# Ketones question



## annieberry (Apr 10, 2014)

Hi,

Last year I was hospitalised with DKA 12 times. I have never checked for ketones myself before just had to go to hospital when symptoms of DKA kicked in.
I have recently been given a new testing meter that tests for blood ketones as well as blood glucose. My ketones are 1.9 according to the leaflet it says seek medical help if over 1.5. I am not feeling sick and if I hadn't have tested I wouldn't do anything as I wouldn't know.
Any thoughts on what to do please ?

Ann


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## annieberry (Apr 10, 2014)

Ps. Apologies for all the questions since joining, and not much advice in return. It is just everyone is very knowledgeable and helpful here


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## Hanmillmum (Apr 10, 2014)

Hi Ann, are you unwell at all or BG's high?. You may well need to consider taking some insulin, (but be cautious as if you haven't eaten or fasted you can have ketones present). So decide the cause - it's usually a sign there is too little or no insulin present. It might help to have a little something to eat along with some insulin to get rid of the ketones - plenty of fluids too  I would personally re-check your ketones to make sure they are coming down once you have done something to sort it.

Sorry to hear you have had DKA 12 times, it would be time well spent for your team to be helping you out a bit more and perhaps have given you some reference for what levels you should be attending hospital for. It's been a while since DKA on dx but we have been told to consider hospital if we get a ketone reading over 3 (I think, will go and check)


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## Sally71 (Apr 10, 2014)

Hi Annie

What is your blood sugar level at the moment, and what have you eaten today?

If your blood sugar is high and you have ketones of 1.9 then you need to get some insulin into you quickly.

If your blood sugar is normal, have you perhaps not eaten much today?  Your body can produce ketones if you have not eaten much carbohydrate, they are a normal byproduct of your body burning up fat for energy (which it does if there is not enough carbohydrate available) and at low levels are not dangerous.  It could just be that these are starvation ketones if you have not eaten much carb today.  In which case test again in a couple of hours to make sure they haven't gone up.

If your BG is normal and you have eaten normally today then I'm a bit stumped, I didn't think it was possible to have high ketones with normal BG but found out on another thread that I posted that this can happen sometimes.  However 1.9 is not serious danger level so maybe monitor it overnight and get in touch with your medical team if it doesn't go down.


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## annieberry (Apr 10, 2014)

Thank you for the reply.
Blood glucose is 23.4, have been taking novorapid correction doses 4 units an hour all day to reduce them, but it isn't going down very fast. Been feeling quite sicky so haven't managed an awful lot to eat a slice of toast and a banana.
Will do another correction maybe a bit more and see if blood glucose comes down any and recheck ketones in a couple of hours.
Thank you for your help.


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## annieberry (Apr 10, 2014)

Thanks Sally.
I am not overly concerned but now I can check them I want to be able to correct so I don't have to go into hospital yet again.


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## Hanmillmum (Apr 10, 2014)

Annie if your BG's are taking a lot to budge down might be worth checking your insulin/pen are ok, have you another vial to try? We find also the longer the BG stays at a high level the more insulin resistant little one becomes and therefore needs lots more insulin than would normally to correct it.

Hope you get on top of it soon and hence feel much better


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## everydayupsanddowns (Apr 10, 2014)

Annie

Your situation does seem quite worrying to me.

I'm not sure what level of corrections you have been doing, but I would consider taking higher levels of insulin if your BGs do not come down within a few hours of taking them.

Is there any chance your insulin might be compromised? Have you got another vial or cartridge you can try?

Keep drinking plenty of fluids to help your kidneys out, and don't muck about if you continue to feel nauseous.

Call 111 and get some advice - or off to A&E with you!


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## Sally71 (Apr 10, 2014)

23.4 

Definitely get some insulin in!!  Do you know how to work out correction doses?  For example we know that 1 unit of insulin will bring my daughter's BG down by 4 mmol, so if she was that level I would give her 4 units of Novorapid.  Adults would probably need more, have your medical team helped you to find out what ratio works for you?

Then make sure you drink plenty of water and monitor those levels (BG and ketones) at least every 2 hours until it comes down again.  If you don't eat you might have a few ketones remaining but I usually find that once you get some insulin in they will drop pretty quickly.  Good luck


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## annieberry (Apr 10, 2014)

Ahhhh I hadn't thought of it might be the insulin !! Have opened a new batch of cartridges and taking an 8ml correction dose of novorapid.

Thank you everyone for your advice x


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## Redkite (Apr 10, 2014)

Hi Ann, have a look at this factsheet from my son's clinic team - scroll down and you will find some excellent tables showing you what to do at any BG/ketone combination, and when to get medical help.

https://www.uclh.nhs.uk/PandV/PIL/P...ick day rules – multiple daily injections.pdf


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## robert@fm (Apr 10, 2014)

annieberry said:


> Have opened a new batch of cartridges and taking an 8ml correction dose of novorapid.



Er, I presume you mean 8 units — 8ml would be 800 units.  The standard dilution is that 1 unit is 10µl, although I've heard on this forum that there is a more concentrated insulin aimed at type 2s.


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## annieberry (Apr 10, 2014)

I was told 1 unit should drop it by 2 so have taken 8 units to start with and will test and correct again in a couple of hours, it was more the ketones that were bothering me as starting to feel quite sick despite domperidone and cyclizine 
It is a novelty being able to check ketone levels so while I'm not overly concerned by the levels I feel better in control and hopefully can stay out of hospital 

Yes I meant 8 units doh !! Although 800 might bring it down pretty quick 

Will look at the link Thank you

You guys have some great advice and are very kind to keep responding x


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## annieberry (Apr 10, 2014)

Redkite according to the charts I should do this :
Give 10-20% of 
TDD as 
correction dose 

Give clear sugar 
free fluids. 

Recheck blood 
glucose and 
ketones after 2 
hours. Repeat 
above steps 
again if ketones 
do not decrease. 

If remains 
unchanged after 
4 hours, seek 
urgent medical 
advice/ go to 
A&E

What is TDD and it says give clear sugar !! Surely I shouldn't be having sugar ?? Confused ...


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## annieberry (Apr 10, 2014)

ps. Have bookmarked the link- Very helpful. Thanks so much

Could you add the link to the useful links section am sure other people would find it as helpful as I did.


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## annieberry (Apr 10, 2014)

Sorry for multiple postings and redkite ignore me- must read things properly !! TDD is total daily dose and it says give sugar free clear fluids !!!
Having a dim day !


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## Northerner (Apr 10, 2014)

annieberry said:


> ps. Have bookmarked the link- Very helpful. Thanks so much
> 
> Could you add the link to the useful links section am sure other people would find it as helpful as I did.



It's in our 'Links' section, rather than the Useful Links thread:

http://diabetessupport.co.uk/boards/showthread.php?t=43081



You don't need to apologise for asking questions Annie, it's why we are here!


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## Redkite (Apr 10, 2014)

Glad you've answered your own questions Ann!

 BTW the UCLH website has a similar fact sheet for pump users (the link I gave earlier is for people on injections).


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