Ketones and normal blood sugar

[kel4han]

I still dont see why ketones (small-moderate) are dangerous if your BS is in range and you are ill. It has been explained many of times. Dont you have ketones becuase you are ill, the stress on the body,not becuase you are at risk of DKA? Can someone explain it in lame man terms?

[lilituc]

Here is the argument as I've heard it: Ketones are a result of not enough insulin. Often high bg is present as well, as another result of not enough insulin. Type 1 diabetics aren't able to clear ketones like other people would, so if they build up, you can end up with DKA. I've heard several instances where someone started going into DKA with "normal" blood sugar and ended up with one IV in each arm - one dextrose and one insulin.

Anecdotally, it seems to me that this is more of a risk with children and not adults. Still, I wouldn't take chances with it. If I had moderate or high ketones, I would try to clear them out (by carb and insulin intake).

[BlueSky]

.... Ketones are a result of not enough insulin. ....
Not quite. Ketones in the urine are the result of burning fat. This can happen with adequate insulin and normal blood glucose, in which case it is not dangerous.

[lilituc]

Not quite. Ketones in the urine are the result of burning fat. This can happen with adequate insulin and normal blood glucose, in which case it is not dangerous.

Well, if you're concerned about what kind of ketones, you can always get a blood ketone meter, which tests for diabetic ketones, unlike the urine strips. It also shows you what's going on in real time.

[Mama Belle]

If the ketones are small to moderate, I personally don't put them in the catgory of "dangerous". I am more watchful, I check ketones more often and I push water and insulin when able. If the small to moderate ketones become large to extra large and cannot be cleared, then there is a huge cause for concern.

Ketones are the result of burning fat stores, which your body does when you don't have enough insulin (as has been said). Ketones are dangerous in large amounts if they cannot be cleared and if the production cannot be stopped. You clear them by drinking lots of water and you stop production by taking insulin which stops the burning of fat stores.

In a non-D body the pancreas regulates blood sugar levels with a coordinated release of glucagon and insulin. So, in a non-D person who is sick, they can turn off the production easily, all their body does is up the blood sugar and then release more insulin. In a person with D the blood sugar cannot be raised without introducing external sources of energy (food). If you can't take in food and you don't have a high enough BG, then you can't give insulin and the ketones continue.

The reason we need more insulin when ill? I've heard that it is mainly due to the fact that insulin dramatically loses its effectiveness because of the large amounts of stress hormones produced during illness. Also, insulin does not absorb properly into the bloodstream if you aren't adequately hydrated. Anyone who has had the stomach flu, knows how easy it is to become dehydrated. ALL Ketones (no matter why they are there) lead to increased acidity in the body (if they are in a large enough quantity) which can cause certain body systems to stop functioning properly.

If you are looking for a very clear description of the physiology of DKA, ketone production, metabolism, etc. as it pertains to Diabetes, I highly recommend reading "Think Like A Pancreas" by Gary Scheiner. Even if you aren't interested in this particular topic, I would still recommend the book. It is an excellent read.

[June91]

Amazingly, in 15 years of living with diabetes, I have never once had a problem with ketones. I don't even measure ketones. I'm not saying it's a good thing - but I'm wondering if it's an individual thing or if there's a forumula for it, sort of like X mmol/l + M, N, etc. various factors = Y ketones?

Apparently I've wished mine away by never thinking about them, now let me try the same with BGs, I'll let you know how it goes... :D

[Scratch]

In a non-D body the pancreas regulates blood sugar levels with a coordinated release of glucagon and insulin. So, in a non-D person who is sick, they can turn off the production easily, all their body does is up the blood sugar and then release more insulin. In a person with D the blood sugar cannot be raised without introducing external sources of energy (food). If you can't take in food and you don't have a high enough BG, then you can't give insulin and the ketones continue.


I don't believe this portion is entirely accurate. Diabetics still have glycogen reserves that the body uses to maintain blood sugar levels. It is entirely because of that the therapy treatment of basal and bolus insulin was derived. The reason we use basal insulins is to attempt to crudely match the body's release of glycogen into glucose to provide us fuel when not eating. I say crudely because it is not the sophisticated response by beta cells, as the best we can do is make some measurements and observations, then try to estimate a way to deliver an appropriate amount of insulin.

[DeusXM]

Ketones in themselves aren't a problem. They just indicate the body is using an alternative fuel source to glucose. Ketones indicate that the body is either in ketosis, which is benign and perfectly natural, or that the body is in diabetic ketoacedosis, which is a serious medical problem caused by a lack of insulin. Ketosis is not caused by a lack of insulin and if you wish to lose body fat then you will have to spend some time in ketosis, which you can induce by exercising.

I've said it before, ketones are a bit like smoke. You can tell that something's burning but you can't tell what is burning.

If your BGs are normal and you have ketones then you don't really have anything to worry about.

[Mama Belle]

I don't believe this portion is entirely accurate. Diabetics still have glycogen reserves that the body uses to maintain blood sugar levels. It is entirely because of that the therapy treatment of basal and bolus insulin was derived. The reason we use basal insulins is to attempt to crudely match the body's release of glycogen into glucose to provide us fuel when not eating. I say crudely because it is not the sophisticated response by beta cells, as the best we can do is make some measurements and observations, then try to estimate a way to deliver an appropriate amount of insulin.

I didn't say that D's don't release glucagon. Their body does not have a coordinated release of glucagon and insulin. Insulin is the key player that is missing in the coordinated effort by the pancreas.

[Scratch]

I didn't say that D's don't release glucagon. Their body does not have a coordinated release of glucagon and insulin. Insulin is the key player that is missing in the coordinated effort by the pancreas.

In a person with D the blood sugar cannot be raised without introducing external sources of energy (food).

Well then I am confused by the meaning of that statement. I agree with the more recent statement of coodinated release since type 1 diabetics lack the release of insulin from beta cells.

[Mama Belle]

If your BGs are normal and you have ketones then you don't really have anything to worry about.

This is not true and dangerous to say. My daughter was admitted to the hospital in DKA with in range blood sugars. My father in law had the same deal. He was hours from dying and suffered a stroke becasue of it. In a non-ill person with diabetes you usually only see ketones with high BGs because they are symptoms caused by the same underlying problem (lack of adequate insulin). In a person who is ill with something like the stomach flu, you can see in range or low numbers and still have high ketones, which will lead to acidosis if not trreated in a timely manner.

[Scratch]

Or I am reminded of the time that I went to the supermarket and first stopped at the MAC machine. After I finished collecting my groceries, I then went to the line for scanning my items out and upon getting to an open station, I went into my wallet and was first puzzled by how I didn't see my MAC card atop all the other cards where my supermarket savings card would be.

I had left my MAC card at the terminal.

I got a rather vicious adrenaline spike where my body dumped a whole bunch of its glycogen reserves. Fine if you're non-diabetic, the pancreas and its beta cells drop in some extra insulin to mediate the extra blood sugar being made available. When I tested my blood sugar an hour after the loss my MAC card, it was over 400 mg/dl. That was without eating any food. I had jumped some 300 points of blood sugar without any food.

[Mama Belle]

Well then I am confused by the meaning of that statement. I agree with the more recent statement of coodinated release since type 1 diabetics lack the release of insulin from beta cells.

The blood sugar often cannot be raised without external sources of energy during an illness like the stomcah flu, when blood sugars tend to be low. Just ask any parent who has been up until all hours of the night with a sick kid. They can't get them to hold any food or liquid down and their numbers are drastically low and can't be raised.

[Mama Belle]

I got a rather vicious adrenaline spike where my body dumped a whole bunch of its glycogen reserves. Fine if you're non-diabetic, the pancreas and its beta cells drop in some extra insulin to mediate the extra blood sugar being made available. When I tested my blood sugar an hour after the loss my MAC card, it was over 400 mg/dl. That was without eating any food. I had jumped some 300 points of blood sugar without any food.


Yes, but you weren't sick, were you? That's I believe what the original post was inquiring about. Low BGs with ketones during illness.

[Scratch]

Yes, but you weren't sick, were you? That's I believe what the original post was inquiring about. Low BGs with ketones during illness.

Well I am still puzzled by the statement you made earlier saying diabetics cannot raise their blood sugars without food. Diabetics can raise their blood sugars with stressful events such as losing a MAC card and no food.

As far as you daughter being admitted to the hospital for DKA with normal in range blood sugars, there are possibly alternate explanations:

1 -- misdiagnosed DKA
2 -- Plenty of ketones because of fat being burned. With enough insulin, the blood sugars can remain in range, but there may still be fat being burned because the body wants energy to fight the stress of infection. And we then still may have an unnecessary diagnosis of DKA. Your daughter may have been ill, and having trouble, but wasn't in fact in DKA.

[Mama Belle]

Well I am still puzzled by the statement you made earlier saying diabetics cannot raise their blood sugars without food. Mine and other diabetics can raise their blood sugars with stressful events such as losing a MAC card and no food.

As far as you daughter being admitted to the hospital for DKA with normal in range blood sugars, there are possibly alternate explanations:

1 -- misdiagnosed DKA
2 -- Plenty of ketones because of fat being burned. With enough insulin, the blood sugars can remain in range, but there may still be fat being burned because the body wants energy to fight the stress of infection. And we then still may have an unnecessary diagnosis of DKA. Your daughter may have been ill, and having trouble, but wasn't in fact in DKA.

I guess I should have clarified my statement by saying that people with diabetes who are ill with something like the stomach flu can have difficulties raising their BGs enough to inject insulin.

1 -- It was not a mis-diganosis. They did lab work her body's pH was lowered.
2 -- I have no clue what you are trying to say? Ketones are ketones. Too many of them building up in the body for long enough can lead to acidosis because the body's pH is lowered. It doesn't matter if the ketones go there from fat being burned due to decreased insulin, vomiting, or both. They are still there. If you can clear them and turn off production then no biggie. We've done this countless times without incidence. But we have also had a time when her Ketones could not be cleared and she ended up in an emergency situation. Ketones can be present in large and dangerous amounts whether BGs are high or not, you can still have too many ketones and you can still go into DKA.

[kel4han]

Well, I understand all arguments entirely but I am still indecisive in which I believe is true. I just cant see ketones being dangerous with a normal blood sugar. But, I hear what you are saying MamaBelle. I am just wondering this to begin with, becuase my 6 yr old had fever and sore throat a few weeks ago. Me being paranoid of her 1st illness with "D" I decided to check her ketones, and they were fairly large, but her blood sugar was 108, this was after nightime fast first thing in the morning. It was simply cleared with a few glasses of crystal light. But I had mentioned this to some moms at the Children with Diabetes website and they freaked at me telling me to watch out for immediate danger. Low carbers have Ketones as a "starvation" defense of metabolism. So, hmm I might have to check out further readings on this. All very good sensible arguments though. Obviously, if my child continued with high ketones and normal BS I would probably think differently. :vollkomme

[Mama Belle]

Well, I understand all arguments entirely but I am still indecisive in which I believe is true. I just cant see ketones being dangerous with a normal blood sugar. But, I hear what you are saying MamaBelle. I am just wondering this to begin with, becuase my 6 yr old had fever and sore throat a few weeks ago. Me being paranoid of her 1st illness with "D" I decided to check her ketones, and they were fairly large, but her blood sugar was 108, this was after nightime fast first thing in the morning. It was simply cleared with a few glasses of crystal light. But I had mentioned this to some moms at the Children with Diabetes website and they freaked at me telling me to watch out for immediate danger. Low carbers have Ketones as a "starvation" defense of metabolism. So, hmm I might have to check out further readings on this. All very good sensible arguments though. Obviously, if my child continued with high ketones and normal BS I would probably think differently. :vollkomme

I think it is good for everyone to reach their own conclusions about this, based on research. Nothing I say (or anyone else) should convince you of your position on this, because it is a very important issue. I don't expect for everyone to agree with me, but I think blanketed statements about ketones not being worrisome in the absence of high BGs can be dangerous and I just wanted to give another position to consider.

I think I remember the thread on CWD. Was this the one where you mentioned what your pediatric endo RN said about ketones? I responded to that thread and what concerned me about it was the fact that she was saying that it was okay to let a kid run large ketones for 3 days. Maybe it was a diferent thread, because I don't remember you mentioning anything specific about your daughter.

But yeah, if the ketones were large but you were able to clear them right away with fluids, there should be no reason to freak out. I think it is important to keep watch in those instances, but it is certainly not an emergency situation. Ketones are going to develop with some illnesses, that is a given. To me it is only worrisome when they are present in large amounts and cannot be cleared.

I think sometimes these parents who have had bad experiences with DKA do get worried when they hear about someone having large ketones. My daughter has had large ketones with illness plenty of times, but has been able to get rid of them in all but one instance, that was the time she ended up in the hospital.

If you haven't already, you may want to check out the couple of chapters about ketones/ketoacidosis from The Pink Panther book (http://www.uchsc.edu/misc/diabetes/ud11.html). Especially as it relates to your daughter. My dad has been type 1 for over 50 years and he never has ketone issues with illness. My daughter can puke once and she starts developing them. I think for some reason kids are just more prone to those type of situations. Maybe it is because they get dehydrated faster, I don't know.

[BlueSky]

..... blanketed statements about ketones not being worrisome in the absence of high BGs can be dangerous ....
The presence of sickness changes things, especially with children. The onset of DKA doesn't always follow a logical pattern. And things can change very quickly. The last time my daughter went into DKA, I tested her BG before going to work and it was about 200. 3 hours later in the doctor's rooms, BG was 540 and ketones were very high. In the hospital, they discovered that she had a boil. This happened three times in a year!

I, on the other hand, have never been into DKA in nearly 30 years of being T1. I am fortunate in that I hardly ever get sick. But even with me being on a low-carb diet, I seldom test positive for ketones....

[right2fight]

I have to agree with Mama Belle as anytime my son has had ketones, pumping water and if large, insulin to cover the ketones has so far worked to diminish them. With this being said, it has been with illness and without, but we always work to get rid of them. Margaret

[Geoff]

I have been at a tutorial today on a diabetic course I am following for dose adjustment for normal eating (DAFNE) and one of the subjects was ketones and ketoacidosis, and the endo giving the talk told us that it is standard practise here in the U.K. to start testing for ketones if you do not feel ill at 14 mmol/lt (252) with ketone sticks or with a bs metre that can take ketone test strips . This is hardly normal bs readings, so I find it hard to understand the comments about ketones and normal bs ranges! He also said that when you test if it reads +1 as stated, drink plenty of water and test at post 30mins, then for the next two hrs on the hour. If the reading goes up to +2 or higher you must be admitted to hospital to be stabilised. He also said that there is no starting point at which ketons develops into ketoacidosis, this can be different in each individual.