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Ketones and worried

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K

Katya

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Relationship to Diabetes
Type 1
I am 7 weeks pregnant with a hba1c of 6.4. All was going pretty well until the night before last when When I tested my levels at 8.30 and they were 10-too high so corrected only to find they went to 13.7 by 10pm. Another correction- this continued all night until 3.30 am when I got them down to 5 after changing infusion set, insulin etc thinking it was a bad site or insulin.

I thought it was a one off but tonight was worse. I went to bed on a 6.8 at 10pm woke up at 2 to 10.8 so over corrected and at 4 was 15.5 it's now 5.40 and after a whopping correction dose am down to 8.

I am now petrified as I think the only explanation is starvation ketones as I had. Nothing to eat since 6.30pm. I know I didn't test (too much rummaging involved to find all my kit at ridiculous hr) but I know they were probably there in large amounts on both evenings and last night from 10 till at least 5am so 7 hours.

I know I can correct this by eating a snack before bed in future but now extremely anxious about what damage I may have caused and beating myself up about it. I know what's done is done and you can only do your best but I'm so worried now!!! Any advice or similar experiences and all turned out ok??

Katy x
 
Hi Katy, welcome to the forum 🙂 Very sorry to hear about the problems you are having :( Are you using novorapid in your pump? Some people are having problems with a particular batch that is not working as expected. Have a look at this thread:

http://www.diabetessupport.co.uk/boards/showthread.php?t=39318

When you say you overcorrected but had a 15.5 do you mean you think you hypoed and rebounded? What pump do you have? Where do the ketones come into this? Ketones in themselves won't raise blood sugar levels, but they will be produced at normal BG levels if you haven't eaten for a long time (starvation ketones), or if you do not have enough circulating insulin to use the glucose in your blood indicated by high BG levels - it is the latter that are potentially dangerous.
 
When I was pregnant my doc used to reassure me that the odd spike, if promptly corrected, wasn't the end of the world - it's prolonged highs & ketones that are the issue...I suspect that he was talking about if soneone didn't do correctives like you did. Sounds like maybe an overnight basal test is in order? Also if you know your cannula sets 'go off' by 'x' days set yourself a recurring reminder on your phone / computer / calendar etc to prompt you to change them a half day / day early maybe, so you can avoid at least some highs...? (I say that because I almost always forget & only realise when I go high! 😱)

Best of luck - it's hard work but worth it!
 
ThAnk you for your replies in response to your questions, I don't definitely know for sure that I had ketones but in past when I've had them I've had to more than double my correction dose to get rid and I needed an almighty amount of insulin to get rid of the 15 last night so I just believe that I had them. I don't think I hypo'd and rebounded as I was 6.8 at 10pm, 10 at 2pm took a correction and 15.5 at 4 and eventually came down at 6 after taking 20 units in one go to just get it down quickly. I'm just panicking now thinking I probably had them - I know I was quite suseptible to them in my last pregnancy at quite low blood sugars but much later on than this.
 
Have you checked your insulin Katya? Maybe even if it's not novorapid from that batch, might there be something wrong with it? It might be worth trying a new vial.However, if your numbers are now OK then perhaps it isn't that.
 
Oh and I'm on apidra and my set was changed the previous night. In reference to my first correction when I was 10- my pump suggested a unit or 2 and I doubled it- which obviously wasn't enough if my levels went up higher- I think this probably means I didn't have enough insulin circulating I suppose. I know I corrected as fast as I could but it's still quite a long time to be high ESP if there were ketones ( which I highly suspect)

Katy
 
Yes I have checked insulin and changed the vial the previous night believing that to be the problem but it isn't as it's working fine now. I ate dinner at 6.30 and didn't eat then till the morning that's what made me think of starvation ketones.

Katy
 
Just a quick update- after changing my vials completely yesterday again as i eas seeming to need more than normal. In day too, I went to bed on 6.7 and woke on 4.6!! So it was the insulin not working correctly not pregnancy hormones making me more resistant. My only worry now is that the ketones I must have had yesterday must have been through a lack of (decent) insulin in my body, hence higher levels. I know I corrected but I must have had them for at least 6 hours (10-4) at 7 weeks pregnant. Twitchy I know you mentioned that I did corrections so it's not prolonged but as my insulin was pretty poor I'm
Worried that makes a difference as I may as well had none in my system!!

Hey go I suppose what's done is done, I can only look forward. I've actually booked in for a early scan (private) today so suppose I'll just see how that goes for a start!

Katy
 
Katy, so pleased you have found out where the problem was, I hope that the scan goes well for today 🙂 I wonder what happened to the insulin?
 
Hi Katy, for what it's worth the dodgy insulin was still having some effect - you did manage to get your levels down to under the teens a lot of the time & if it hadn't been working at all I imagine you'd have been at least up in the 20s. 🙂 Plus although I dare say noone has any formal data, I took what the doc said to mean roaring high levels for days at a time....whilst they aren't ideal I had a few 'blips' like yours & my babies are now healthy, feisty big brats... :D Like you said, no point stressing over it - I'm really glad you've pinned down the problem & it was relatively straightforward to deal with. 🙂
 
Thanks for those words- it keeps me hopeful! Will keep you posted. The only thing i can think of re the insulin is maybe my fridge was too cold??! Just got to put a new prescription in on tues to get some new vials and hope that I don't
Come into too much questioning from the doctors receptionists who think they rule the place ;-)

Katy
 
Hope they are humane! 🙂 I've learnt the hard way to put my insulin in a tupperware type box, fenced in by other stuff in the fridge so it never touches the sides of the fridge...the things you have to think of eh?! 🙄
 
Well I had my scan- measurements are spot on and their is a heartbeat however there was a small bleed to the right of the sac.. The sonographer did say this could have been caused by implantation or could be bruising, may be absorbed by body or may produce a bit of brown blood loss.... I can't help but worry that the bleed is fresh from the two nights of highs and ketones but I suppose it's just a case of wait and see.

Katy
 
Katya said:
Well I had my scan- measurements are spot on and their is a heartbeat however there was a small bleed to the right of the sac.. The sonographer did say this could have been caused by implantation or could be bruising, may be absorbed by body or may produce a bit of brown blood loss.... I can't help but worry that the bleed is fresh from the two nights of highs and ketones but I suppose it's just a case of wait and see.

Katy
Click to expand...

Glad to hear the scan went well Katy, try not to let your imagination cause you too much worry (easier said than done, I am sure).
 
Hi Katy
Pleased to hear that the scan went well. I know it's easy for me to say but try not to worry about things too much.....
You're doing a great job with your hba1c so keep up the good work !
Cleo x
 
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