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Ketones in urine but not diabetic?

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#1
hkcool

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Got a quick call today from my doctor since I had a routine physical and got bloodwork and urine tests done.

He said everything was normal except for really low vitamin D levels and oddly enough, ketones in my urine. He explained that typically it's a sign of uncontrolled diabetes but my blood sugar is fine. He ordered an a1c done at the time that I got all of my bloodwork done just to be thorough. I don't have the results in front of me but I could request a hard copy of them. Anyway, he assured me that I'm not diabetic.

I'm a 20 y/o college student.

Is ketones in the urine a precursor to diabetes? I did read that fasting or starvation can lead to temporary high ketone levels. As a full-time college student, let's just say that my sleeping schedule is rather...irregular. I had to fast for the blood test that morning so my last meal was dinner that evening. I didn't sleep until 7 am that morning and my appointment was at 9 am, so...yeah...

The doctor said the next step would be a 24 hr urine test since they double-checked my results to make sure I actually had ketones in my urine and I did. But he also said there's no rush at all. I can't get the test till I'm actually back home so I'm just wondering now what it could be

#2
labrat

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Did you know the volume of ketones in your urine? Was it slight or high?
Slight to moderate ketones can occur with exercise. Did you work out or do some strenuous physical activity before your appointment?
People on low carbohydrate diets go into ketosis (usually preferably). These are things to consider if your testing does rule out Diabetes.
Plus, this was a one time test. Without other symptoms or clinical presentations to preclude a diagnosis, it may be easier to simply repeat a urine sample next time, too. Shouldn't need to be a fasting sample, either.
Dx Type 2: 7/13/2012 FBS 380 or 290 (one office meter, other Bayer Contour in office same day)
HA1C: 13.1% 7/13/12 (initial dx)
5.8% 10/26/12 (1st 3 month post dx)
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#3
sweetthing

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Most likely caused by dehydration. Young people often do not get enough to drink. I would just make sure you have lots of water before your next test. You said you had been fasting since supper the night before? If you were a bit dry then and didn't drink anything, you could very easily have been dehydrated.

#4
Sulli

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About 8 years ago I was getting a physical for work and the Dr. ask how long I had been a Dx? I told him I was not Dx and he stuck my finger and Bg was 81. Then he said when you do need to go to your regular Dr. because your urine is FULL of Keytones and that tells me you are Dx.

All I did was bought a test kit to test BG's and it was always high but I felt ok and I didn't know really what was too high to seek help back then.
Well later I was on several pills and insulin for my Dx. Was the keytones a early sign? My regular Dr. said a lot of things can make high Keytone levels and it's ok as long as temporary. All I know is here I am now.
Metformin (ER) 2000 mg.........( 2 of 500 mg (ER) at Morning and Supper time )
Tradjenta 5 mg.. ...................( * Stopped taking * on 8/09/12 ) :)
Glimepride 8 mg.....................( * Stopped taking * on 7/16/12 ) :)
Levemir FlexPen Insulin.........( 7 Units at Bedtime )

Low Carb Diet ( losing weight :))
June 2012 Trigl.. = 2,280 :(
June 2012 A1C's = 11.8 :mad:

Sept 2012 A1C's = 5.1 :)
Sept 2012 Trigl.. = 71
:)

#5
Hooterville

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One can have ketones because their blood glucose is extremely high. This is called, ketoacidosis or DKA - Diabetic Ketoacidosis. It's very dangerous

One can have ketones in their urine because they are on a low carbohydrate diet and their body is producing ketones as a result of burning fat. This is called, ketosis. It's not the same thing as ketoacidosis mentioned above and is not dangerous. Carbohydrate stores in the body are low from low carbing and the body turns to fat stores for fuel and ketone bodies are produced and present. This is something that some people work hard to achieve. I try to be in ketosis and am able to accomplish it with low carbohydrates and a ton of exercise.

As mentioned above, one can have ketones from fasting overnight or being dehydrated or lots of exercise.

A1c's: 1/11 9.4 ~ 3/11 7.9 ~ 6/11 7.8 ~ 7/11 7.6 ~ 10/11 7.5 ~ 12/11 6.4 ~ 3/12 5.9 ~ 6/12 5.4 ~ 9/12 5.4 ~ 12/12 5.3 ~ 3/13 5.1 ~ 8/13 5.5 ~ 10/13 5.4
Meds: 30 units Lantus - 2,550 mg Metformin
Diet: LCHF ketogenic, 30 to 40 carbs, dabbling in Paleo
Exercise: Lifting, walking, stair climbing
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#6
hkcool

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Thanks all. I think I'll call the doctor tomorrow and ask for the specific numbers.

I don't really exercise at all, so I don't think it's that. I suppose dehydration could be it though. I actually forgot they were going to ask me for a urine test so I peed before going to the appointment...I think I was lucky I was actually able to fill up the vial haha. I don't have any of the typical symptoms as far as I can tell, I'm just kind of curious at this point

#7
kyteflyer

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Ad if you are low in vitamin D, DO get some Ostelin (or similar) and take it all the time, get those levels up. Low vitamin D has been implicated in the etiology of Diabetes and I wish I had known a long time ago.
A1c Results
10th October 2010: 9.4
7th April 2011: 8.7 | 27th July 2011: 6.9 | 24th October 2011: 7.0
2nd April 2012: 8.6 | 29th June 2012: 6.0 | 20th Jan 2013: 6.2

#8
ant hill

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Ad if you are low in vitamin D, DO get some Ostelin (or similar) and take it all the time, get those levels up. Low vitamin D has been implicated in the etiology of Diabetes and I wish I had known a long time ago.


And get in the sunshine!!! as this supplement will not work by it's self.
Ketones are a sign that you have high Blood Glucose in your body for too long as then become acidic as this becomes poisonous. Oh sure water may clear some of the acid but not all of it. Ask to do a antibody test as this will see if there's any radical immune cells attacking the Islets that carry insulin to the mussels!!! :)

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#9
xMenace

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I've read that it's common for "normal" people to show ketones in the morning. Either this isn't true or your doctor is a quack, or maybe the levels were higher than "normal"

I show ketones almost daily now. I'm curious why my PCP didn't mention them. They had to be there in my last test.
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Back on MDI and doing well. Trying Victoza and loving it. A1C 6.0, no major hypos; a few highs; lots of shots. Diagnosed Oct 19th, 1975.
HDL-101; LDL-64; TG-36; TOT-172

#10
sweetthing

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ketones in urine can be about a lot more than high blood sugar! from major to minor problems. if all other labs are okay, you have to look at the minor first, like dehydration.

#11
Tribbles

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DKA ia caused by ketosis but it's like most things it's the level that matters. Ketones are acidic and that's where the acidosis in DKA comes from. With diet you simply never reach anywhere near that level of ketones and hence acidity though.

#12
jillybean

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Ketones are a sign that you have high Blood Glucose in your body for too long

Not always...ketones could simply be a sign of ketosis, which has nothing to do with blood sugar levels.

DKA ia caused by ketosis...

I think this is very misleading. You can be in ketosis for years without ever having DKA. Symptoms of DKA are typically spilling of ketones AND high bloog glucose leveles (there have been some anomolies, but this is the most common pairing). Ketosis is simply that your body is burning fat for fuel instead of burning glucose. The two really are not very closely related at all with the exception that both happen to involve ketones. One does not cause the other to occur.
*Jill*
Diagnosed Type 2 May 21, 2008, A1C 9.5, Fasting Glucose 214
Had Duodenal Switch (DS) surgery to resolve diabetes on March 27, 2009.
Most recent A1Cs prior to surgery: 8.1 and 7.9 while on 2500mg metformin and 50mg Januvia (sitagliptin) :(
A1C on 7/10/2009: 5.4 :)
A1C on 12/3/2010: 4.9 (off all meds) :cool:
6/9/2011: A1C of 4.6, fasting: 70, fasting insulin: 2 :D:D:D
A1C on 10/13/11: 4.8 :) (fasting: 60)
A1C in August 2012: 4.9 :)
A1C on 3/11/2013: 4.8 :)

#13
Tribbles

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I think this is very misleading. You can be in ketosis for years without ever having DKA. Symptoms of DKA are typically spilling of ketones AND high bloog glucose levels (there have been some anomolies, but this is the most common pairing). Ketosis is simply that your body is burning fat for fuel instead of burning glucose. The two really are not very closely related at all with the exception that both happen to involve ketones. One does not cause the other to occur.


Actually they are the exactly the same mechanism. If you have a serious shortfall of insulin your body has no glucose and falls back on burning fat, equally if you get into ketosis via diet your body falls back to burning fat. In both cases ketones are generated and will acidify your blood. The difference is that for diet you never get near the ketone levels you hit with insulin insufficiency. It is extremely difficult to eliminate all carbs and since your body will output insulin and that will down-regulate the ketosis, but in Type 1 with an absence of insulin there is no down-regulation of the ketosis and it runs away swamping your ability to balance your blood pH. Low levels of acidity are no problem and your body can correct that easily, high levels cause DKA.

In summary; it's the same ketosis process in both cases but you will never reach the point where you swamp your ability to control your blood pH from diet alone.

#14
Sulli

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I bought a bottle of test strips at Walmart. Tested 4 times this week and all said normal so far and I am on a real low carb diet.........
Metformin (ER) 2000 mg.........( 2 of 500 mg (ER) at Morning and Supper time )
Tradjenta 5 mg.. ...................( * Stopped taking * on 8/09/12 ) :)
Glimepride 8 mg.....................( * Stopped taking * on 7/16/12 ) :)
Levemir FlexPen Insulin.........( 7 Units at Bedtime )

Low Carb Diet ( losing weight :))
June 2012 Trigl.. = 2,280 :(
June 2012 A1C's = 11.8 :mad:

Sept 2012 A1C's = 5.1 :)
Sept 2012 Trigl.. = 71
:)

#15
Tribbles

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I bought a bottle of test strips at Walmart. Tested 4 times this week and all said normal so far and I am on a real low carb diet.........


It varies from person to person but typically it is very easy to knock your body out of ketosis. The presence of insulin shuts down the process fast and, although I hadn't really thought about it, but that is probably more of an issue for Type 2 where the insulin response is strong despite the uptake being poor. In other words carbs will produce a much larger insulin release than they should which means you need to eat even less carbs to stay in ketosis than a non-Type 2. I have no proof of this but it sounds reasonable (which is no guarantee of anything!)




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