, and although not dangerous numbers are frightening, I am not on a low carb diet, and I'm taking more insulin than ever.

 

[Inka]

@Annette Arundell Sounds like ‘feet on the floor’ syndrome - ie your body starts pumping out glucose as soon as you get up. Mine does the same but not to that extent.

When did you last do a basal test? If your basal is ok then, you could bolus a small amount of insulin on getting up to stop that rise. I do that if i have to delay breakfast.

 

[rebrascora]

Hi and welcome.

It sounds like you need help to improve your BG management to prevent the high BG levels and ketones. How are you measuring ketones? Blood glucose strip or Ketostix to dip in your urine? If the latter I would be wary of their accuracy. If the former I am impressed that they are continuing to supply you with enough to test so regularly, as they are very expensive. I would have thought that that would have put pressure on them to help you manage your levels better.

Have you had any educational courses like DAFNE (Dose Adjustment for Normal Eating) or an equivalent carb counting course?
Which insulin(s) do you use? Are you on MDI (Multiple Daily Injections) or an insulin pump?
Do you know how to do a basal test?
Do you check your BG with a finger prick or do you have a Freestyle Libre sensor which you scan to get readings?
What was your most recent HbA1c result?

Sorry, lots of questions, but the more info you can supply us, the more chance we have of understanding what is going on.

The increase on a morning is Dawn Phenomenon or "Foot on the Floor" syndrome as @Inka mentioned. I inject 1-1.5 units of rapid acting insulin to cover it as soon as I wake up. What is your reading when you first wake up if it then increases to 12?
Personally I would not test for ketones unless my BG was 15 for several hours and not coming down with correction doses of rapid acting insulin, but that is just me. I don't think you need to test with a BG under 14. Have you considered that your symptoms may not be linked to your BG or ketones?

 

[Annette Arundell]

Hi ok I will but it stays like this all day, it goes down, then back up, I take 2 x 10 units o

Hi and welcome.

It sounds like you need help to improve your BG management to prevent the high BG levels and ketones. How are you measuring ketones? Blood glucose strip or Ketostix to dip in your urine? If the latter I would be wary of their accuracy. If the former I am impressed that they are continuing to supply you with enough to test so regularly, as they are very expensive. I would have thought that that would have put pressure on them to help you manage your levels better.

Have you had any educational courses like DAFNE (Dose Adjustment for Normal Eating) or an equivalent carb counting course?
Which insulin(s) do you use? Are you on MDI (Multiple Daily Injections) or an insulin pump?
Do you know how to do a basal test?
Do you check your BG with a finger prick or do you have a Freestyle Libre sensor which you scan to get readings?
What was your most recent HbA1c result?

Sorry, lots of questions, but the more info you can supply us, the more chance we have of understanding what is going on.

The increase on a morning is Dawn Phenomenon or "Foot on the Floor" syndrome as @Inka mentioned. I inject 1-1.5 units of rapid acting insulin to cover it as soon as I wake up. What is your reading when you first wake up if it then increases to 12?
Personally I would not test for ketones unless my BG was 15 for several hours and not coming down with correction doses of rapid acting insulin, but that is just me. I don't think you need to test with a BG under 14. Have you considered that your symptoms may not be linked to your BG or ketones?

My blood sugar is usually around 7 on waking, I'm on levirmir and novorapid, I use ketone blood testing strips as more accurate, they give me 10 strips a month, I've spent a fortune on them myself, as so scared of what is happening, I don't often go above 14, but I do rise sharply before I get up, usually around 12, I get ketones showing most of day around 1.00, 1.2, 0.9, but they go to Lo before bed, then back up in morning, to around 1.00, and constant fight through the day with them, they said not to test much, but when you're over 0.6 your supposed to test 2 hourly, this has been getting worse over last 5 months, I now take nearly double of both insulin, I have given myself loads of extra novorapid, and drinking loads of water, but the rise in blood sugar always starts in morning, then stops in afternoon, never over 12, but I do get big spike in the morning. I wonder if liver continues to pump them out, dawn phenomenon, when not needed, I take 10 units of levirmir at night, and 10 in morning, more than I have taken, I eat carbs, but don't have anything after 6.30pm, which is what I've always done, hope I can get help, thank you..

 

[Annette Arundell]

Sorry forgot to say these levels make me very cold, and nauseated, even tho not dangerous levels.

 

[Ditto]

That sounds terrible and no way to live. I hope you can get sorted asap.

 

[rebrascora]

Have you changed your activity routine or has your weight increased in recent months as these will both cause an increase in insulin needs and many people have found that Covid and lockdown has had an impact on both of those factors, so that may be why you are needing more insulin. It is not usual to need more Levemir during the day rather than a straight 50/50 split so that might be something else to consider if you haven't already. I have to adjust my Levemir on an almost daily basis.... particularly my night time dose which can vary anywhere between none if I have been very active for a few days in a row, to 7 or 8 units, but my daytime needs are usually about 16 and have been pretty steady at that for over a year although I have just had to up it to 17 in the last couple of days. I tend to follow a low carb way of eating so my bolus insulin needs tend to be fairly low but just recently I have needed more of that too.... Accepting that you need whatever you need is quite an important factor in managing your diabetes and we are all different. I sometimes get a bit too frugal with my insulin and resist increasing my Levemir even though I know I will just end up fire fighting with my fast acting insulin if I don't, so I do understand, but a small increase in basal insulin can make a significant difference to making your levels easier to manage and result in quite a lot less bolus insulin being needed to keep you in range.

I would do some daytime basal testing to see if an increase in daytime Levemir might be appropriate. The amounts of basal you are using are not excessive so I would not be concerned about using a bit more if you need to. It is likely to reduce again during the summer when it is warmer and perhaps your activity levels are higher, so don't be concerned that it is going to constantly increase for evermore. Many people find that they need more through the winter months and dial it back in the spring/summer.

 

[helli]

My understanding is ketones are a bi-product when you break down fat.
There are question above about gaining weight but with high ketones, I would expect loss of weight.
As well as diabetes, ketones are a symptom of an eating disorder. That may be a red herring but to me it could lead to the suggestion that diabetes is not the cause, especially as your blood sugars are not overly high.

 

[Inka]

Sorry forgot to say these levels make me very cold, and nauseated, even tho not dangerous levels.

When you say that you test your ketones every two hours because you’re at the numbers to do so, what’s your actual blood sugar when you test for ketones? I was told not to test unless above 13.

Are you eating enough? There’s something called ‘starvation ketones’, which I had once when I was in hospital and not eating much.

With your raised pulse and feeling cold and nauseous, I’d be speaking to a doctor just to check it’s not anything else eg a stomach issue, liver issue, UTI, etc etc

 

[Annette Arundell]

When you say that you test your ketones every two hours because you’re at the numbers to do so, what’s your actual blood sugar when you test for ketones? I was told not to test unless above 13.

Are you eating enough? There’s something called ‘starvation ketones’, which I had once when I was in hospital and not eating much.

With your raised pulse and feeling cold and nauseous, I’d be speaking to a doctor just to check it’s not anything else eg a stomach issue, liver issue, UTI, etc etc

Thanks for reply I will if I can get one to speak to me, as seems hard at moment as have tried

 

[Annette Arundell]

Have you changed your activity routine or has your weight increased in recent months as these will both cause an increase in insulin needs and many people have found that Covid and lockdown has had an impact on both of those factors, so that may be why you are needing more insulin. It is not usual to need more Levemir during the day rather than a straight 50/50 split so that might be something else to consider if you haven't already. I have to adjust my Levemir on an almost daily basis.... particularly my night time dose which can vary anywhere between none if I have been very active for a few days in a row, to 7 or 8 units, but my daytime needs are usually about 16 and have been pretty steady at that for over a year although I have just had to up it to 17 in the last couple of days. I tend to follow a low carb way of eating so my bolus insulin needs tend to be fairly low but just recently I have needed more of that too.... Accepting that you need whatever you need is quite an important factor in managing your diabetes and we are all different. I sometimes get a bit too frugal with my insulin and resist increasing my Levemir even though I know I will just end up fire fighting with my fast acting insulin if I don't, so I do understand, but a small increase in basal insulin can make a significant difference to making your levels easier to manage and result in quite a lot less bolus insulin being needed to keep you in range.

I would do some daytime basal testing to see if an increase in daytime Levemir might be appropriate. The amounts of basal you are using are not excessive so I would not be concerned about using a bit more if you need to. It is likely to reduce again during the summer when it is warmer and perhaps your activity levels are higher, so don't be concerned that it is going to constantly increase for evermore. Many people find that they need more through the winter months and dial it back in the spring/summer.

Hi I still work part time in care home, I had Covid-19 in December, I have actually lost weight in last few weeks as problem with ketones, I have increased all my insulin by quite a bit, but today have had much more, so may be that's it, I will increase more, was wary because I used to have hypos during night, but not now, thanks for that

 

[rebrascora]

I think diabetics who have had Covid are experiencing increased insulin needs afterwards, so it may well be as a result of that. Test more frequently if you increase your basal insulin some more. It may just be a temporary measure or it may be a long term thing. I don't think anyone knows the true implications of Covid on people's health in general but as diabetics we are likely to see higher BG levels as a result and need to be prepared to increase our medication as much as is necessary to deal with that and bring levels back under control.

 

[Bruce Stephens]

I had Covid-19 in December, I have actually lost weight in last few weeks as problem with ketones,

It's been reported that coronavirus infections can cause ketones even at normal BG levels (and for people to watch out for that). I'm not sure what the advice would be for someone seeing ketones at normal BG levels weeks later.

 

[everydayupsanddowns]

Yes I was wondering about starvation ketones too @Inka, though @Bruce Stephens ’s thought about covid19 and ketones at normal bg is certainly worth considering, as that had significant care implications to T1s being treated for C19 from what i can tell.