[milfordj]

I'm new to this forum and new to blogs / forums, so not sure if I'm doing this right or not. Anyway, I have a question about ketones. I've had Type I for 50 years and have acquired a good bit of knowledge about this "condition". I've just started using a pump and am trying to obtain better control than through multiple injections. When my BG is a bit over 200 mg/dl, my pump tells me to check my ketones. I've used the ketostix in the past, but they expire before I use very many of them. I'm not sure I need to replace and use them because I feel that, even if they show ketones, I would not really do anything different than I do without that knowledge. I would still take the needed bolus of insulin and retest my BG very soon. That seems to always get me back into a good range. Obviously, if it didn't, I would do further research into the problem, to include contacting my physician if needed. So, do I really need to keep testing for ketones?

[fgummett]

Hi milfordj!

Of course testing for ketones couldn't hurt but I also understand about the stix getting out of date before you get to use them all!

I think, more importantly you are doing the right thing by monitoring your blood glucose and using the fast-acting insulin via the pump to make corrections (isn't that great!).

As you have recently started I assume you still have access to a pump nurse who could advise you further?

Remember that ketones can build up when your body burns fat for energy. The buildup can cause an emergency condition called ketoacidosis.

[Mich]

Hi MilfordJ,

Welcome to the forum. I won't hit the 50 year mark until 2010, but I feel empathy for you and all of the years past. We've seen so many improvements in ways to deal with diabetes over the years. I just started pumping in January of 2006. I love the convenience and record keeping abilities of the pump.

I came to the same conclusion on ketones myself. The meters always say to test, but I only test when I am very sick or have an infection. I never spill any high amounts of ketones, even when I am sick.

I have only been in keto-acidosis once--just before I began taking insulin. It was a long, slow slide over about a month's time. I lost a lot of weight and could taste a sulphur-like taste which I will never forget. My digestion went entirely haywire, the acidosis made me burp. I could lie down and go to sleep anywhere at any time. I drank liquid and ran to the bathroom incessantly. It made a big impression on me.

Years ago, I used a meter that tested both blood sugar and blood ketones simply by switching the type of strip. I confirmed during that 3-4 year period that my hunches were correct and that ketones were a fact of life for me. I was already eating low-carb at the time.

Sooo, in my experience you don't have to test every time the meter says so. But as a caution, I should mention that some folks seem to go into keto-acidosis easier than others. After a while, I knew I wasn't one of them.

Mich

[Scratch]

The basic reason why the meters and stuff give the test ketone message is because if you don't have any working insulin in you, you'll begin burning fat for energy and that'll produce ketones in large quantities if they become your primary energy source. Since elevated blood sugars can be caused by a lack of insulin, testing for ketones can be a good way to check for a lack of insulin, at which point if so indicated, a pumper might check the infusion set or someone on MDI might consider possibilities of why they don't have any insulin working.

[Mich]

Very good point, Scratch, especially for pumpers. I just test so often, I didn't think of it.

[morrisma]

Ask your endo or d-nurse for a sample of ketone strips if they think it wise for you to do the testing. I agree with you that since I correct for highs so quickly, it is doubtful if ketones really build up under those conditions.

If you do contact the dr office, let us know what they say.
Mike

[Jan B]

I got sick with pneumonia soon after my first experience pumping. My "educator" gave me a sliding scale for taking extra insulin during the presence of keytones while I was sick. I've only used this info twice, but it was successful. In addition to my normal correction amount, I was told to take 1 extra unit with slight, 2 extra units with moderate, and 3 extra units with high ketone readings.

[Subby]

I agree with your reasoning that if you agressively treat highs (as in, act properly and quickly), you are dealing with the ketone issue at the same time and hardly need test them most times. It sounds like you keep on top of things with quick action and solid retesting, so for many instances it makes sense just to get back on track rather than worry about the ketone testing.

That message tends to cater for the "lowest common denominator", example, the person who tests now and then and may not take a high test seriously. Personally, I was told to start testing for ketones around the 15 mmol/l 270 280 mark by my "team". I might do that if things are up in that region and things are not going as I predict. You should check with your doctor where they think it is a practical, useful threshold for you.

As for the strips, you might want to invest in an optium exceed BG monitor instead. It lets you test for ketones with a strip, just like a BG test. I have this as my backup monitor with my showbag of pump stuff I carry. If you don't want that, get some strips again. You definitely need the ability to test for ketones when things start to go awry.