Ketones without high sugar

[AJLang]

When the nurse tested my sample the other day she seemed surprised because there were ketones but no sugar. She thought that I may not be drinking enough but I drink loads of alcohol free, sugar free caffeine free liquid. I just tested it again with a "normal" BS and it showed plus one ketones. At DAFNE we were taught to inject insulin if there were ketones even if BS is normal but I'm not keen on that. Any thoughts/suggestions please?

 

[AJLang]

I've just checked my DAFNE book and it says 10% of total daily insulin dose every two hours (including during thr night) if ketones is plus one - it calls it serious illness - that seems a lot of insulin and very scary but the nurses on the course seemed certain what should be done. Not sure what to do.

 

[fencesitter]

This from the Joslin Foundation:
http://www.joslin.org/info/ketone_testing_what_you_need_to_know.html

This seems to be the important bit:
There are situations when you might have ketones without the blood glucose being too high. Positive ketones are not a problem when blood glucose levels are within range and you are trying to lose weight.

It is a problem if blood glucose levels are high and left untreated. Untreated high blood glucose with positive ketones can lead to a life-threatening condition called diabetic ketoacidosis (DKA).

 

[AJLang]

Hi Willsmum thanks very much for this. It is very helpful but I'm now confused because of what it says in my DAFNE book. I had the ketones on Tuesday even though I was eating normally. I think that I won't do anything now and will then check the ketones later in the day. Thank you for your help🙂

 

[Robster65]

Hi Amanda.

If your BG is normal, and not climbing, you should never inject insulin because iof ketones.

As Willsmum says, there are other reasons why there may be ketones present, usually due to not eating recently or a period of recent high BG.🙂

Just another of those complicated situations that has a million possible causes and cures!🙄

Rob

 

[AJLang]

Thanks Rob the DAFNE guidance didn't make sense to me when it said I should inject even if my BS is ok. Yet they were adament that you should do this on the DAFNE corse. It's very confusing🙄

 

[Robster65]

If you inject insulin, there's only one thing that'll happen. BG will drop. If you eat after you inject, that's fine, but if you're not about to eat, you'll hypo.

Had you eaten anything before the test?

Rob

 

[Northerner]

Thanks Rob the DAFNE guidance didn't make sense to me when it said I should inject even if my BS is ok. Yet they were adament that you should do this on the DAFNE corse. It's very confusing🙄

Doesn't really make sense to me either The danger is that, if you don't have sufficient insulin circulating, then the ketones will build up to dangerous levels as insulin is required to help remove the ketones from the blood. High BG levels therefore would indicate insufficient insulin, but normal BG levels would suggest you have enough circulating.

 

[Robster65]

I've never done DAFNE, but they do seem to give some counter-intuitive advice.

I'd still seek advice from your GP/DSN if you've got ketones present but normal BG. It may be a side effect of one of your other meds or something.

Rob

 

[AJLang]

Thanks Rob and Northerner. From what I remember of the DAFNE course ketones mean that there isn't enough insulin circulating even if your BGs are normal. I think that the idea is that you inject extra insulin - but sip Lucozade etc to stop your BGs falling. If the ketones continue I will check with the DAFNE nurse to try to get clarfication. The last thing I want is to inject extra insulin get rid of the ketones and have a massive hypo😱

 

[AJLang]

Had you eaten anything before the test?

Rob

The test that the nurse did was an early morning one but I had eaten dinner the night before. Ditto with the one that I did today but it was at midday and I hadn't yet eaten (I often don't feel like eating in the morning because of the gastroparesis)

 

[Hanmillmum]

I am incorrect in thinking it is normal to have ketones present first thing on a morning if you have gone all night without food ? Normal for non-D's too especially in kids who probably go longer without food. I'm sure we were told this at some point

 

[DeusXM]

Ketones do NOT mean you need more insulin every time. Ketones are the byproduct of metabolising fat. You metabolise fat when you're in DKA. But you also metabolise fat when you reduce your carb intake and increase your fat intake. Or when you exercise. Or don't eat enough calories in the day. If you're trying to lose weight, you NEED ketones. They can be perfectly normal and safe, depending on circumstances. Ketones are like smoke. They tell you something is burning. What they don't tell you is whether what's burning is a perfectly normal BBQ, or a house on fire.

 

[Tina63]

I know I am not really qualified to reply being non-D myself, but when I was pregnant with my lad I had +++ ketones on a few occasions. I was eating, but only small amounts as I was feeling full very quickly after eating late in pregnancy. I put on next to no weight during the whole pregnancy so I was obviously actually losing weight and that caused the ketones. Are you losing weight at the moment? That would almost certainly explain it.

As others have said, injecting insulin sounds dangerous. If your blood sugars are in normal range it will only make you plummet. Chances are you body just needs more fuel than you are giving it but if you are feeling well and/or trying to lose a little weight then don't worry about it.

(Only my opinion of course!)

Tina

 

[AJLang]

Thanks Tina for reassuring me.