[corwin]

I keep hearing about ketones and DKA and I thought it's time to understand it better. I've seen it mentioned many times but I still don't fully understand it. I know I was tested for ketones when I was dx'ed but it wasn't really discussed so I assumed I don't have to worry about this yet, but now that I'm in pretty decent control I want to know about this aspect as well.

From what I know it's something that happens when the BG levels are high, when the body breaks down fat for energy, it's bad and it's something I should avoid. However I never got ketones strips (if that's the correct term) nor was I ever instructed to test for it or do anything about it.

I want to know if and when I should worry about it? Do I need to get test strips? When should I test for ketones? What should be done if it's high? As well as anything else I should know about the issue.

As always, thank you in advance for the info. I don't know what I would've done without this forum and the great advice and knowledge I find here.

Corwin.

[DeusXM]

At the risk of incurring the wrath of the forum....ketones are not the major hellhole everyone makes them out to be. People seem to think that even if a tiny amount of ketones show up in your urine you're in fullblown DKA and about to die.

This isn't true at all. A lot of people (diabetic or not) wake up with traces of ketones in their urine. However, ketones are a cause for concern (that's 'concern', not 'panic') if they are very high or show up throughout the day.

As for what ketones are, they're the byproduct of your body metabolising fat instead of glucose for energy. Therefore if you're not getting enough insulin, then your body will start burning fat to give you energy.

Testig for ketones is dead easy - some people dip their strips into a pot of urine, I just pee on them and see what happens. You should get a pack of test strips but bear in mind that they need to be changed every 6 months after opening - you will probably get through about 4 strips in this time so unfortunately there will be a lot of waste. You should test for ketones:

-When you're ill
-When your BG is high (above 10/180 is a good starting point)
-Whenever you think there's something wrong

More than likely, you will find that there aren't any ketones. Perhaps you might find a trace of ketones. If this happens DON'T PANIC. Check your BG. If it's high, comp. bolus and work out why your BG was high, and then take steps to eliminate that happening again.

If your ketones are high, then you should check your BG and comp. bolus if your BG is high. You should then also start drinking a lot of water to help flush your system and a phone call to your doctor or ER would probably be a very good idea.

[David]

At the risk of incurring the wrath of the forum....

No wrath from this part of the forum, I think you've given a great explanation.

David

[KrisinNM]

DeusXM has got it right. Ketones in themselves aren't bad but DKA is nothing to mess around with......caused me to have a heart attack several years ago.

[corwin]

Great explanation, thanks.

Can you please add more details about DKA? What is the difference between just having ketones and DKA? How do I know I have it? What are the implications?

Thanks again,

Corwin.

[DeusXM]

Jen is probably the best person to ask about this because she's the science wizz. However, the main difference is that ketones are the byproducts of fat metabolism, whereas DKA is a very specific and serious medical condition. When you burn fat, you create ketones. DKA is a form of fat burning which happens because your body simply can't get enough energy from your glucose.

This is a problem for two main reasons. Firstly, DKA makes your blood acidic. Secondly, it also means your sugars are running high. I find it helpful to imagine that the more sugar is in your blood, the more your blood is like sandpaper. All that sugar going round is scraping all your organs, and combine that with the acid...yeah, you're in trouble.

DKA is the reason that people with untreated diabetes die. Depending on the individual, you could be dead within a few days or a few months, which is why A+E usually get involved.

The reason ketones are a problem is because usually, nobody really ends up with ketones in their urine because the body's preferred food source is glucose, not fat. Because ketones indicate fat burning, it could be a result of either DKA or just regular fat burning. Ketones are like smoke - although there's definitely a fire somewhere, the smoke alone can't tell you whether it's a purposeful rubbish bonfire or a house burning down.

Bottom line is, if you find ketones and you're not expecting to find them, then you may have a problem. But ketones alone don't mean that you have DKA - they just suggest its a possibility.

[JediSkipdogg]

Wow Deus, excellent explanation both times and possible even better and more understandable than I could do.

[jak123]

I know about it a bit as this is how we were diagnosed. DKA stands for Diabetic Keytone Acedosis. It is a condition where the pH level of the blood becomes acedic. This is a happens when the body breaks down protein for energy instead of sugar. It gets protein from vital organs, which isn't good obviously. It does this because your cells are in need of glucse but haven't gotten any because there's no insulin. Anyway, I'm sure you can read up about it at other medical sites. We were told, if the BG is abve 300 to check for keytones. (240 if we're sick). If there are keytones, I'm supposed to call the doctor. Hope this helps.

[jen_slc]

Yeah, Deus has pretty much covered it.

A little bit of ketones isn't disastrous if your blood sugar is normal - it just means you are burning fat for energy instead of glucose. This is what happens on the low carb diets. Although ketones are acidic and could potentially mess with your blood pH, this ketosis is usually pretty mild and doesn't lead to ketoacidosis. But you'd want to drink a lot of water to flush your system of acidic bodies.

Large amounts of ketones could be a bad sign when your blood sugar is high - your body can't do anything with that glucose so your kidneys get rid of it through your urine, along with a lot of water. You end up peeing a ton and therefore become dehydrated. The dehydration worsens the acidic state your body is in and things could go horribly wrong.

If you find you have ketones and your bg is running high, take a correction bolus and drinks lots of water. I know I am spilling ketones and have got a high bg when I start smelling hairspray (acetone), I feel like I'm being suffocated to death and I get chest pains! And sometimes I only have to reach the high 100s before I get this way, so the "point" at which you start producing ketones will vary for everyone. Like Deus mentioned, don't wait till your bg is 300+, test if you feel off even if your bg is 180+.

I've always been told by my endos that to get your bg back to normal and get rid of ketones, you may require a larger correction bolus than what you'd normally give for high bg alone. Your doc can help you out with that, but personally I've experimented with myself and found that I need an extra 2 units on top of my normal correction bolus for ketones (that extra dose works out to be ~5% of my total daily dose of insulin). Of course that brings in the possibility of hypos while trying to get rid of ketones and then it gets a bit complicated.

[corwin]

Thanks a lot guys. I'll go get myself some ketones strips soon. Now that I know what do to with it. I'm glad to take ketones out of my "dangerous things I know nothing about" list.

[Cyborg]

Originally Posted by jen_slc

Yeah, Deus has pretty much covered it.

A little bit of ketones isn't disastrous if your blood sugar is normal - it just means you are burning fat for energy instead of glucose. This is what happens on the low carb diets.

Just losing weight alone causes me to dump ketones due to my body burning it's fat reservers (the losing weight part). As long as I take enough insulin by raising my basal rates or by using higher insulin-to-carb ratios to offset the increase in bg levels, there is no problem. I can stay in a state of ketosis for quite a awhile and safely. I do consume alot of water while in this state and I watch my bg levels closely. It has nothing to do with carb intake while I am in this mode, more to do with caloric intake.

While in this weight loss mode, if my insulin delivery from my pump were interfered with, I would need to address the situation rather quickly or I would be at risk for DKA. I have always stated that losing weight as a type 1 diabetic can be dangerous and this is my reason why.

[rzrbks]

Understanding ketones

If you feel that the problem between you and the ketones might be communication

You might try

Berlitz: Helping the world communicate since 1878

With 128 years of experience, more than 450 centers in over 60 countries, and millions of satisfied graduates, Berlitz is the only source you need for effective language instruction, whether for business or personal enrichment

.

[corwin]

Lol rzrbks, I knew I should've learned the keton language in school, too bad I took spanish.

Cyborg: Makes sense about burning fat. I had no idea I should raise basal when that happens, I'll keep that in mind as well, I guess everybody is always either gaining or loosing some weight all the time but it's the rate that really matters. Glad I'm not planning a major diet any time soon

[rzrbks]

corwin

Lol rzrbks, I knew I should've learned the keton language in school, too bad I took spanish.

Although Keton is a very difficult language to learn, there are many fine books that have been published in English that might help you out.

Here are a list of some my favorites:

Ketonography: An Honest Exploration of Ketone and surrounding areas, Dr. Gustoph HinterBohrung, University of Ketone Press, 1987


Ketonites: Benefactors or Assailants?: The true story of CIA Intervention in Ketonia, 1983-2014, Brick Stonejaw, Harper, Collins, 2017


Hunting for The Wild Ride: Ketones in the Rough, Mitch Blaster, Breakaway Books 2004


God Save Ketonia: Why I be came an Ex-Pat, Col. Sourd-muet Hinter, Paladin Press 2006