Ketones ate my butt

[rebeccaspacex]

Ketones ate my butt.

Ketones. If you've heard of them and you're not diabetic, you have most likely been introduced to them by the Atkins diet. They form when the body needs to feed off fat due to lack of adequate carbohydrates or inability to properly use insulin(http://www.webmd.com/hw/diabetes_1_2/hw7738.asp ). They cause rapid weight loss and are yearned for by Atkins dieters. It’s actually a form of self-preservation. Unfortunately for us, they can be deadly if you reach the state of ketoacidosis (DKA), which I have had the misfortune to experience 5 times in the last 3 years.

I was diagnosed with Type 1 diabetes in April 2003. At 34 years old, it was a complete shock. I had been diagnosed with Celiac disease the year before, after being sickly my entire life. Celiac disease is a condition in which an autoimmune reaction to wheat and barley gluten cause an inability to absorb nutrients.(http://www.webmd.com/content/article/103/107220.htmdefined). I've since learned that the two diseases have some sort of link, but the researchers are just beginning to understand how they are tied together.

I could go on about the various disasters of trying to get a diagnosis for the constant suffering I endured throughout my life, but my purpose here is to discuss ketones. Since the Atkins diet is so popular now, I want to make sure people area aware of the potential dangers involved. People who are leaning towards “pre-diabetic” may be more susceptible to problems involving ketones.

There is a urine test for them available at most pharmacies. I feel like I'm going to pass out when I see that strip turn dark purple, not because I'm probably in a seriously bad medical state, but because I know it might mean a trip to the hospital with the horrors that entails for someone in DKA. “Don’t throw up. Don’t throw up,” I think to myself over and over.

On the other hand, these ketones eat away all traces of fat they can get to and it just seems to melt away. My boyfriend doesn’t like though; he just told me he could “feel my ribs.” For a diabetic, they should only be really high if you have a really high blood sugar and/or not enough insulin. I'm a bit unique, and so they appeared in full force on Christmas day when my blood sugar was under 150 mg/dL. I’m on an insulin pump and my site was working well. However, I had a flu shot two days before and experienced some symptoms I believe where associated with the dose (rash, vomiting, body aches, elevated temperature). Since there may be others who suffer from unusual ketone episodes, I wanted to share what I have found out from my recent experiences:

1. Sports drinks are the cure for ketones if you catch them early enough. Take extra insulin to cover the sugar in the drink, and after one bottle you should notice the ketones disappearing. Notify your doctor of your episode.

2. If you are diabetic, you must check yourself for ketones if you have an abnormally high blood glucose reading and/or you are sick--NO MATTER WHAT ANYONE HAS TOLD YOU ABOUT YOU NOT NEEDING TO CHECK FOR THEM. When I was diagnosed, I was told I did not ever need to check for ketones, even though my blood glucose was 980. And, just for clarity, a normal blood glucose reading for a non-diabetic probably averages around 100.

3. If you are in the hospital and they are having trouble getting your ketones under control, ask your doctor about ordering an insulin and glucose drip cocktail. Basically, you are doing the same thing as the sports drink on a much more aggressive level. This cocktail has saved my life more than once recently and unfortunately it is the only kind I ever get to enjoy these days.

Hopefully, this information and my future submissions will help someone who is unique like me.

[Cyborg]

Ketones should only be a problem if you are not getting sufficient insulin to keep your bg down.

[DeusXM]

Precisely. Ketones are by-products of ketosis, which is the metabolic state Atkins dieters aim for, and also of diabetic ketoacedosis. The two conditions are very different - one is a natural metabolic process and the other is a serious medical problem.

[lilituc]

Perhaps some of those who have reported dka when they were sick even though their bgs were "normal" will weigh in here. ;)

[Cyborg]

Is it even possible to have DKA with normal bg values?

[2high]

I've certainly had high ketones when sick with normal (or close to normal) levels, but not DKA in those circumstances...

There's a heck of a lot of difference, and trust me... you DON'T want to get the two confused!!

[JediSkipdogg]

Is it even possible to have DKA with normal bg values?

My assumption would be no since the major cause of DKA is lack of insulin for glucose to enter the cells. Therefore higher sugar in the blood.

I wonder how this affects a CGMS. I would definitely think with DKA that the two would differ greatly. Since insulin isn't pushing sugar into the cells it can't give the energy to the cells to convert into interstitual fluid. Therefore I would think the blood would definitely be higher than a CGMS and possibly a time when a person would really get mad at their CGMS device. Just a thought I had.

[Dan Gato]

Rebecca, Thank you, for this valuable information. Happy new 2007 !!

[rebeccaspacex]

I'm not as well informed as the rest of you. What does CGMS stand for?

All 5 times I was in DKA, I had a blood sugar of over 250, however I still get enough ketones to eat a lot of fat on my several times a month and have trouble keeping weight on.

[Erin]

Rebecca,

Hi and Welcome to the forums. You seem to be one of the unlucky ones who gets ketones easily.

Some people need to see bgls in the 500's before they get high levels of ketones, some folks (like you) can look at a chocolate bar the wrong way and end up with ketones. That must really suck. I wonder if the combination of T1 and celiac makes you especially prone to DKA.

I am pretty lucky in that I almost never get ketones. I attribute this to lucky genetics and to the fact that I keep myself *ridiculously* well hydrated. Try drinking as much water as you can comfortably consume... it might help flush ketones out of your system faster, so they don't build to high levels.

CGMS stands for Continuous Glucose Monitoring System, and they guys were theorizing about how high levels of ketones might interfere with such a system working properly.

[Jackets]

I never go DKA anymore. Happened quite a few times when I first became a diabetic. It'd take me probably 3 days of being incredibly high to go DKA now I'm guessing; but in the old days it seemed to just jump out of nowhere.

[poodlebone]

I haven't had ketones in about a year. I was getting them when I was using Quick-Sets, which failed often. A set would fail, I'd have a high BG when I checked 2 hours later (BG anywhere from high 200s to 400s) and I'd have ketones in my urine. Since I check my BG often and catch things within a couple of hours, it did not progress to DKA. I didn't hit the darkest color on the urine strip, but a couple of times I went up to the one just below it.

I switched to Silhouettes in January 2006, have had very, very few problems with them and have had very few instances where ketones showed up in my urine, even if I had a high BG reading.

[blonde kiddo]

I wonder if I have lucky genetics because I have often gone to 25mmol/L or so (450?) but rarely get ketones, and have never been in DKA. Not that those high numbers are anything to brag about

[Cyborg]

Simply losing weight will result in one showing ketones.

[Eri's mom]

Well, Eri is sick now with a major cold...has normal bgl's and has high ketones...they are having me treat her at home right now.(extra insulin, she has to drink regular soda, etc...)
They say these are dehydration/starvation ketones, as bad as high glucose levels...(she had been throwing up, now she's not, thank God).

I had ketones at my gtt...I see my endo this month...

[duck]

Is it even possible to have DKA with normal bg values?

I dunno...But I have had ketones when I have worked out real hard and been sore to the touch...It's about the only time I get ketones.

[Cyborg]

I get them when I'm losing weight or extreme low carbing (which I don't do anymore).

[duck]

For the longest time, I thought my Keto-strips were defective, because even when I was high and the Cozmore wold warn me to check ketones, I'd get nothing...Not even a trace.

Then my wife did Atkins for a little while...She asked if she could test. Wow. So I guess I'm just...lucky?

[Cyborg]

Have you tried testing for them first thing in the morning?

[duck]

Have you tried testing for them first thing in the morning?

Yeah, free and clear. I don't wake up high very often anymore, but back in October I was having some issues, so a couple times I tested. Nothing.

I need to dig into the archives here, but there is a blood glucose monitor that can also test blood ketones with specific strips...it's sorta expensive, but for grins I may buy the monitor just to see.

[Cyborg]

I have that meter. It's the Precision Xtra. The strips are outrageously expensive and hard to find. I got lucky and was able to get a huge supply of them. Now I'm worried they will go bad before used...

[tanyatype1]

Are the ketones that are produced (from the natural metabolic process) harmful to non-diabetics who are exercising hard and losing weight? I've often wondered about this, although I have read from someone on this forum, that the answer is No. What if they are producing ketones for a few months at a time? Still no problem?

[DeusXM]

Producing ketones is just fine provided the muscles are getting enough energy from insulin, which shouldn't be a problem in non-Ds.

Sometimes I feel like the odd one out here. I've never been in DKA (apart from when I was dxed, presumably) in 8 years of having diabetes. Haven't ever had an incapacitating hypo either, come to think of it.

[Georgia]

Could you have DKA & recover from it without going to hospital? I remember years ago I was very ill, had no energy, slept a lot. hardly ate & lost a lot of weight - could this have been DKA? At that time I was a bad diabetic & didn't check my blood :( Mind you, I didn't know what DKA was then either.

[JediSkipdogg]

Are the ketones that are produced (from the natural metabolic process) harmful to non-diabetics who are exercising hard and losing weight? I've often wondered about this, although I have read from someone on this forum, that the answer is No. What if they are producing ketones for a few months at a time? Still no problem?

There is no harm in naturally produced ketones. They just let you know you are burning fat which for body builders and those losing weight is a good sign.

Sometimes I feel like the odd one out here. I've never been in DKA (apart from when I was dxed, presumably) in 8 years of having diabetes. Haven't ever had an incapacitating hypo either, come to think of it.

In 24 years of diabetes I have only had DKA once that I recall. As for major lows, I'll put that up to a few handfuls. All of them happened at the exact time of a peak with NPH. Once I was off NPH and on the pump I've never had either.

Could you have DKA & recover from it without going to hospital? I remember years ago I was very ill, had no energy, slept a lot. hardly ate & lost a lot of weight - could this have been DKA? At that time I was a bad diabetic & didn't check my blood :( Mind you, I didn't know what DKA was then either.

I believe so. In a hospital the general practice for DKA is mass fluids and insulin. Don't quote me on that, just what I recall from my experience. The only difference is they give the insulin and fluids through an IV so they take effect much faster. But one could treat DKA at home it just may take more insulin that normal and giving it in a few different sites. There are many times in the past year I've run over 500, and probably quite a few with ketones (haven't tested for ketones in about 10 years) however all of them have been home treatable. BUT, that is not medical advice I'm giving. If you are in severe DKA go to the hospital ASAP.

[poodlebone]

Could you have DKA & recover from it without going to hospital? I remember years ago I was very ill, had no energy, slept a lot. hardly ate & lost a lot of weight - could this have been DKA? At that time I was a bad diabetic & didn't check my blood :( Mind you, I didn't know what DKA was then either.

That was me for the first 11 years of my diagnosis. I had that fruity breath so often I couldn't begin to count. AT the time I had no idea what it meant, but I know I felt bad. Luckily I never got to the point of puking and going into full blown DKA. I took my 2 shots a day of NPH/R and so I guess I always had at least a little insulin in my system, enough to keep DKA at bay but still produce some major ketones.

[mark-TN]

Sometimes I feel like the odd one out here. I've never been in DKA (apart from when I was dxed, presumably) in 8 years of having diabetes. Haven't ever had an incapacitating hypo either, come to think of it.In 32 years of diabetes I have never been in DKA, not even at diagnosis. Like Jedi I have had my fair share of bad hypos- but none since switching to Lantus from NPH in early 2003.

Mark

[Simon]

I guess if you are il and not eating then the liver will run out of glycogen and so your body will then start metabolising fat without your blood sugar rising.

[Cyborg]

Not just fat, but muscle too. And your bg will rise...

[tanyatype1]

Producing ketones is just fine provided the muscles are getting enough energy from insulin, which shouldn't be a problem in non-Ds.

Sometimes I feel like the odd one out here. I've never been in DKA (apart from when I was dxed, presumably) in 8 years of having diabetes. Haven't ever had an incapacitating hypo either, come to think of it.

I don't want to jinx myself but I haven't been in DKA either, and my lowest bg was 2.2 - but now that I've said that.........!

A year and a half before diagnosis, I bought a treadmill and started working out really hard everyday, and started following the Weight Watchers points program. I lost 45 pounds in 4 1/2 months. Then about 7 months after reaching my goal weight, I lost another 11 pounds, really quickly. Diabetes. When I left the hospital, the 11 pounds were back on but I have always wondered if somehow the hard exercising and dieting could have triggered something in me.......with all the ketones and stuff??? I guess not - just grasping at straws for an answer I guess. What do you guys think?

[duck]

I have that meter. It's the Precision Xtra. The strips are outrageously expensive and hard to find. I got lucky and was able to get a huge supply of them. Now I'm worried they will go bad before used...

The last time I checked (years ago, now) eBay was well-stocked. By Shy (a former member here) basically talked me out of getting one of these meters.

[mark-TN]

...but muscle too. And your bg will rise...But only with insufficient insulin levels. So if you are sick be sure to continue basal insulin (may even want to increase it) and do corrections every 4-5 hours or so. Got to keep insulin levels up to avoid gluconeogenesis.

Mark

[rebeccaspacex]

You're awesome--thank you!
I think I can learn a lot here. :)

[rebeccaspacex]

Gatorade has cured me of ketones many times when I wanted to avoid the hospital.

I've always been accused of not eating enough, "to keep a bird alive." Food has made me sick since I can remember and I even have a sensitive digestive system now--even though I'm completely gluten-free (the only treatment for Celiac disease). Since I've been in the hospital 4 times in the last 2 years with DKA, they have now decided I have gastroparesis, so I still have touble eating. This could be causing ketones, I guess.

I will try to drink more water to flush them.

Thanks again all!

[parrotletzoo]

Ketones didn't do it. They be the result of your body eating your butt!

[JasonJayhawk]

They form when the body needs to feed off fat due to lack of adequate carbohydrates or inability to properly use insulin(Ketones (http://www.webmd.com/hw/diabetes_1_2/hw7738.asp) ). They cause rapid weight loss and are yearned for by Atkins dieters.

Just a bit of correction... not sure if anyone really cares, but maybe someone does... and maybe someone already pointed this out!

Ketones do not form when the body needs to feet off fat; rather, the ketones are formed as a result of breaking down fat stores.

Ketones do not cause rapid weight loss; rather, ketones can be (among other causes) an indicator of rapid weight loss because of the break-down of fat. (Think of it this way -- if ketones caused rapid weight loss, you would find a bunch of quacks offering injected ketones to let people lose weight!)

DKA is often avoidable by most people with use of a regular basal insulin such as Lantus or Levemir (probably with best success using two shots a day to ensure full 24-hour coverage). Pump users are in more danger of DKA because of technical problems with the pump.

Atkins dieters use ketones as a measurement of knowing that they are "burning fat." Everyone produces ketones. Ketones tend to accumulate during a dehydration state -- or even a fasting state of 8 hours -- in a healthy person. Ketones aren't bad unless accumulated at high levels in a person who can't eliminate 'm fast enough! :sleep:

Maybe our discussion will keep someone from going into DKA.

[JasonJayhawk]

they have now decided I have gastroparesis, so I still have touble eating. This could be causing ketones, I guess.

Did you have the "radioactive egg" test? If not, insist on it -- it's typically a very low-cost test that will quantitively decide how much gastroparesis you have. There are medications that can help minor cases (actually, an antibiotic) and medical devices to help severe cases of gastroparesis.

Did you test positive for Celiac by a biopsy obtained during a colonoscopy? (There's also a blood test--did you test positive on that?). The reason I'm asking is to ensure that you've investigated other possibilities -- if you were positive, then certainly, you're doing the right thing to avoid being "glutened"! (I read on the celiac message boards that it can take a year before a person even begins to feel better, and that each accidental "glutening" starts that clock over again).

Did you ever get tested for sensitivities to common foods (eggs, wheat, nuts, etc.?)