question about ketones

[thomasb]

I can pretty much shut my pump off or take it off if im say out and abou on town, walking. Having it off for 3 hours does not really raise my sugars if im walking about.

Now, ketones start forming about that time right? If my bloodsugar does not go up, will i still get ketones in my blood?

[xMenace]

No. Ketones start forming when your liver stores become depleted. Typically this would be after a few days of starvation.

[BlueSky]

..Ketones start forming ... after a few days of starvation.
I am not sure about that. If the supply of insulin is stopped, keytones can start forming in hours. Especially in children, and/or if illness is involved. But large amounts of keytones are normally acompanied by very high blood sugars. If disconnecting the pump doesn't increase your blood sugar, your pancreas must be producing adequate insulin. So there is no need to break down fat, and you shouldn't get keytones.

[RLK]

If disconnecting the pump doesn't increase your blood sugar, your pancreas must be producing adequate insulin. So you should be OK.

Or you're simply burning off through exercise whatever glucose your liver's releasing, and you therefore do not require much basal insulin. Keep in mind that, even though you've disconnected, you still have some active insulin, either from a previous bolus or the basal insulin that was delivered earlier.

My understanding of ketones is limited, but IIRC, you don't produce ketones until your body is forced to burn fat for energy. This can be because you don't have enough insulin on board to use the available glucose or because you simply haven't eaten anything for a long stretch (i.e., you don't eat because you have the stomach flu and this leads to starvation ketones).

Somebody correct me if I'm way off track on this....

[Scratch]

Ketones form when fat is burned for energy. Everyone always has some level of ketones present in the blood.

When the body is deprived of insulin and can't use glucose for energy, then more fat is burned and more ketones will form.

Exercising can also cause greater levels of ketones as the body will tap into the fat reserves to help provide energy.

[BlueSky]

Here is my take on the exercise/insulin issue :
Or you're simply burning off through exercise whatever glucose your liver's releasing, and you therefore do not require much basal insulin. .....
Except that the muscles can't use glucose without insulin. Exercise increases insulin sensitivity, and muscle glycogen is used during anaerobic exercise, so not as much insulin is required. But we still need more of it. It took me a long time to figure this out, but we need more insulin when we are exercising than we need when we are resting. I was only able to stop my blood glucose rising during and after exercise by bolusing beforehand.

Inadequate insulin will soon cause very high blood sugar, no matter what we are doing. If you are very active at the time, you will also run out of energy while the body desperately tries to switch energy sources from glucose to fat. This is what causes keytones to be produced.

Thomasb was diagnosed T1 very recently, so he will still have some beta cell function left. This is probably why he can disconnect the pump for extended periods without blood sugar going up. But, as the honeymoon wears off, the period for which he can do this will shorten.

[xMenace]

Here is my take on the exercise/insulin issue :

Except that the muscles can't use glucose without insulin. Exercise increases insulin sensitivity, and muscle glycogen is used during anaerobic exercise, so not as much insulin is required.

I was always told that muscles used glucose without the help of insulin when they were being used. Somebody ask their endo! :stupido3:

[BlueSky]

I was always told that muscles used glucose without the help of insulin when they were being used. Somebody ask their endo! :stupido3:
I remember being told that by an endo too, but it is not entirely accurate. I think it might be the case with muscle glycogen. This glycogen can only be used in the muscle in which it is stored. And I don't think insulin is required for this (someone please correct me if I am wrong). But glucose from the bloodstream can't get into muscle cells without insulin. Exercise increases insulin sensitivity, but that just means that not as much insulin is required. Maybe your endo was oversimplifying the process for the sake of clarity.

[Erin]

I can pretty much shut my pump off or take it off if im say out and abou on town, walking. Having it off for 3 hours does not really raise my sugars if im walking about.

Now, ketones start forming about that time right? If my bloodsugar does not go up, will i still get ketones in my blood?

Even the short acting insulins have a 2 - 5 hour active period. If you're walking about you increase the insulin sensitivity, so you get more bang for your buck. This should prevent ketones or at the very least prevent ketosis for some time. After th 5 hour mark it won't matter how much you're walking, no insulin is no insulin no matter how sensitive you are to insulin. That is unless you're still producing natural insulin, then you could go longer.

[xMenace]

I remember being told that by an endo too, but it is not entirely accurate. I think it might be the case with muscle glycogen. This glycogen can only be used in the muscle in which it is stored. And I don't think insulin is required for this (someone please correct me if I am wrong). But glucose from the bloodstream can't get into muscle cells without insulin. Exercise increases insulin sensitivity, but that just means that not as much insulin is required. Maybe your endo was oversimplifying the process for the sake of clarity.


We're going back before the term endo was invented ;)

[thomasb]

Hm, thanks the the replies. Interesting interesting. I guess i still honeymooning, or producing insulin anyway. Dont ge me wrong, i appreciate the honeymoon, but it feels somewhat like im just waiting for things to get harder. Oh well. There's no difference in my insulin needs so far, so i'll just keep on doing what im doing...

[Wolff]

How long should this honeymoon period last per say?? I'm not entirely sure whats going on with me. My Insulin requirements have been pretty stable since I was diagnosed and after they gave up on the metformin tabs etc. Last Saturday I went out with my company for our year end function and had a good many drinks until I was attacked by some guy who obviously could not comprehend what he was doing cause he was so drunk. The thing is that now, If I touch insulin i have a hypo. Bolus mainly but my usual basal dose is taking my sugar down way too fast aswell, I've completely stopped my basal now and use like 2 units Humalog for meals ( and even thats too much cause if I exercise I go low immediately. got a huge fright at 2.6mmol/L on sunday morn) whereas I was using 10 units Levemir per day and 6 to 8 units depending on what I eat

[Real4]

Except that the muscles can't use glucose without insulin.

That is a widely held belief, thankfully it's not true. Were it true, exercise would not be as effective in lowering blood glucose levels as it is.
Muscles will not take up glucose to convert to glycogen without insulin, but they will take up glucose from the blood for immediate conversion to energy. Insulin is not required for the take up of glucose for many tissues. Notably, nerves can utilize glucose without insulin.

[BlueSky]

... Muscles ... take up glucose from the blood for immediate conversion to energy. Insulin is not required for the take up of glucose for many tissues. Notably, nerves can utilize glucose without insulin.
This is new to me. It is my understanding that insulin is required to get glucose into all cells. :confused: Insulin resistance is defined as : The diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Can you give me a reference on the other way glucose is transported into cells?

[lilituc]

If your blood sugar is not high with a few hours of no insulin, you're probably still making insulin and would not expect to see ketones, possibly even if your blood sugar was high. Not that that means you shouldn't still check.

Generally, with an adult, you would not expect to see significant ketones without high blood sugar unless they were really ill. You might see trace ketones with exercise, but that's something different.