Ketones with normal blood sugars? Feeling worried.

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StephanieMLW

StephanieMLW

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Relationship to Diabetes
Type 1
Hello

I am currently travelling in New Zealand and for the second time am having issues with ketones appearing, but my sugars being OK.

The first time was after a long haul flight (I was shattered and had a bad headache so just had an inkling I should test), and this time it appears to coincide with an episode of dehydration (was sat in traffic in the camper van, sun blazing down, hadn’t had enough water. Afterwards felt a little heat stroke-ish so tested for ketones.)

At the moment they are at 0.7, having come down from 0.8 a couple of hours ago. I have drank a HUGE amount of water (on my third 1.5 litre bottle..). The best advice I’ve been able to find in terms of what to do when my sugars aren’t high has been this site: https://www.royalfree.nhs.uk/servic...ople/managing-your-diabetes/managing-illness/

I had dinner which contained some carbs and bolused for half (following advice from the site I found above), and my sugars have since dropped to 5.2, so again have followed the advice from the site above and taken 20g carbs with no bolus.

If my sugars were high I’d follow my sick day rules but they’ve been between 5.2 and 8.8 so I’m just super confused!

Any other advice on how best to deal with this? Any ideas what might be causing it?! I’m trying to keep calm but I only found out about my diabetes 6 months ago after being hospitalised with DKA, so this does make me quite nervous. I’m also hours away from a hospital and can’t speak to my team at home due to the time difference, so trying to do my best!
 
StephanieMLW said:
Hello

I am currently travelling in New Zealand and for the second time am having issues with ketones appearing, but my sugars being OK.

The first time was after a long haul flight (I was shattered and had a bad headache so just had an inkling I should test), and this time it appears to coincide with an episode of dehydration (was sat in traffic in the camper van, sun blazing down, hadn’t had enough water. Afterwards felt a little heat stroke-ish so tested for ketones.)

At the moment they are at 0.7, having come down from 0.8 a couple of hours ago. I have drank a HUGE amount of water (on my third 1.5 litre bottle..). The best advice I’ve been able to find in terms of what to do when my sugars aren’t high has been this site: https://www.royalfree.nhs.uk/servic...ople/managing-your-diabetes/managing-illness/

I had dinner which contained some carbs and bolused for half (following advice from the site I found above), and my sugars have since dropped to 5.2, so again have followed the advice from the site above and taken 20g carbs with no bolus.

If my sugars were high I’d follow my sick day rules but they’ve been between 5.2 and 8.8 so I’m just super confused!

Any other advice on how best to deal with this? Any ideas what might be causing it?! I’m trying to keep calm but I only found out about my diabetes 6 months ago after being hospitalised with DKA, so this does make me quite nervous. I’m also hours away from a hospital and can’t speak to my team at home due to the time difference, so trying to do my best!
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I’m not T1, so just really making enquiries that might help others when they’re up and about.

Im in a UK+7 environment at the moment, but it’s still quite early in UK, where most members here live.

In terms of your eating; have you eaten enough recently? Being in starvation mode can lead to nutritional ketones which aren’t usually considered a problem, and as I’m sure you know high blood sugars + elevated ketones is a red flag.

if you are committing, or feeling unwell, please speak local advice, perhaps on New Zealand’s equivalent of NHS111, or if you are vomiting, seriously consider attending emergency care.

keep your fluids up and keep testing, but if in doubt, seek help. It’s way, way better to be safe that have something escalate over time.

fingers crossed someone else will be along shortly, but take care.
 
@AndBreathe thank you for taking the time to respond

I have been eating pretty normally, though admittedly did not have a proper lunch today. I’m not feeling wonderful (a bit tired and headachey) but I’ve also been travelling for 6 hours in the sun today so that could be the cause!

I’ve managed to locate what I think is the equivalent of the NZ 111 service - so I will give them a call if things don’t improve. Thanks again - always nice to hear from someone who understands when something like this happens!
 
Your ketone level isn’t horribly high. If you didn’t have much lunch and have generally been eating less that could be the reason, or maybe you’re coming down with an illness? Keep drinking water and keep taking your insulin and carbs. I’ve had low levels of ketones a number of times. Keep monitoring and seek medical advice if necessary.

From the NHS:

If you do a blood ketone test:

  • lower than 0.6mmol/L is a normal reading
  • 0.6 to 1.5mmol/L means you're at a slightly increased risk of DKA and you should test again in 2 hours
  • 1.6 to 2.9mmol/L means you're at an increased risk of DKA and should contact your diabetes team or GP as soon as possible
  • 3mmol/L or above means you have a very high risk of DKA and should get medical help immediately
 
Also not T1. If I get dehydrated I feel awful - I get a headache which nothing except rehydration will fix, and one time felt very nauseous. Drink water or oral rehydration fluid (ORF) until you need to pee as soon as you see something to drink, then re-evaluate. By this stage your pee should be very pale. You can either get sachets for ORF that you mix with water, or find an online recipe.
 
Thanks @CatsFive - I do feel like I’ve had too much sun and dehydrated myself. I’ve drank almost 3 1.5 litre bottles of water in the past 2hrs45…at first I didn’t need to pee at all! But for the past hour I’ve been very thankful my camper van has a toilet - and seem to be at the very pale pee stage so I think that’s good.

@Inka thankfully stomach all good 🙂 thinking back over the day now, prior to the ketones I hadn’t eaten very well at all…two slices of toast for breakfast, a small ice cream and some crisps! usually I am a bit of a health freak but camper van life means we are picking up whatever is at the local shop most days. Post-ketones I had salad, wholemeal bread and tempeh for dinner, which is a bit more my usual diet…plus some digestive biscuits to get some carbs in me.
I’m on steroid cream for some nasty blistered insect bites…so whilst not an infection, I wonder if that’s not helping. Reassuring to hear you’ve had low levels a number of times too. They definitely cause me to panic a bit but I’m working on that. I’m hoping I can get down to 0.6 and then I’ll feel safe to go to bed!
 
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You will feel rough because of them but they’re not high enough to warrant concern. As you’ve been doing have plenty of fluids and eat normally and they should resolve. You can in this situation use insulin for the ketones and then add glucose to keep your BG up if necessary or as you’ve done use insulin for your carbs as long as the ketones respond. Generally insulin goes to treat the ketones first before lowering BG so you may find that taking your regular insulin works anyway or that you still need extra on top of your bolus but it’s all a bit of a juggle but you have plenty of chance to take a cautious approach as long as the ketones respond.
 
@StephanieMLW Not eating much can definitely cause ketones. They’re called ‘starvation ketones’. If it’s that, then making sure you eat enough and eat regularly should clear them. Make eating well a priority and hopefully the ketones won’t bother you again. Stock up on some non-perishable foods if you can, including snacks, so you know you’ll always have enough.
 
Be careful you dont drink too much water as you can deplete your Electrolytes. I would suggest that 4.5 Litres is a bit on the high side? Drinking re-hydration salts with your water will be an advantage
 
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