Ketones vs DKA

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wrighteb

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Type 1
Hi,
Possibly a random question, as one I can’t seem to find raised before hence reaching out.
I have been doing the keto diet for probably over a month now and feeling fine with stable sugar levels. In the last few days I’ve had high levels I’ve struggled to get under control and been feeling pretty rubbish - I had imagined the start of a cold or something.
I thought I should check my ketones which have come up higher, but now I’m not sure whether this is due to having normal ketones from the diet or potentially start of DKA.
Has anyone any thoughts/experience of this. I’m not excessively thirsty or peeing a lot, although do feel very lethargic.
TIA
 
wrighteb said:
Hi,
Possibly a random question, as one I can’t seem to find raised before hence reaching out.
I have been doing the keto diet for probably over a month now and feeling fine with stable sugar levels. In the last few days I’ve had high levels I’ve struggled to get under control and been feeling pretty rubbish - I had imagined the start of a cold or something.
I thought I should check my ketones which have come up higher, but now I’m not sure whether this is due to having normal ketones from the diet or potentially start of DKA.
Has anyone any thoughts/experience of this. I’m not excessively thirsty or peeing a lot, although do feel very lethargic.
T,
Click to expand...
Welcome to the forum, I see you are Type 1. It would help people comment if you give a little more detail on how you manage your condition, insulin regime, diet, whether you have a CGM like the Libre and what blood glucose levels you are experiencing.
 
wrighteb said:
Hi,
Possibly a random question, as one I can’t seem to find raised before hence reaching out.
I have been doing the keto diet for probably over a month now and feeling fine with stable sugar levels. In the last few days I’ve had high levels I’ve struggled to get under control and been feeling pretty rubbish - I had imagined the start of a cold or something.
I thought I should check my ketones which have come up higher, but now I’m not sure whether this is due to having normal ketones from the diet or potentially start of DKA.
Has anyone any thoughts/experience of this. I’m not excessively thirsty or peeing a lot, although do feel very lethargic.
TIA
Click to expand...

A keto diet can put you at higher risk of DKA @wrighteb (because you’ll already have some ketones). Illness plus ketosis can be risky. What are your ketones now? What’s your blood sugar?
 
Here is the NHS info page:

www.nhs.uk

Diabetic ketoacidosis

Find out about diabetic ketoacidosis (DKA), including what the symptoms are, when to get medical help and how to prevent it.
www.nhs.uk www.nhs.uk

Note the info in the black box:

Call 999 or go to A&E if:​

  • you have a high level of ketones – over 3mmol/L in your blood, or over 2+ in your pee
  • you do not know your ketone levels but have symptoms of diabetic ketoacidosis, such as feeling thirsty and needing to pee more often, feeling sleepy or confused, and breath that smells fruity (like pear drop sweets or nail polish remover)
  • you have symptoms of diabetic ketoacidosis and have not been diagnosed with diabetes
Diabetic ketoacidosis can be life threatening so it's important to get treatment quickly.

There’s also something called euglycaemic ketoacidosis where blood sugar is normal but there are still dangerous levels of ketones. Being on a keto diet can increase your risk of this.
 
Leadinglights said:
Welcome to the forum, I see you are Type 1. It would help people comment if you give a little more detail on how you manage your condition, insulin regime, diet, whether you have a CGM like the Libre and what blood glucose levels you are experiencing.
Click to expand...
Thank you - I have a Dexcom and take insulin via injection. I haven’t had the need to be taking a lot of insulin because I’ve been eating v low carb. Blood levels down from 18-20 to 13-14 now so they are headed in the right direction. Ketones 3+ on urine samples, 2.1 on blood test. Ideally I’d like to bring down without any intervention from medical professionals
 
Inka said:
Here is the NHS info page:

www.nhs.uk

Diabetic ketoacidosis

Find out about diabetic ketoacidosis (DKA), including what the symptoms are, when to get medical help and how to prevent it.
www.nhs.uk www.nhs.uk

Note the info in the black box:

Call 999 or go to A&E if:​

  • you have a high level of ketones – over 3mmol/L in your blood, or over 2+ in your pee
  • you do not know your ketone levels but have symptoms of diabetic ketoacidosis, such as feeling thirsty and needing to pee more often, feeling sleepy or confused, and breath that smells fruity (like pear drop sweets or nail polish remover)
  • you have symptoms of diabetic ketoacidosis and have not been diagnosed with diabetes
Diabetic ketoacidosis can be life threatening so it's important to get treatment quickly.

There’s also something called euglycaemic ketoacidosis where blood sugar is normal but there are still dangerous levels of ketones. Being on a keto diet can increase your risk of this.
Click to expand...
Thank you, I don’t feel I have those symptoms so am hopeful I could reverse the higher ketones - or they are as a result of the keto diet? Although I don’t even know if medical professionals can determine that?
 
Inka said:
A keto diet can put you at higher risk of DKA @wrighteb (because you’ll already have some ketones). Illness plus ketosis can be risky. What are your ketones now? What’s your blood sugar?
Click to expand...
Thank you - ketones 3+ on urine sample and 2.1 on blood tester.
Blood sugar at 13.0 so headed in the right direction although still high for what I have been used to, so I am wondering if it’s this that’s making me feel bad.
 
If you use a meter to test for ketones in your blood:

  • under 0.6mmol/L is normal
  • 0.6 to 1.5mmol/L is slightly high – test again in 2 hours
  • 1.6 to 3mmol/L means you're at risk of DKA and should speak to your diabetes care team for advice
  • over 3mmol/L is high and means you may have DKA and should call 999 or go to A&E
If you use strips to test for ketones in your pee, over 2+ is high. This means you may have DKA and should call 999 or go to A&E.
 
If you want to try to avoid medical input, you need to monitor things extremely carefully. Things can change quickly and DKA can be fatal.

Insulin will get rid of ketones. If you can keep hydrated with water that will help too.I felt rubbish when I had 3+ on a urine test. I spoke to my team for advice. I managed to get them down by myself but it was a bit scary. If you can eat and inject, that will help too. But importantly, watch things very, very closely.
 
Remember there’s also 111 for advice if you’re feeling unsure. Keto plus illness is a potential risk. At too high a level, dietary ketones can be bad too. People without diabetes can sometimes get ketoacidosis on a very low carb diet.

Sorry to go on and on, but it can be risky. Keep testing the ketones every hour or two and look after yourself. Please let us know how you are later.
 
Thank you that is helpful - I will keep testing and drinking, and reach out to my diabetes team if no change by tomorrow - I appreciate you taking the time to reply
 
Hope things improve for you @wrighteb Ketones in the presence of high BG, and insufficient insulin can be very nasty.

Some of our low carb T1 members found that lower carb intake increased insulin resistance, so you may need a little more insulin that you expect?
 
everydayupsanddowns said:
Hope things improve for you @wrighteb Ketones in the presence of high BG, and insufficient insulin can be very nasty.

Some of our low carb T1 members found that lower carb intake increased insulin resistance, so you may need a little more insulin that you expect?
Click to expand...
That’s interesting, I will try that - thank you
 
Afternoon wrighteb
I do see your BG levels are regularly above 10 which some say requires ketone testing whereas others give a higher figure guidance.
There is also the condition of euglycemia DKA which is basically DKA but with normal BG levels but the treatment and consequences are the same as normal DKA.

​

 
Can I just ask if you are eating very low Carb are you bolusing for protein? most people find they have to do that when not eating much carbs due to the body converting protein to glucose in the absence of carbs.
 
Thank you, my ketones have come down so I’m hoping with continued fluids and extra insulin they’ll continue to drop.
I’m not sure where you’ve seen my levels are regularly above 10, but that is not the case. Although they have been higher this weekend admittedly.
I have not been bolusing for protein so that is a point to consider, although that being said I haven’t seen any need to until this point - although maybe this is the turning point…
 
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wrighteb said:
Thank you, my ketones have come down so I’m hoping with continued fluids and extra insulin they’ll continue to drop.
I’m not sure where you’ve seen my levels are regularly above 10, but that is not the case. Although they have been higher this weekend admittedly.
I have not been bolusing for protein so that is a point to consider, although that being said I haven’t seen any need to until this point - although maybe this is the turning point…
Click to expand...
You said in your post 5 that your blood levels were down to 13-14 from much higher.
 
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