Problem with high ketones

[Duane Charles]

That’s not correct. It’s the high ketones that are the danger. It’s possible to get ketoacidosis with normal blood sugar - euglycaemic ketoacidosis. Here’s one of many articles:

Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma

Summary Euglycemic diabetic ketoacidosis (EDKA) is a clinical triad comprising increased anion gap metabolic acidosis, ketonemia or ketonuria and normal blood glucose levels <200 mg/dL. This condition is a diagnostic challenge as euglycemia masquerades the underlying diabetic ketoacidosis. Thus...

edm.bioscientifica.com

People without diabetes can also get ketoacidosis on rare occasions and their blood sugar is normal. As ketoacidosis can sometimes be connected to certain medication that a number of people with diabetes are on, saying that it’s somehow ok just because your blood sugar is normal is potentially dangerous.

High ketones are a concern whatever one’s blood sugar.

Although in the early stages of my monitoring regime, a number of readings have flashed up “ketones”. Only once did I get it checked and was assured that it was fine by the DN doing a dip test. Perhaps I should now invest in some dip tests to be on the safe side.

 

[Nidge76]

When you have higher ketones, what are your blood sugars at the time? Greatest concerns are where elevated ketones are accompanies by high blood sugars.

My sugars have been fairly normal. I haven't been testing regularly but my last hba1c was 46. When I had high ketones this week my sugars were maximum 8

 

[Nidge76]

That’s not correct. It’s the high ketones that are the danger. It’s possible to get ketoacidosis with normal blood sugar - euglycaemic ketoacidosis. Here’s one of many articles:

Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma

Summary Euglycemic diabetic ketoacidosis (EDKA) is a clinical triad comprising increased anion gap metabolic acidosis, ketonemia or ketonuria and normal blood glucose levels <200 mg/dL. This condition is a diagnostic challenge as euglycemia masquerades the underlying diabetic ketoacidosis. Thus...

edm.bioscientifica.com

People without diabetes can also get ketoacidosis on rare occasions and their blood sugar is normal. As ketoacidosis can sometimes be connected to certain medication that a number of people with diabetes are on, saying that it’s somehow ok just because your blood sugar is normal is potentially dangerous.

High ketones are a concern whatever one’s blood sugar.

Thank you. I'll have a read of that article

 

[trophywench]

Pee testing strips only cost approx £5 a tub - BUT only last about 6 months after you first break the seal since, there's normally some element of moisture in the air.

Euglycaemic DKA - this was frighteningly common during the Covid pandemic and though Oh yes normal 'Obs' like temperature, blood pressure, oximeter reading and BG tests were done on the majority of patients - ketones weren't always unless the HCPs were very switched on, depending on wherever the person landed up having their Obs done and by whom.

 

[everydayupsanddowns]

Hope you are able to get a cPeptide check arranged @Nidge76

As far as I am aware a single antibody check isn’t very conclusive, especially the further away from diagnosis.

CPep will show how much insulin you are producing - it may be worth upping your carbs for the results to reflect your body’s ability to react to dietary carbohydrates?

 

[Nidge76]

Hope you are able to get a cPeptide check arranged @Nidge76

As far as I am aware a single antibody check isn’t very conclusive, especially the further away from diagnosis.

CPep will show how much insulin you are producing - it may be worth upping your carbs for the results to reflect your body’s ability to react to dietary carbohydrates?

I'll ask the GP if I can get that test done. My DN team have already said I'm a bit of a strange case, but then again they just left me to it.

 

[everydayupsanddowns]

I'll ask the GP if I can get that test done. My DN team have already said I'm a bit of a strange case, but then again they just left me to it.

Well you have a tick in pretty much all of the ‘clinical indications’ boxes in the NICE Guidelines:

1.1 Diagnosis and early care plan​

Initial diagnosis​

Make an initial diagnosis of type 1 diabetes on clinical grounds in adults presenting with hyperglycaemia. Bear in mind that people with type 1 diabetes typically (but not always) have 1 or more of:

• ketosis
• rapid weight loss
• age of onset under 50 years
• body mass index (BMI) below 25 kg/m2
• personal and/or family history of autoimmune disease. [2015, amended 2022]

Recommendations | Type 1 diabetes in adults: diagnosis and management | Guidance | NICE

www.nice.org.uk

which also addresses concerns about single antibody checks and the possibility of false negatives…

Measure diabetes-specific autoantibodies in adults with an initial diagnosis of type 1 diabetes, taking into account that:

• the false negative rate of diabetes-specific autoantibody tests is lowest at the time of diagnosis
• the false negative rate can be reduced by carrying out quantitative tests for 2 different diabetes-specific autoantibodies (with at least 1 being positive). [2022]

 

[rayray119]

Although in the early stages of my monitoring regime, a number of readings have flashed up “ketones”. Only once did I get it checked and was assured that it was fine by the DN doing a dip test. Perhaps I should now invest in some dip tests to be on the safe side.

That wouldn't have been a a ketone reading that would a been warning on your metter to check for ketones as the reading was high some metters will give a warning for to check if the reading is above a certain level

 

[Nidge76]

@everydayupsanddowns That's extremely helpful. I will mention this as I fit all of those things. Thank you.

 

[Duane Charles]

That wouldn't have been a a ketone reading that would a been warning on your metter to check for ketones as the reading was high some metters will give a warning for to check if the reading is above a certain level

Morning @rayray119, thank you for your comment. I will be trying to get some urine test strips to keep any eye on my ketones, should I get the warning on my meter. This morning my reading was 14.5 with also a ketone alert for checking.

 

[Dragonheart]

Although in the early stages of my monitoring regime, a number of readings have flashed up “ketones”. Only once did I get it checked and was assured that it was fine by the DN doing a dip test. Perhaps I should now invest in some dip tests to be on the safe side.

Is that reading advising you to check ketones or telling you they are high?

Blood ketones are more accurate than urine dip ones but they can fall (or rise) very quickly eg between a home test and getting to see the nurse.

Most type 2 don’t have ketone testing unless they have a history or are on medication that can make it more likely (sglt2 for example). That’s said it’s not a bad thing to be able to check.

 

[Duane Charles]

Is that reading advising you to check ketones or telling you they are high?

It’s advising me that because of the BG being high that the Ketones may or rather should be checked. It seems to be when the reading is above 13

 

[trophywench]

My BG meter tells me that, whenever it reports 13.0 or more.

If that is still within a couple of hours of a meal, I ignore it. Been doing that very thing this afternoon, but by now yes I do know I need a new cannula right now, cos this one's obviously gorn orf. Libre says 11.9 and a horizontal arrow. Meter says 12.1 and I need a correction of 2.1u. So, changed cannula and tubing, primed tubing, primed cannula (another 1u) and had a manual bolus of 2u. Literally just about to start cooking dinner, pork chops, roast spuds and parsnips, green beans. (and gravy) Will lob some onion in with the roasties. Did.

Pud after the washing up, Tesco's dark choc, choc ice. Just had a satsuma, OK but not very sweet. Meter BG 10.7 and said I needed 1.4u so I did that - bearing in mind the satsuma's only just been swallowed, no danger of going hypo in a bit!

 

[everydayupsanddowns]

It’s advising me that because of the BG being high that the Ketones may or rather should be checked. It seems to be when the reading is above 13

A few meters added this warning in the past 5 years or so. My Ascensia/Contours do it, as did my last Accu-chek.

I think there may be an assumption that meter-users will most likely be T1, where ketones are more common at high BGs, and potentially more immediately concerning? As I understand it it’s the combination of ketones and insufficient insulin that cause the worry, because insulin is a key regulator of ketone production, and without it ketones can run amok and begin to turn the blood acidic.

 

[Duane Charles]

A few meters added this warning in the past 5 years or so. My Ascensia/Contours do it, as did my last Accu-chek.

I think there may be an assumption that meter-users will most likely be T1, where ketones are more common at high BGs, and potentially more immediately concerning? As I understand it it’s the combination of ketones and insufficient insulin that cause the worry, because insulin is a key regulator of ketone production, and without it ketones can run amok and begin to turn the blood acidic.

Thank you, if and when I get a warning I think I’ll check my ketones just to b me sure, but I’m positive they’ll be fine.

 

[harbottle]

Yes, insulin inhibits ketone production so if there is no insulin in the bloodstream, it can cause ketogenesis to run amok.

 

[Duane Charles]

This evening I did my pre-meal reading which was 10.2 after eating and waiting 2 hours my reading was 19.7 with the ketones warning. I checked these with the reading being about 0.15. However, the meal was a few chicken wings, mixed veg and some air fried low fat chips. I was quite surprised by the 9.5 jump between pre and after.

 

[rayray119]

This evening I did my pre-meal reading which was 10.2 after eating and waiting 2 hours my reading was 19.7 with the ketones warning. I checked these with the reading being about 0.15. However, the meal was a few chicken wings, mixed veg and some air fried low fat chips. I was quite surprised by the 9.5 jump between pre and after.

It could have possibly been the chips even though Thier low fat there still made of of photo which is quite carby(by the way I'm not citizeing just offering some insight) were they packet chips that should tell you the amount if so the packet should tell you the carb content

 

[Leadinglights]

This evening I did my pre-meal reading which was 10.2 after eating and waiting 2 hours my reading was 19.7 with the ketones warning. I checked these with the reading being about 0.15. However, the meal was a few chicken wings, mixed veg and some air fried low fat chips. I was quite surprised by the 9.5 jump between pre and after.

Good that the ketones were OK but that is a whopping increase from your meal.
I suppose it depends on the quantity you had, Chicken wings can be quite high carb if they have a coating or marinade and chips are high carb 6 small chips could easily be 10g carb and would depend on what the mixed veg were, sweetcorn, carrots, peas could be high carb.
It would be a good idea to weigh what you have and get an estimate of the carbs as if you are genuinely having low carb meals and still getting such a large increase that is going to strengthen your argument for a better medication regime.

 

[Duane Charles]

The wings did have a salt and pepper coating, the chips weren’t fresh and the mixed veg consisted of peas, carrots, sweetcorn and green beans and were frozen. I’m assuming that all this contributed to the increase. I need to ensure packet reading is done on shopping trips.