Ketones vs DKA

[Satan’s little helper]

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…

Maybe your basal had been handling the protein in the past? It can happen pending on what basal used. I’ve used non recommended means to fix a basal hypo.

At a loose guess. You may have come down with “something” elevating your BGs beyond the norm.

When were you actually diagnosed?

 

[Wendal]

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…

Apologies Wrighteb if your levels are normally lower than I quoted.My main point was to highlight the eDKA concept as you may not have been aware of it.
I did look for reference to your normal BG levels but only saw the figures above 10.
Once again apologies but some folk think if you have BG levels often in the normal range then DKA will never be an issue and whilst unlikely it is not impossible.

 

[wrighteb]

You said in your post 5 that your blood levels were down to 13-14 from much higher.

This weekend not permanently

 

[rebrascora]

Hi and welcome from me too.

Good to hear that your Ketones and BG are coming down.

Can I ask, have you been diagnosed very long and was there a particular reason for you trying keto? I too would guess that your basal may have been covering some of the protein release or perhaps, if you are newly diagnosed, that your own insulin production was covering it, but maybe you are coming to the end of your honeymoon period and your own insulin production is running dry. I follow a low carb way of eating but don't do full keto as it is just a bit too restrictive for me. I have to inject up front for any carbs I eat and then about 2 hours later when the protein starts to release or I time it so that I do exercise at the 2 hour point and the protein will stabilize my levels whilst I exercise. I find it surprising how much insulin I need to deal with the protein and in reality I don't "save" on insulin (ie use less) eating low carb, but I have other reasons for following a lower carb higher fat way of eating.

Which insulins do you use? I find Fiasp works better with my low carb approach but it was not an easy swap from Novo(not so)Rapid and I do need to use more Fiasp to get the result I want but at least it works a bit faster.

Interested to hear more about your diabetes journey, if you would like to share it.

 

[wrighteb]

Hi and welcome from me too.

Good to hear that your Ketones and BG are coming down.

Can I ask, have you been diagnosed very long and was there a particular reason for you trying keto? I too would guess that your basal may have been covering some of the protein release or perhaps, if you are newly diagnosed, that your own insulin production was covering it, but maybe you are coming to the end of your honeymoon period and your own insulin production is running dry. I follow a low carb way of eating but don't do full keto as it is just a bit too restrictive for me. I have to inject up front for any carbs I eat and then about 2 hours later when the protein starts to release or I time it so that I do exercise at the 2 hour point and the protein will stabilize my levels whilst I exercise. I find it surprising how much insulin I need to deal with the protein and in reality I don't "save" on insulin (ie use less) eating low carb, but I have other reasons for following a lower carb higher fat way of eating.

Which insulins do you use? I find Fiasp works better with my low carb approach but it was not an easy swap from Novo(not so)Rapid and I do need to use more Fiasp to get the result I want but at least it works a bit faster.

Interested to hear more about your diabetes journey, if you would like to share it.

That is really interesting, I had no idea on the protein having to be “paid for”.
I’ve had diabetes for over 15 years so no honeymoon period unfortunately.
I wad using keto to lose weight and to try and use less insulin as a bonus from that.

 

[rebrascora]

In the absence of enough carbohydrate, approx 40% of protein will be broken down to release glucose and about 10% of fat. I tend not to try to calculate it it and just inject according to my Libre readings so that when my levels reach 8 about 2 hours after a meal and they are clearly drifting upwards, I inject a couple of units of bolus insulin. If they continue to go up I inject another couple of units. I use Fiasp which is quite fast acting so I can usually see in just over half an hour if it is dealing with the protein release or it is going to need a bit more. The down side I find with Fiasp is that it turns to water once my levels get above 10 so I have to be very proactive and quite aggressive with it sometimes to keep below 10, unless I can do exercise. I have found that 20 times up and down stairs at a jog will usually turn it around or obviously a longer walk or jog if I have time to head out. I am not recommending anyone stack corrections but this is what works for me on a low carb way of eating with Fiasp. I have been low carb since diagnosis 4.5 years ago and it seems to really suit my body but it isn't an easy option or necessarily a reduced insulin option. For me, increasing my exercise is the way to lose weight and reduce insulin usage.

As always, your body, your diabetes and your insulin may react differently to mine, but the 40% of protein and 10% of fat, glucose release, is quite well documented and for me you can see it happen on Libre about 2 hours after eating and it will last for about 4-8 hours.