Keytones

[Jimmy2202]

Hi guys.

How long would your levels have to be high to develop keytones?

Since Xmas my levels have been high most of the time. I do correct to try to bring them down but I’m finding even 2 units of novarapid might only bring me down 2 mmol lol

Would this be because the insulin is fighting keytones first?
I have the keytones finger pricks here at home but I won’t ever use then due to my anxiety.

I had a episode a week or two ago where I was sick for 24 hours and couldn’t keep any fluid down - I read that I should go hospital but I was never going to do that so I just drank loads and loads of water when I could eventually keep it down, and was correcti g every 2 hours.

Keytones freak me out so want to learn more about them

 

[Thebearcametoo]

How high is high? Once you’re above 14 or so it can take more insulin to bring you down even without ketones. Ketones aren’t the big bad bogey. Testing for them if you are ill and high will help you know how much insulin to give and if you need to speak to a doctor. You can be high (above 20) and not have ketones. You can be at 14 with ketones if you’re ill but that would be unusual. The only way to know is to test. Knowing what to do will mean you can treat ketones at home so knowing what they are and what to do is in your best interest.

 

[Sally71]

It depends on several things. 1. How high exactly are you, and how long for? If it’s just a brief spike due to food but you’ve dealt with it then ketones are unlikely. 2. Why are you high, e.g. if you’re pumping and the cannula is failing and no insulin has gone in for a while then you might get ketones, or if you accidentally forgot an injection and haven’t realised. 3. Are you eating normally? E.g. if you’re ill and off your food you’ll get starvation ketones, they are a normal byproduct of the body burning fat instead of carbohydrate, but in that case as long as you have enough insulin in your body they won’t rise to dangerous levels.

 

[Lucyr]

I get ketones if I’ve been high for more than a couple hours ish usually, as that’s a sign I’ve not got enough insulin on board

 

[Jimmy2202]

It depends on several things. 1. How high exactly are you, and how long for? If it’s just a brief spike due to food but you’ve dealt with it then ketones are unlikely. 2. Why are you high, e.g. if you’re pumping and the cannula is failing and no insulin has gone in for a while then you might get ketones, or if you accidentally forgot an injection and haven’t realised. 3. Are you eating normally? E.g. if you’re ill and off your food you’ll get starvation ketones, they are a normal byproduct of the body burning fat instead of carbohydrate, but in that case as long as you have enough insulin in your body they won’t rise to dangerous levels.

So we’re talking highs up to 22 on a couple of occasions. Yeah they do always come down. I’ll attach a photo of the theme the last few weeks.

 

[everydayupsanddowns]

Ketones with high BG levels are a pretty nasty combination @Jimmy2202

Do you have any idea why your levels have been running high like that? Is that normal for you, or is this out of the ordinary? Are you ill or coming down with something? Are you injecting OK before food, or sometimes forgetting? How are your sites? And is your insulin fresh (have you got another pen/vial you can try if it doesn’t seem to be working as expected?).

Hope you find a way to gently get those levels back more onto an even keel - they must be making you feel pretty rough

 

[helli]

@Jimmy2202 do you check your Libre reading with a finger prick when Libre is reporting that high?
I ask because I find Libre tends to exaggerate highs.
If my Libre says 22, I will be high but more likely in the mid teens than twenties

If my levels stubbornly stayed there for a few hours, I would test f is r ketones but not if it was a spike that quickly came down

 

[Jimmy2202]

This is a combination of Christmas messing up my normal routine. Poor diet. I do believe I have some insulin which is faulty as I swear ‘it doesn’t work’ so I’ve chucked it.

Also I think my honeymoon period is ended as even the slightest things are sending my levels high

 

[Jimmy2202]

@Jimmy2202 do you check your Libre reading with a finger prick when Libre is reporting that high?
I ask because I find Libre tends to exaggerate highs.
If my Libre says 22, I will be high but more likely in the mid teens than twenties

If my levels stubbornly stayed there for a few hours, I would test f is r ketones but not if it was a spike that quickly came down

Hi yes sometimes I will. A couple of days ago Libre said 15 ish but finger prick was 12

I do really need to get this under control tho is messing me up mentally again

 

[rebrascora]

Hi Jimmy. Sorry to hear you are having problems with your levels and worrying about ketones.
Looking at that graph, it appears that your levels drop significantly overnight but then you look like you are battling high levels during the day. Is this a common pattern?
I know you use Levemir but is it a split dose or do you just take it once a day and if so, when?

I think it is likely that you may have lost a few more beta cells. Whether it is the last of them or just another step closer to the end of the honeymoon period, it can be impossible to say. I usually find that if my levels are not responding to corrections or they come down a little but but go straight back up, that it usually means I need to increase my basal insulin, but if you are only taking your Levemir once a day at night then that might not be a good idea if there is a pattern of your levels dropping overnight, which is why I asked that question about your basal insulin above. Ultimately I think you need to talk to your DSN and get some support and guidance since you are clearly anxious and not confident of managing this yourself. But the thing to look at would most probably be your basal insulin. Of course, if you have been off work over Christmas then you might be wise to see how things settle down when you are back at work with you having such a physical job.
I know I often find that my corrections seem to turn to water when I inject them when my basal insulin dose is not enough. I can end up injecting 4 or 5 corrections a day which might amount to 10 units of fast acting insulin, when a couple of extra units of basal insulin the next day will sort it. I am not suggesting that you increase your basal by 2 units as that might be too much for you, but just saying that when I get this situation with corrections not working, it is almost certainly because my basal insulin doses need adjusting a bit.

As regards testing for Ketones, please don't be frightened of testing. Knowledge is power, so you are better off knowing what the result is and making appropriate decisions based on that info, be it injecting more insulin or heading off to get some help at hospital, than worrying about it possibly being high and burying your head in the sand which is dangerous. Drinking water is much less effective than injecting insulin. If you inject a bit too much insulin, you can always eat a jelly baby or 2 if it looks like it is going to drop you a bit too low. You have Libre so you can monitor your levels closely to watch it coming down. I find that if I hit 5 with a vertical downward arrow, then a jelly baby will usually level it off, or at least slow it down so that I can then watch it more closely and decide if I need another Jelly Baby or not.

So far, in nearly 4 years of using insulin, I haven't needed to test for ketones because I don't let my levels remain in the mid teens or above, even if it means stacking corrections to bring it down. I am always careful to record each correction I give so that I can keep track of how much insulin is still active, but the important thing is to do it when you can keep a close eye on your levels and have some fast acting carbs to hand to slow things down if it looks like you are going to drop too low.
I see it a bit like piloting a plane and coming in to land.... If I am coming in to my target level at too steep a descent, I lift the nose a bit by eating a few quick acting carbs (maybe 1 JB or a dextrose tablet) and if I am not losing altitude quickly enough (or not at all 🙄) then I give it a bit more insulin and I just use small amounts of each as necessary to slowly and gently touch down at my target level. It might take me a few hours but as long as the progression is mostly downwards then I am winning. It took me a while to be confident with using my insulin to do that, but now I have experimented with it, I feel much more confident that I can bring high levels down even when they are stubborn and then prevent them the next day by increasing my Levemir.