Ketones

[MeganN]

Hi all.

Been feeling very sore in my back recently and tender in lower stomach so have been testing my urine every now and then just to see if I am getting a bladder or kidney infection.

My test yesterday had ketones in it but no glucose. Is this normal??

 

[Northerner]

Urine tests aren't great - they show the situation a couple of hours ago rather than the more current blood tests, plus the glucose (in most people) will only show when it is above 10 in the bloods (again, a couple of hours ago).

If you've not been eating well then ketones can occur due to the processing of fat for energy and aren't normally a problem unless blood sugar levels are above 17 or so at the same time. I'd have a word with your nurse or GP so you can have appropriate tests for possible UTI or kidney infection. Hope you feel better soon! 🙂

 

[MeganN]

Thanks northerner. My bloods aren't above 10 much at the mo but hovering around the sevens as I get used to the insulin dosages x

 

[bev]

Urine tests aren't great - they show the situation a couple of hours ago rather than the more current blood tests, plus the glucose (in most people) will only show when it is above 10 in the bloods (again, a couple of hours ago).

If you've not been eating well then ketones can occur due to the processing of fat for energy and aren't normally a problem unless blood sugar levels are above 17 or so at the same time. I'd have a word with your nurse or GP so you can have appropriate tests for possible UTI or kidney infection. Hope you feel better soon! 🙂

Hi Northerner,

But you can have ketones at lower levels than 17mmols and sometimes they might need treatment (i.e. Hospital admission) - so not always the case that levels necessarily have to be high as I know of people who have had levels of 5 or 6 but high ketones and needed to go to Hospital. I dont think it matters what your BG levels are if ketones are high does it?🙂Bev

 

[trophywench]

Well the thing with HONK (Hyperosmolar thingy) as opposed to DKA, is when your BG goes up and down and stuff plus ketones.

But if you can only test your pee and nit your blood you aren't gonna know..

I dunno what to suggest for the best really, except get to the docs asap.

 

[MeganN]

Thanks everyone.

It was only very low levels showing and the tests since have been clear.
Will watch both this and bloods for a few days though. Hospital on Wednesday anyway but will go sooner if anything else creeps up

Xx

 

[DeusXM]

I dont think it matters what your BG levels are if ketones are high does it?Bev

It matters a lot.

Ketones are a byproduct of fat metabolism and high ketones in themselves are not 'bad'. Anyone losing weight through diet and exercise will have moderate to high ketones in their urine. The issue comes when there is insufficient insulin to meet the body's needs. I would cautiously suggest that anyone with BGs in the 5-6s on a lower carb diet with high ketones will be in much better shape than, well, anyone.

 

[bev]

It matters a lot.

Ketones are a byproduct of fat metabolism and high ketones in themselves are not 'bad'. Anyone losing weight through diet and exercise will have moderate to high ketones in their urine. The issue comes when there is insufficient insulin to meet the body's needs. I would cautiously suggest that anyone with BGs in the 5-6s on a lower carb diet with high ketones will be in much better shape than, well, anyone.

Hi DeusXM,

Sorry but I disagree - especially a child with Type 1. I know of children who have been close to DKA and still had good BG's - but really high ketones +++. Obviously I know you can have starvation ketones - but when the ketone levels are high you shouldnt delay getting treatment. Our team (best in UK in my opinion) advise that if ketones are over 2.5 (blood meter) you need to go to Hospital as things escalate very quickly after this - no matter what your BG levels are.🙂Bev

 

[lauraw1983]

Hi DeusXM,

Sorry but I disagree - especially a child with Type 1. I know of children who have been close to DKA and still had good BG's - but really high ketones +++. Obviously I know you can have starvation ketones - but when the ketone levels are high you shouldnt delay getting treatment. Our team (best in UK in my opinion) advise that if ketones are over 2.5 (blood meter) you need to go to Hospital as things escalate very quickly after this - no matter what your BG levels are.🙂Bev

I'm sure on the DAFNE course we were told the ketones had to be alongside high BG's too for them to be of concern.

BUT that's for adults and I imagine there are quite a few differences between child and adult guidelines for diabetes?

 

[DeusXM]

I know of children who have been close to DKA and still had good BG's - but really high ketones +++. Obviously I know you can have starvation ketones - but when the ketone levels are high you shouldnt delay getting treatment.

Yes, I should have perhaps included a few more caveats in my original post. I certainly wouldn't want to comment on ketone levels in children as that's well beyond my realm of experience and the margin for error is far smaller. It's also worth pointing out that T1s in general should be careful when considering ketone levels.

However I do still think it's worth asserting that high ketones that are easily attributable to benign causes should not be a cause for concern. For instance, I know that if I have a few days where I eat very low carb (under 50g) and a lot of fat, my ketone levels will be significantly elevated while my BGs are normal. However, because I don't go into DKA on my basal insulin, I know these ketones are simply the result of me metabolising the fat I'm eating and so I'm not concerned. If I was showing high ketones and was either a)eating a higher carb diet or b)less certain about my basal matching, I'd be more concerned.

Ketones are like smoke. They tell you something is burning. Ketone levels can't, however, tell you whether it's a BBQ (ketosis) or someone burning down your house (DKA). More info is needed, and this will involve weighing up what is more likely depending on type of diabetes, diet, BG levels and a variety of other factors.

For T2s - my experience is again insufficient but I believe HONK only occurs when ketones are high and BGs are REALLY high, ie in 30s or more. Therefore I would have thought a T2 with ketones but normal BGs has nothing to worry about.