ketones

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kitten

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Type 1
hey all ,
this is a bit of a moan really.
Have high ketones yet again :( as I do most days :(
Feeling really really poorly with it now, btw I have repeatedly checked and changed my cannula and injected large amounts of insulin through a pen so I know that it is most definately not a lack of these. The insulin is all fresh brand new outta the fridge too.
Just wondering if anyone thinks that my job could be contributing to them?
I worked 8-almost 6 yesterday and 9-5:30 today and today I didn't have a break (not even to get a drink or go to the toilet!) untill 4:15 as we were just that busy. Just wondering if anyone has any thoughts on this type of working pattern? I actually love my job but it is very very busy.
love to all xx
 
I wonder if it's possible you're not getting enough insulin for such a busy day? Normally, you'd expect less insulin when you are very active, but it can depend on your levels at the start - if they are on the high side then you might not have sufficient insulin circulating to help use the glucose in your blood or process the ketones, and both glucose and ketone levels rise. Stress may also play a part - even though you enjoy what you are doing, you may be getting a lot of adrenalin released and this can push your levels higher by causing your liver to release more glucose. This might also be 'overwhelming' the amount of insulin you have circulating.

I think, however busy you are, you must make sure you get a few moments to test and make sure your levels are not high. If they are, then you will need more insulin, but don't give it without testing.

I think you need to discuss a strategy with your DSN for busy work days. 🙂
 
A couple of things.

Have you got a fridge thermometer - check that the Fridge is working properly the insulin should be stored between 4 and 8 degrees. The temp will vary within the fridge so try the thermometer where the insulin is kept. If the fridge is out of range the insulin can degrade.

Are you testing for ketones using urine or blood testing strips ?
The urine strips should be OK for 6 months after opening but sometimes they go off. So maybe a new box.

If you are testing for blood ketones over 1.5 is considered high. I was told at this level to take supplementary insulin every 4 hours day and night and to seek medical advice quickly.

Stress can cause you to need more insulin as can some medications such as steroids.

If your ketones are above 1.5 or +++/++++ then it might be wise to call NHS direct or the out of hours GP.
 
hey to northerner and margie 🙂
northerner my bsl was 5.2 this morning and 8.2 on finishing so not really high enough to take too big of a correction , although i did 4-6 units. You have a point about testing but it is really not a job where that is particularly possible all the time. Particularly today when I was one of only 3 tills and the other tills were newbies so I had to help them with their work plus make up for their slowness due to being new to avoid qs. Maybe thought I need to make work make adjustments, I never want to because I never want to seem that I'm not part of the team and I never wanna be seen as diabetic first and crew second but perhaps this is wrong. You tell me your thoughts because its not really an area I've thought about in great detail if you get what I mean?!
Margie - I use blood testing strips and my ketones are always above 1.5 at the moment theyre at 4.8 I do ring the nhs direct but they often advise to go to the hospital and the people that I live with refuse to give me a lift there and I don't know any one else that has a car well enough to ask them to take me :(. Really really good idea about teh fridge thermometer tho so ty so so much I'll try to buy one asap and give it a check
ty so much for your support peoples 🙂 xxx
 
As your BMs all seem to be in range, are you losing weight?

It could be that you are not eating enough and the ketones are because you are burning fat to give you energy. You really need to talk to someone who has a medical background to help you figure out what is happening and to give you some advice. Can you take the morning off and make an emergency appt with GP or DSN. It may be that given your BMs are in range they will be happy but they can at least explain stuff to you and work out a plan.
 
Some good advice from Margie. It could well be that you're not eating enough for your busy work load. Plus, as Northerner suggests, your stress/adrenalin levels are high and your insulin isn't able to do its job properly or getting used up early providing your muscles with glucose.

Rob
 
hey margie and robster 🙂
i know what you mean but to be honest ive seen several consultants and dsns about this problem as i get it very very frequently and NONE of them can ever suggest anything that prevents it. i do really appreciate your help though and im not trying to shoot you down or dismiss what your saying so please dont think that i am 🙂
re calories ive had roughly 2500 today which should be more than enough for me cus im a little woman hahaha! good suggestion thought and i know where your coming from 🙂
they never have any advice that works its a problem that i have very very frequently :(
 
To add to the thoughts given so far...

You say that you didn't have time to have a drink or even go to the loo's this could be aggrevated both your reading etc..

Ketones are flushed out via the urine, if you producing them but not going to the toilet then you aren't flushing them out, but storing them giving a higher reading than they actually are!

Also if you aren't having a drink then you will be dehydrating again aggrevating the problem... Is it possible that while you stuck on a till that you have a bottle of water to slurp on between customers.. And insist on a toilet break..

It could still be related to your food, you mention a total calorie intake, but not the amount of carbs you eat..

If you look at an extreme low carb diet, such as Berntiens/Atkins, these can be quite high calorie wise but are extremely low on the carbs side..

As by reducing the carbs intake, the body is forced to fuel itself by burning the fat creating ketones..

There is also a rare form of DKA, called Euglycemic ketoacidosis were you go into dka with low blood glucose, here some info http://pjms.com.pk/issues/janmar08/article/bc2.html
 
Once ketones are in urine, even if they're still in the bladder, they are out of blood. However, usually ketones are produced when blood glucose levels are high, which also means higher urine production to get rid of them, so that usually means a full bladder and need to go to loo.

A bit of a puzzle, Kitten. 8 to 4.15 is a very long time for anyone not to pass urine nor to drink anything!
 
Can't really add anything else, hope ketones start behaving themselves for you lucy!

Emma xxx
 
hey to all, this is just a super quick reply, merely to thank you for your contributions and time and efforts(as they are all very much appreciated) as I am having to ring the hospital back up again in a minute.
Just to say total carbs yesterday was 260 grams and I use a blood ketone meter so that I can always see what is happening at present regarding the ketones because I have them so often at such high numbers that it would be too dangerous for me to measure the urine ones.
re the work situation your not allowed to drink at the till or eat. so a bottle of water is a definate no due to company policy. In short Mcdonalds is the craziest place to be a piece of human capital tbh!
love to all
p.s. emma im so touched u remembered my name! 🙂 xxxx
 
kitten said:
hey to all, this is just a super quick reply, merely to thank you for your contributions and time and efforts(as they are all very much appreciated) as I am having to ring the hospital back up again in a minute.
Just to say total carbs yesterday was 260 grams and I use a blood ketone meter so that I can always see what is happening at present regarding the ketones because I have them so often at such high numbers that it would be too dangerous for me to measure the urine ones.
re the work situation your not allowed to drink at the till or eat. so a bottle of water is a definate no due to company policy. In short Mcdonalds is the craziest place to be a piece of human capital tbh!
love to all
p.s. emma im so touched u remembered my name! 🙂 xxxx
Click to expand...
It might be worth thinking about the DDA here just a thought
 
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