Ketones!

[Vix]

Help - my sugars are crazy at the moment but for the second time I have ketones of 4 (rare for me) and I don't know when to start worrying... this is the pattern last Tues:

2 hrs after lunch: 13.6, no ketones
Before dinner: 17.7, ketones of 1.5
Felt rubbish an hour later : 19.6, ketones of 4
Half hour later: 17.7, ketones of 4
Half hour later: 14.6, ketones 1.5
Before bed: 12.3, ketones 0.5
Next day: waking 7.4, no ketones and that day was the best readings for ages... Since then my levels have been an improvement on recent weeks

Today...

2 hrs after lunch: 11.1
Before dinner: 13.6, ketones 0.5
Hour after dinner ie now: 17.8, ketones 4

I hope it doesn't keep going up, but apart from drinking lots of water, what do I do if it goes up and still have ketones??? 😱

Xx

 

[Northerner]

Vix, are you sure your insulin is OK? Do you use a pen or a pump and might it not be working properly? If you can't reduce your BG levels and the ketones remain high then you may need to go to A&E so they can stabilise you.

 

[Vix]

Well I changed my basal cartridge today so I did wonder if there is something wrong with it, but that doesn't seem to explain the same pattern last Tues as I used the same cartridge for several days and I woke up at 13.5 and I did my basal after that result... I was dreading 'A&E' being mentioned My sugars are slowly coming down, now at 15.5, bit scared to check my ketones so will do it in half an hour to give them more chance to go away!! Ironically it stresses me out when they're high which will make them even higher!! xx

 

[Northerner]

Well I changed my basal cartridge today so I did wonder if there is something wrong with it, but that doesn't seem to explain the same pattern last Tues as I used the same cartridge for several days and I woke up at 13.5 and I did my basal after that result... I was dreading 'A&E' being mentioned My sugars are slowly coming down, now at 15.5, bit scared to check my ketones so will do it in half an hour to give them more chance to go away!! Ironically it stresses me out when they're high which will make them even higher!! xx

What about your Humalog? Are you correcting?

 

[Vix]

Yes, been correcting since breakfast! Saw dietician today, which was the biggest waste of time, but she did confirm that my correction calculations are right (in theory!!) but I did a correction at breakfast and my sugars were still 13.7 after breakfast... My body has had enough at the moment, hope it's not something wrong with my kidneys???

 

[Northerner]

Yes, been correcting since breakfast! Saw dietician today, which was the biggest waste of time, but she did confirm that my correction calculations are right (in theory!!) but I did a correction at breakfast and my sugars were still 13.7 after breakfast... My body has had enough at the moment, hope it's not something wrong with my kidneys???

Might it be your injection sites? Could be the insulin is not getting absorbed properly? Do you have any 'fresh' sites where you could try a correction, that you haven't used in a long time? High BG and high ketones are usually a sign of insufficient insulin circulating - insulin is needed to clear the ketones as well as bring down the BGs.

 

[Vix]

Well I literally just changed my injection sites 2 weeks ago as I was injecting in arms and thighs as I have for the past 18 years as didn't realise I shouldn't be using my arms so now using my tummy, which is much more painful... My DSN checked my old sites and said they were fine... I have just changed to 4mm needles instead of 5mm, can that make a difference in absorption? xx

 

[Northerner]

Well I literally just changed my injection sites 2 weeks ago as I was injecting in arms and thighs as I have for the past 18 years as didn't realise I shouldn't be using my arms so now using my tummy, which is much more painful... My DSN checked my old sites and said they were fine... I have just changed to 4mm needles instead of 5mm, can that make a difference in absorption? xx

Shouldn't do, I wouldn't have thought. Have you tried (sorry to be indelicate!) your bum? Are you doing airshots to make sure the insulin is getting through the needle as expected? Cartridges not cracked? Do you have a different box of cartridges, as the whole box might be affected.

Sorry for all the questions!

 

[Vix]

Hee hee, I'm recovering from hip surgery so struggle to 'twist' to inject in my bum! Yes, doing airshots every time... changing needle every time... cartridge doesn't seem cracked... Good idea, I'll change the cartridge tomorrow from a different box - I keep them in the fridge but shouldn't make a difference if been in there a few weeks should it?? Questions welcome, as there's got to be something I'm missing/not thinking about 😉 xx

 

[Northerner]

Hee hee, I'm recovering from hip surgery so struggle to 'twist' to inject in my bum! Yes, doing airshots every time... changing needle every time... cartridge doesn't seem cracked... Good idea, I'll change the cartridge tomorrow from a different box - I keep them in the fridge but shouldn't make a difference if been in there a few weeks should it?? Questions welcome, as there's got to be something I'm missing/not thinking about 😉 xx

Should be fine - I always keep a spare box of novorapid in case I think the one in use might have been compromised, like kept out of the fridge any length of time before it reached you, for example.

Hope you can get to the bottom of it, I know how horrible it can make you feel!

 

[Vix]

Thanks, it's come down to 14.8 now, which isn't great but at least it's not going up 😉 and my ketones have gone which is the main thing - I'll try changing cartridges tomorrow and see what happens... thanks for all your suggestions 🙂 xx

 

[Northerner]

Thanks, it's come down to 14.8 now, which isn't great but at least it's not going up 😉 and my ketones have gone which is the main thing - I'll try changing cartridges tomorrow and see what happens... thanks for all your suggestions 🙂 xx

You're welcome, glad to hear things are coming down 🙂 Hope tomorrow is a MUCH better day for you!

 

[trophywench]

All from the same box of cartridges? - it might have been out the fridge for days before you got it. I know it shouldn't but you just do NOT know. I'd get a repeat scrip and go to another pharmacy for that one and see if things improve.

I did have some well in-date Humulin cartridges go off on me some years ago. Wouldn't work so I'd corrected after hours and then half an hour later I was flat on the floor severely hypo and Lucozade wouldn't work. Landed up having an ambulance ride to A&E in Telford as we were out at the Ironbridge Gorge museum(s) - on a motorbike! - that day.

 

[Vix]

I've changed to a new box of cartridges this morning, and it's still not behaving... gone up from 10.2 waking to 14.5 now!!! I despair

Oooh that doesn't sound good trophywench... I've been told that whatever I do I shouldn't correct unless it is with my meal bolus as there could be a cross-over so that means I just have to feel rubbish and it's stressing me out!! Hope I can speak to my DSN later today as I think it's like I'm coming down with something but you would have thought after a week I'd at least have symptoms if I wasn't well... Apart from the fact I feel bleurgh I'm having a blood test for my hba1c tomorrow and I seriously dread to think what it is and can just hear the nurse at the doctors surgery 'oh dear, you've got bad control haven't you??' I'm TRYING!!!!!

xx

 

[rosebreakell]

ketones

i am on gilcazade and pioglitazon tabs for diabetes but i have had a trace of ketones and something begining with l in my urine my sugars are way of my blood presure is up have been put on trimethoprim anitibacterial tabs as they dont know if i have abladder infection or kidney infection and have just had a bad 2 days feeling ill have to see nurse again thursday thats all iwant to say im new here thanx

 

[Northerner]

i am on gilcazade and pioglitazon tabs for diabetes but i have had a trace of ketones and something begining with l in my urine my sugars are way of my blood presure is up have been put on trimethoprim anitibacterial tabs as they dont know if i have abladder infection or kidney infection and have just had a bad 2 days feeling ill have to see nurse again thursday thats all iwant to say im new here thanx

Hi Rose, welcome to the forum 🙂 Sorry to hear you are not well, I hope the tablets do the trick and that you are feeling much better soon. If you are not feeling well and not eating much as a consequence then the trace of ketones should not be anything to worry about. Hope your appointment gets to the bottom of things - let us know how things go, or if you have any other questions 🙂

 

[trophywench]

Well the trouble with correcting 'in between' is, as I'm sure you're aware, the danger of dose stacking. But if there was more than about a 4 hour gap - eg at work I had my lunch 12 till 1, but didn't have my evening meal until say 7pm ish, if I was really high about 4pm then I might risk it.

But let's think about this .... are you 500% sure it's not lack of basal rather than lack of bolus?

Hi Rose - 'trace' ketones aren't really a great big worry, esp if they are in urine because the urine ketone test doesn't distinguish between the 'really bad for diabetics ketones' and the dietary sort - ie the sort of ketones anyone (diabetic or not) gets if they haven't eaten for a while. Plus what appears in your bladder is approx two hours after it happened in your blood - so urine ketone testing or glucose testing just isn't very reliable for making mega decisions.

Would you like to tell us a bit about yourself in the introductions section?

 

[Vix]

No Trophywench I'm not 500% sure about anything at the moment! I wish I could post a page of readings from my book as there is no obvious pattern - I think it's my basal that is out but for 5 days my waking readings were fine and then suddenly I shoot up and have ketones of 4 which has rarely happened to me in the last 10 years, infact the last time I had ketones that high was about 7 years ago when I ended up in hospital with ketoacidosis I also only test urine as my meter doesn't allow me to check ketones in my blood so going to ask my DSN on Friday if I can change meters to one that does!

Hi Rose, Hope you are feeling better soon! I don't worry about a trace of ketones if especially if feeling ill and hopefully when you are better they will disappear. Get well soon xx

 

[Flutterby]

Hi Vix, sorry to hear of your problems. You mentioned you are just recovering from hip surgery - does this mean you are maybe not as mobile as usual perhaps and so may need to increase basal and possibly bolus amounts? Could there also be a slight infection which is causing these high levels? All just little thoughts really as everyone has mentioned the usual things. You seem to be doing all the right things and I do wish it would settle for you. Take care of yourself.

 

[Vix]

Thanks Flutterby... Yes I am much less active now that I was a few years ago before I shattered my hip but I am more active now than a year ago (I had operation no. 3 in November 2012 which has been a much quicker recovery than operation no. 2 in November 2011) and I'm now off my crutches so trying to walk everyday... I have actually been told by my DSN to reduce my basal as was having night hypos! But I agree in theory I should be doing more basal/bolus because I'm not very active. Maybe I do have an slight infection that I don't know about but I feel fine within myself

Off for a walk now to see if that helps 😉 It just doesn't make sense that my day to day routine is fairly similar and because I work from home my food is almost the same for breakfast and lunch each day to try and rule things out yet my sugars have no day the same!

Thanks for all your suggestions everyone 🙂

Xx