# Keytones but not above 13mmols



## pgcity (Dec 27, 2012)

Hi All
For the second time this week I have had keytones and felt rubbish but blood glucose levels have not been higher than 11mmols.
I have corrected with a pen and changed cannulas which seems to have sorted me out.
I didn't think you could have keytones unless blood sugar was over 13mmols or if you hadn't eaten for some time.
Any ideas how this has happened?


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## Northerner (Dec 27, 2012)

I have heard of this happening, but I'm not sure I understand why. As you suggest, ketosis usually happens when you haven't eaten and your body is converting your body tissue for energy, or when you have insufficient insulin circulating for your body to use glucose properly, causing your levels to rise and again, using your body fat for energy. BG levels that are not particularly high would suggest that your body is using blood glucose for energy. It may depend on the amount of carbs you have eaten e.g. if you haven't had much carbohydrate then perhaps your levels won't rise, but your body uses body fat for energy because fat and protein are so slow to convert?

Just my speculation, I'm afraid! I would keep checking to see if the ketones rise. Are you testing blood or urine ketones?


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## pgcity (Dec 27, 2012)

Testing urine keytones. Everything is ok now. Bg down to 7 so just eaten. 
I am glad you have heard of this happening. It is very reassuring to have you around.
Ta


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## Northerner (Dec 27, 2012)

pgcity said:


> Testing urine keytones. Everything is ok now. Bg down to 7 so just eaten.
> I am glad you have heard of this happening. It is very reassuring to have you around.
> Ta



Glad to hear things have improved


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## bev (Dec 27, 2012)

pgcity said:


> Hi All
> For the second time this week I have had keytones and felt rubbish but blood glucose levels have not been higher than 11mmols.
> I have corrected with a pen and changed cannulas which seems to have sorted me out.
> I didn't think you could have keytones unless blood sugar was over 13mmols or if you hadn't eaten for some time.
> Any ideas how this has happened?



Hi Pgcity,

I have heard of this many times and Alex has had it too - when levels have been within range. Like Northerner says - no idea why it happens but dont worry it isnt just you!Bev


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## pgcity (Dec 27, 2012)

Thanks Bev. Your reassurance means so much. 
Does ALex have a pump and if so do you change the cannula or is there another cause?


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## bev (Dec 27, 2012)

pgcity said:


> Thanks Bev. Your reassurance means so much.
> Does ALex have a pump and if so do you change the cannula or is there another cause?



Hi Pgcity,

Yes Alex uses the Medtronic VEO and has been on it for three years now.Often there is no cause - but we follow the Hospital protocol of checking after an hour and if no change then do a set-change. I personally think that because we are all told that ketones arent present unless levels are over 14 or so that we just dont test at times when perhaps there is slight illness so we wouldnt necessarily know that there are ketones - so feel that they are more common than we realise. Our old team were adamant that you couldnt have ketones if levels were within range - but our new team have said the opposite and as we have witnessed it in both Alex and others it seems they are right. There was a link on here a year or so ago explaining why this happens but cant remember what it was called. As long as you follow the protocol and top up your insulin then you should be fine. I find that if Alex goes over 1.5 using the blood meter then it quickly escalates so we try lots of insulin and lots of water over an hour (I have even bribed him to drink it!) and that seems to do the trick.Bev


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## pgcity (Dec 27, 2012)

Thanks again for your help


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## Ellie Jones (Dec 28, 2012)

Yes it can happen...

When I was having my youngest daughter I probably spent more time in the hospital being treated for DKA than I did out during the pregnancy

My levels only had to hit about 8mmol/l and DKA would kick in..

But it can happen for others, there is a name that is used within a certain group of diabetics, but can't remember what it's called now


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## pgcity (Dec 28, 2012)

My goodness. That must have been tough. I have a lot of admiration for my pregnant sisters. Luckily I had my son before I got type one


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## Tina chick (Dec 29, 2012)

I've had this before my bg was around 7 but my pump cannula was not in correctly so got ketones was sent to the hospital and there said its as the body was still getting some insulin to deal with the blood sugar but not the ketones hope that helps.


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## DeusXM (Dec 29, 2012)

Ketones and normal blood sugars generally aren't a problem.

Ketones are produced when you metabolise fat instead of glucose. There are two processes where this happens: ketosis, and diabetic ketoacedosis. 

These two processes are completely different. Ketosis is benign and in fact, anyone who is looking to lose weight will have to go through ketosis. People who primarily get their energy from fat rather than carbs will also by definition be in ketosis. 

DKA is very different and very dangerous but is caused by insufficient insulin to meet the body's basic metabolic needs, where as ketosis is caused by insufficient carbs to meet your basic energy needs. The difference is, you can make up the energy difference with other food groups. There's no alternative for insulin. If you are eating a lot (say more than 50g) of carbs but have high ketones and normal BG, that could be a cause for concern. If you're not eating a lot of carbs or simply haven't eaten for a few hours, your ketones are high but your BG is good, you're probably ok.


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## bev (Dec 29, 2012)

DeusXM said:


> Ketones and normal blood sugars generally aren't a problem.
> 
> Ketones are produced when you metabolise fat instead of glucose. There are two processes where this happens: ketosis, and diabetic ketoacedosis.
> 
> ...




Hi DeusXM,

Anyone with ketones on the higher end of the scale needs advice from either their team or the Hospital. I know of many children who have been hospitalised with normal BG's and high ketones - so it isnt something that should be shrugged of as 'starvation ketones' and it isnt wise to advise people 'your probably OK' as everyone will have their own team to advise and certainly ketones in children appear to escalate a lot quicker than with adults.Bev


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## pgcity (Dec 29, 2012)

My keytones were not starvation related. Far from it, I have identified 2 potential causes. Pump going off or getting ill. Either way I got rid of the keytones as quickly as poss as I felt dreadful.
I spoke to a gp friend today and she said not to worry until bg was 16+ and was very sceptical that I could tell when I had keytones. I must say I was a little disappointed with her attitude.


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## trophywench (Dec 30, 2012)

Well I feel nauseous, apart from feeling as if my mouth has had a flock of birds living in it for too long  (ie a tongue that feels like the bottom of a birdcage)

How do they make you feel?


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## bev (Dec 30, 2012)

pgcity said:


> My keytones were not starvation related. Far from it, I have identified 2 potential causes. Pump going off or getting ill. Either way I got rid of the keytones as quickly as poss as I felt dreadful.
> I spoke to a gp friend today and she said not to worry until bg was 16+ and was very sceptical that I could tell when I had keytones. I must say I was a little disappointed with her attitude.



Hi Pgcity,

Most GP's 'learn' all about diabetes in 3 days at Uni!It doesnt surprise me that they have such little knowledge - but what I really resent is that sometimes they think they do and sometimes they think they know better than us! I had an occasion last year when a GP said something along the lines of 'I know all about pumps - all you do is plug them in and your good to go - they dont need any other intervention'!!!!!!!!!!!Her husband (who is a Barrister) couldnt understand why I fell about laughing and very quickly dismissed his wife's opinion.

So if you had ketones at the top end of the scale and your BG was 9 for example this same GP would say you didnt need to worry. Is it any wonder we dont use GP's for such specialist advice and support? Hopefully when the new Tariff comes into play it should help to identify this sort of 'training' and either send them on proper training or ditch them.

Alex can tell he has ketones as he has pains in his chest and doesnt like taking a deep breath as it hurts so anyone who is sceptical about how it feels really should listen to their patients.Bev


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## pgcity (Dec 31, 2012)

Got em again now. Blood sugar 11.9 when I tested but on its way down, 9.5 now. Definitely illness related this time as I have a cold.
I felt very sick, shaky and everything was blurred. Feeling much better now


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## bev (Dec 31, 2012)

pgcity said:


> Got em again now. Blood sugar 11.9 when I tested but on its way down, 9.5 now. Definitely illness related this time as I have a cold.
> I felt very sick, shaky and everything was blurred. Feeling much better now



Hi Pgcity,

What levels of ketones do you have? Sorry to hear you might be sickening for something - hope your feeling better now.Bev


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## pgcity (Dec 31, 2012)

Hi bev. I was 3+ but now nothing with bg 5.6.
It took 5u to sort out which was scary as 1u brings me down 6mmols.
I have just spoken to my dsn who advised checking every 2 hours and adding a unit for any trace so the keytones don't increase. She also advised testing every four hours overnight until my cold has gone.
I must admit I have never had this much trouble with a cold before


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## bev (Dec 31, 2012)

pgcity said:


> Hi bev. I was 3+ but now nothing with bg 5.6.
> It took 5u to sort out which was scary as 1u brings me down 6mmols.
> I have just spoken to my dsn who advised checking every 2 hours and adding a unit for any trace so the keytones don't increase. She also advised testing every four hours overnight until my cold has gone.
> I must admit I have never had this much trouble with a cold before



Hi Pgcity,

How scary!Do you use a blood meter for testing ketones? I only ask as if using wee strips then it isnt as accurate as the blood ketones are 'real time' rather than delayed. Yes - keep testing and checking every couple of hours - but if you are worried or it starts to escalate dont hesitate to go to A & E or ring your team if you have 24 hour help. I Hope things settle down for you.Bev

p.s. I am sure you know this but drinking water really does help to flush them out - I have bribed Alex to drink before now!


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## pgcity (Dec 31, 2012)

Very scary indeed. Will keep checking. Just sent me dad to get me some blood beta keytone strips as I am aware they are more real time and it felt like forever waiting for the urine ones to register a change. 
I am drinking plenty so hopefully I can keep the blighters at bay.
Thanks for your help


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