Ketones - help !

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tiptoptapper

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Am currently at A&E having been sent here by my diabetic nurse. BG was 8.6 at my 6pm appointment but ketones 1.5 rising to 2.4 on 2nd blood test.

I feel absolutely well.

Quick history - diagnosed type 2 with hba1c 126 4 weeks ago. Prescribed glicazide and metformin but decided to go low carb and only take the metformin.

Have got finger prick readings down to less than 10.5 mainly, often they are 8 or 9.

Eating low carb - less than 50g a day. Could this be causing the ketone issue?

Currently freaking out......
 
Yeah low carb causes ketones, make sure you let them know you’ve been low carbing. I imagine they’ll be doing more blood tests to look into things anyway.
 
tiptoptapper said:
Am currently at A&E having been sent here by my diabetic nurse. BG was 8.6 at my 6pm appointment but ketones 1.5 rising to 2.4 on 2nd blood test.

I feel absolutely well.

Quick history - diagnosed type 2 with hba1c 126 4 weeks ago. Prescribed glicazide and metformin but decided to go low carb and only take the metformin.

Have got finger prick readings down to less than 10.5 mainly, often they are 8 or 9.

Eating low carb - less than 50g a day. Could this be causing the ketone issue?

Currently freaking out......
Click to expand...
When people do not know that there is ketosis and ketoacidosis and they are different things, then it can cause problems.
There is a situation where you can have diabetic ketoacidosis and normal blood glucose levels, but I suspect that on a low carb diet, normal blood glucose and ketones from normal natural processes is far more common.
People usually feel unwell with diabetic keto acidosis - if you look for the symptoms online, perhaps that will help the medics.
 
Drummer said:
There is a situation where you can have diabetic ketoacidosis and normal blood glucose levels, but I suspect that on a low carb diet, normal blood glucose and ketones from normal natural processes is far more common.
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With a hba1c of 126 though it is important to be in hospital getting checked out to find out whether it is ketoacidosis with a normal bg (euglycaemic ketoacidosis) or whether it’s ketones from low carb. Hopefully with some carbs and fluids the ketones just vanish.
 
tiptoptapper said:
When I was diagnosed 4 weeks ago my ketones were fine.
A&E just tested and they are 1.9 now.
Waiting for Dr now
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You weren’t low carbing when you were diagnosed, but also it could be that your diabetes isn’t being treated correctly ie you might need more carbs and medication, as you haven’t been taking the gliclazide.

I can’t low carb because I get high ketones which make me unwell. Just let the dr know about the diet change and the hba1c at diagnosis and I’m sure they’ll figure it all out. I wouldn’t panic though, your bg is okay.
 
tiptoptapper said:
Am currently at A&E having been sent here by my diabetic nurse. BG was 8.6 at my 6pm appointment but ketones 1.5 rising to 2.4 on 2nd blood test.
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Oh no! Sorry to hear you’ve found yourself in A&E @tiptoptapper

Hopefully the Dr can get to the bottom of your ketones, and whether they are nutritional or the result of insulin deficiency.

Let us know how get on :care:
 
Sorry to hear you are in hospital. Hope that they get your bloods sorted out quickly. Best wishes xx
 
@tiptoptapper sorry to hear you’ve been sent to hospital, but hopefully they can soon find out why your in the situation your in 😳
TC :care:
 
Hi all

Thank you so much for your replies.

I wasn't overly worried about my health, as I felt (and still feel) very well. The best I've felt in a long time. But I was freaking out as I was terrified they would make me stay in hospital and / or have additional medication.

Everyone I saw at A&E was happy with my BG (in the 8s) and not overly concerned about my ketones which read at 1.5, 2.4, 1.9 & 2.5 during the evening I was there.

The person who discharged me understood that I've been eating v low carb (under 50g a day) and was happy I was in nutritional ketosis rather than at risk of DKA based on the fact a) my BG was acceptable, b) I'm type 2 not type 1, c) I'm not taking any meds other than metformin and d) I feel very well.

She sent me home and advised me to drink more fluid (I drink very little I must admit as I never feel thirsty) and to modify my diet to increase my carbs somewhat. She advised me to try and strike a balance and experiment while testing my numbers.

My diabetic nurse at my GP earlier had given me a ketone meter and strips and told me to contact A&E if my ketones go over 1.5. The hospital said test for a few days and don't worry if they go up to 3 or even 4 unless I feel unwell.

I know how serious DKA is - my brother in law died of it in the summer - he was type 2 and lived alone, but he was taking an SGLT2 inhibitor which we understand can cause DKA even with BG in the normal range. Sorry if this triggers anyone. We're still coming to terms with it.

So, last night I had eggs on toast for supper which was lovely, giving me an additional 35g carbs. My BG increased by 1.8 2 hours later which I felt was really positive.

I've woken up hungry this morning though, and I've honestly not felt hungry in ages. So that's frustrating. I have quite a lot of weight to lose and eating v low carb has suited me - I've lost a stone in 4 weeks and not felt hungry at all - I've been eating only 2 meals a day. It's the first time in my life I've felt in control of my diet, rather than the other way round.

But I feel like unless I get my ketones down a bit then my diabetic nurse won't be happy. She was insistent yesterday that my ketone level could not be due to my low carb diet. The person who discharged me from hospital actually rolled her eyes when I told her that.

My diabetes nurse also was not happy when I told her I wasn't taking glicazide because I was afraid of hypos. She said I must take it- and I questioned this, explaining that my BG was consistently 11 or less (often 8 or 9). I have achieved this by diet & metformin with my readings coming down from 23 when diagnosed 4 weeks ago. She said yes, I must take it due to my hba1c of 126 - but again that was 4 weeks ago. She is insistent I take it. But I'm afraid I'm not going to, I just feel its going to make me hypo.

My plan is to increase my metfotmin to x3 a day as planned (nurse wants me on x4, I'm currently on x2) to cope with increase in carbs (going to try and increase from 50g to 75 or 80g) for now and see how it goes. Test regularly.

Diabetic nurse is going to ring today, i dont think she'll be happy with me.

Yesterday at my appointment she saw my BG was 8.5, down from 23 four weeks ago, and I told her I'd lost a stone in four weeks, and she said 'why are you starving yourself". I'm really not. It's just a bit frustrating.

I'm determined to get in remission, not sure the diabetic nurse is on the same path as me. We will see.

Sorry for the long post!!
 
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tiptoptapper said:
I know how serious DKA is - my brother in law died of it in the summer - he was type 2 and lived alone, but he was taking an SGLT2 inhibitor which we understand can cause DKA even with BG in the normal range. Sorry if this triggers anyone. We're still coming to terms with it.
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I’m so sorry to read this, it’s a risk that GPs don’t explain enough I feel. I really would increase your carbs in the circumstances so that you just don’t need to think about the ketones. You won’t have to increase them that much to shake them off I expect, and you have the gliclazide if your Bgs look like they need it to help bring them down.
 
tiptoptapper said:
But I'm afraid I'm not going to, I just feel it’s going to make me hypo.
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What is it about a hypo that makes you scared? Maybe we can help reduce that fear.
 
If you take the gliclazide you would probably need to up your carbs as very low carb is not advised with that medication.
Increasing your fluids would be a good idea as that may help with the ketones.
It would be good idea to have another HbA1C when you have had a period of 3 months on the full metformin and carb routine.
I have about 70-80 g per day but no meds and find that a sustainable new way of eating.
 
Tiptoptapper - sounds like we are on parallel paths. I was diagnosed with an HbA1c of 119 3 weeks ago based on a blood test 4 weeks ago. I also have a lot of weight to lose. I am on Metformin, stepping up from an initial 500mg to the 4x500mg that I'll start tomorrow.
I have been following a low calorie, lowish carbs (but not as low as you) diet since then. I have also lost over a stone. I turned down gliclazide yesterday, which the DSN wanted to start me on - I want to see where I can get to with just Metformin & diet (follow up blood test showed HbA1c down to 101 after 3 weeks).
Sorry you are having a less than ideal situation with your DSN - as everyone on here keeps saying, diabetes affects everyone differently and we should be treated as individuals, not as just someone on a predetermined prescribing pathway. I hope you get the support you should be getting.
 
I’m glad you’re ok @tiptoptapper and I’m so sorry to hear about your brother-in-law.

I agree with @Lucyr that you should increase your carbs a bit. You should be able to lose weight, eat healthily - and avoid ketones. Nutritional ketosis or starvation ketones aren’t always benign and, IMO, best avoided.
 
Hello @tiptoptapper sorry to hear about your loss.

Regarding your Diabetes management you are doing a good job and it can get confusing, remain positive as stress can make it worse... so we'll done for losing that weight, keep up the good work.

If you can keep on Metfirmin 3 or 4 x500mg and your BG is healthy and your Ketones are low, then keep off Giicizde if you have a choice.

This forum is fully iof very helpful and supportive people, so as they say a problem shared is a problem shared.
 
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