Checking Ketones

[jillsp]

How often (if at all) does everyone check for ketones. I can honestly say in 15 years I have only checked once and I already knew I was in DKA, my husband made me do it before dragging me to the ER.

[JediSkipdogg]

Ummmmmmmm....last time I checked was maybe 10 years ago. I personally don't see the point in it, even in mild DKA, where a doctor says you need immediate medical assistance, you can bring yourself out of it. And if you are severe enough that you can't walk or drive or something, then you need an ambulance anyways and let the hospital figure out you are in DKA.

[Cyborg]

I check when my bg gets real high (400)...

[jillsp]

I check when my bg gets real high (400)...


Can I ask why? I guess I don't really understand why I would do that b/c I don't think it would change my course of action. Is it just that you want to know to be safe or sure? I've seen lots of people posting on here about checking ketones and I have never thought to do it. Just wondering if I'm missing the boat somewhere......which is very possible! :stupido2:

[JediSkipdogg]

I'm seconding jill's question...And this can be answered by anyone...

If you have ketones what do you do differently than if you don't have them and are running say 400? Isn't the goal to bring the BG down either way? What can you really do different if ketones are present verse if not?

[Cyborg]

For me, it's assurance as to whether I'm heading for ketoacidosis or not. My bg does not normally go that high any longer. If it is that high, than something is wrong. Treatments are both the same to get the bg down, but if showing large ketones, I may use a syringe rather than my pump, etc...

[camjen1]

I also hardly ever check for ketones. The last time I checked I was also in DKA. I don't think having a little amount of ketones warrents a ER visit. It just means you have to do a bit more aggressive treatment. There were a handful of times where I sensed I was going into DKA but treated it asap and I was fine a few hours later.

[poodlebone]

I usually check just for the **** of it when my meter tells me to. I think that's any BG over 250. Most times it's negative or a trace. The only times it read high was when I had a bad set in. But seeing the strip go to the "large" color (next to last color) didn't make me do anything differently. I just put in another set, took my correction, and drank water.

I think that in my Minimed pump manual, it says something about a situation where you can have ketones but not have a really high BG. It said you're supposed to drink something with sugar in it and take insulin to cover the carbs. I'm not sure why. I know in the past I've shown moderate ketones with a BG of only 180 or so, but that hasn't happened since I started pumping.

I don't think I'd ever go to the ER just for a high BG + ketones, unless I was vomiting and feeling really sick. Otherwise I treat myself like any other high reading.

[sofaraway]

my doctor likes me to check for ketones if my blood sugar is above 20mmol/l. i can test on my meter so it's not a big issue. if i was to have ketones above 0.6 then i have to seek medical attention. but it's highly unlikely that would ever happen being a MODY. when i was admitted a few months ago with a blood sugar of 32mmol/l ketone reading was 0.0.

[poodlebone]

I also want to say that the reason I usually check over 250, even though I doubt there are ketones, is because I paid for the stupid strips and figure I might as well use them up before the 6 month expiration. I have used a vial longer then 6 months after opening but eventually threw it away and got a new one.

I wish they came in smaller vials. 10 strips in a 6 month period would be more than enough.

[JasonSmithMT]

You check ketones because ketoacidosis is very serious and life-threatening. Things can go very bad very quickly. Even though initial home treatment for a high blood sugar with moderate ketones is not very different from treatment for high blood sugar without ketones present it is worthwhile to monitor because of the seriousness of DKA. It not terribly difficult to slip into DKA with moderate to high ketones present even while blood glucose levels are dropping. Once DKA sets in, home therapy is not going to be enough (or too risky). You need a lot more than just insulin with DKA. It is fairly simple to monitor ketones at home with either urine or preferably if available blood every few hours so why not do it? Are they really that expensive? Is it that much of hassle to test? If ketones continue to go up or if any nausea occurs it might just save your life.

Jason

[camjen1]

I just wanted to clarify myself a bit. When I said that little amounts of ketones doesn't warrant a ER visit what I really meant to say is if you have traces of ketones but are feeling fine then I wouldn't make a trip to the ER. Now on the other hand if you have traces of ketones and doesn’t feel like yourself and you feel you have to vomit then I would say pack your bags and prepare for a stay at the hospital. Please don't rely on my advice only though because what may work for me doesn't work for everyone.

I don't mess around anymore. The day I went into DKA happened so fast and by time I got to the hospital my Blood pH was 7.04. I was vomiting every 30 seconds and had nothing left in me. At that time I didn't care if I died because I was miserable.

[jillsp]

You check ketones because ketoacidosis is very serious and life-threatening. Things can go very bad very quickly. Even though initial home treatment for a high blood sugar with moderate ketones is not very different from treatment for high blood sugar without ketones present it is worthwhile to monitor because of the seriousness of DKA. It not terribly difficult to slip into DKA with moderate to high ketones present even while blood glucose levels are dropping. Once DKA sets in, home therapy is not going to be enough (or too risky). You need a lot more than just insulin with DKA. It is fairly simple to monitor ketones at home with either urine or preferably if available blood every few hours so why not do it? Are they really that expensive? Is it that much of hassle to test? If ketones continue to go up or if any nausea occurs it might just save your life.

Jason

I asked the question b/c the one time I have been in DKA, I already knew it without checking for ketones (even though I checked to appease my husband). You don't have to be a rocket scientist to figure it out when your blood sugar is 400, you are vomiting uncontrollably and can't see straight. It wasn't a flippant question, it just seemed lots of people on here talk about checking their ketones and I don't do that....even if my blood sugar is 400. I'll get a 400 and feel fine, so I pump up a bolus, monitor and move on. I just wondered what everyone else did. It seemed like you just jumped down our throat. I realize DKA is VERY serious....it's kinda hard not to know that when you have Type 1.

[lgvincent]

I can't recall the last time I did it. I used to do it whenever my blood or urine sugar was high but it was so rare that I spilled ketones that I stopped. I've been trying to find a way to lose some weight and I understand that burning body fat creates them so in I'll probably need to start checking them to see if my efforts are working.

[notme]

I haven't checked for ketones in at least 18 years. For me, the course of action would be the same as always if I am high and producing ketones. I assume if I am over 250 that there is a problem and would treat exactly the same.

[JasonSmithMT]

I asked the question b/c the one time I have been in DKA, I already knew it without checking for ketones (even though I checked to appease my husband). You don't have to be a rocket scientist to figure it out when your blood sugar is 400, you are vomiting uncontrollably and can't see straight. It wasn't a flippant question, it just seemed lots of people on here talk about checking their ketones and I don't do that....even if my blood sugar is 400. I'll get a 400 and feel fine, so I pump up a bolus, monitor and move on. I just wondered what everyone else did. It seemed like you just jumped down our throat. I realize DKA is VERY serious....it's kinda hard not to know that when you have Type 1.

I am not trying to jump down any ones throat. Far from it. I do think the question of why we test for ketones is a very good one. One that goes through the mind of many people since nearly all the time when someone tests for ketones the results come back normal.

I have personally have been in a profession in which it was my job to recommend, perform, analyze and interpret clinical lab tests. It is those cases, for example, in which someone who didn't necessarily feel like they were in DKA, develops cardiac dysrhythmia from an electrolyte imbalance and subsequently dies before they make it to the ER that would compel to always recommend home ketone testing. I have personally never seen any guidelines that don't recommend it when a certain glucose level is reached or a person is vomiting. Remember that treating DKA is not always simple as giving more insulin. In fact it can be fatal to correct hyperglycemia during DKA too fast and nearly always requires fluid and electrolyte therapy. Most often DKA requires ICU care.

As always, don't take my word for it, talk to your physician and/or CDE about when ketone testing is needed and why.

Jason

[JediSkipdogg]

Remember that treating DKA is not always simple as giving more insulin. In fact it can be fatal to correct hyperglycemia during DKA too fast and nearly always requires fluid and electrolyte therapy. Most often DKA requires ICU care.

But a high BG and Ketones does not mean you are in DKA. And there is no home way to truely test for DKA. If one is running 400, they will give the same amount of insulin to bring them down to say 100 whether or not they have ketones. Ok, so say you test again in 45 minutes and you are now running 500. Are you going to change anything different? Ok, this time you may or may not call 911 or drive yourself to the hospital, but that's a call you have to make. I really don't think having the ketones will make a huge difference if you increase 100 mg/dl without reason when you give insulin.

The help will be in the hospital, at which point they will do a ketone test and other tests to see if the person is in DKA. And then the treatment method changes. But you can't test for DKA at home that I know of.

So Jason, are you saying if you test and are 400 at home with ketones, you drive to the ER without question? That just adds up to alot of extra hospital bills that are unnecessary in my opinion. Not to mention possibly missed worked and other items when it could be corrected normally.

[camjen1]

So Jason, are you saying if you test and are 400 at home with ketones, you drive to the ER without question? That just adds up to alot of extra hospital bills that are unnecessary in my opinion. Not to mention possibly missed worked and other items when it could be corrected normally.

Jedi, I think that would be one owns choice. If I called my doctor and told him that I was high and had ketones he would tell me to go to the ER. If you are feeling well then I would say treat it at home but if you are feeling sick and have high blood sugar and ketones then yes you need to go to the ER. A lot of people have this perception that DKA doesn't happen overnight and I'm the very proof that it does, matter of fact, it can happen within hours.

I have relayed my story over and over again about the situation that I had to deal with when MM recalled the Quick Set Plus infusion sets. I awoke one morning and by the early evening I was in the hospital nearly dead. **** my doctor was shocked to see me awake and alert. I admit I tried my hardest to correct at home but it just wasn't enough. Since then I have felt my body going to towards DKA twice but since I knew all the signs I chose to fight it at home. If I found out that I was losing the battle I would have brought myself directly to the ER.

You have to also remember that each one's body acts differently. I used to be able to handle bs in the 400-500 but now anything higher then 300 I'm already feeling the ill affects and start to have flu like symptoms. Now on the other hand someone such as yourself can be 500 and feel perfectly normal at which point I don't think it is necessary to visit an ER if you had slight ketones. The medical people will always assume different and would want you to be checked out.

[jillsp]

You all have great points. I know that I, personally, can handle VERY high blood sugars without feeling ill and can correct at home. The one time I went in for DKA, I wasn't full blown, but had been correcting for a couple of hours, wouldn't quit vomiting, had medium level of ketones, so went in to get help. By the time the IDIOTIC ER people got me back (1 hour of waiting) my BS had come down and they just put me on IV fluids. My endo chewed them up and down after I told her I sat in a waiting room with poosible DKA for an hour. I got very lucky. But, to your point Sandi, you are right that we all have such different thresholds of how high we can tolerate our sugars. I guess you just have to listen to your gut on when to suck it up and go to the hospital ( I avoid it like the plague).

Jason, sorry for the miscommunication. I have to constantly remind myself that typing doesn't always come across like speaking face to face. Thanks for clearing it up.

[JasonSmithMT]

But a high BG and Ketones does not mean you are in DKA. And there is no home way to truely test for DKA. If one is running 400, they will give the same amount of insulin to bring them down to say 100 whether or not they have ketones. Ok, so say you test again in 45 minutes and you are now running 500. Are you going to change anything different? Ok, this time you may or may not call 911 or drive yourself to the hospital, but that's a call you have to make. I really don't think having the ketones will make a huge difference if you increase 100 mg/dl without reason when you give insulin.

The help will be in the hospital, at which point they will do a ketone test and other tests to see if the person is in DKA. And then the treatment method changes. But you can't test for DKA at home that I know of.


You are right, there are no tests to confirm acidosis that can be done at home. In the hopsital they will look at things such as pH, bicarbonate levels, and anion gaps.


So Jason, are you saying if you test and are 400 at home with ketones, you drive to the ER without question? That just adds up to alot of extra hospital bills that are unnecessary in my opinion. Not to mention possibly missed worked and other items when it could be corrected normally.

Fortunately I have never been in DKA since diagnosis but in your example if I have a 400 mg/dL (22.2 mmol/L) glucose level and positive for ketones it would depend on what my blood ketone levels are if I would go to the ER. If my blood ketone level was above 1.5 mmol/L or I was vomiting no matter what the level then it would be off to the ER without question. Now this is probably at a higher level than most physicians will feel comfortable with so as a disclaimer I will say be sure to follow your own guidelines. All other levels I would watch the ketone and glucose levels closely over several hours. In my opinion at lot can depend on individual circumstances as well. For example, do you live alone, do you live close to an ER, is your roomate, spouse, etc. a compent care giver who can handle a medical emergency.

As almost a general rule it is always better to play it safe especially when you are making recommendations for others. If a loved one was having chest pains would you recommend them going to the ER? Better safe than sorry in my opinion.

Jason

[parrotletzoo]

I used to check for ketones when my blood sugar was elevated for an extended period, but only if it were over 300. Why? when I had ketones in my urine I generally needed more insulin to correct a high then when ketones were absent.