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Permalink Reply by Brian (bsc) on May 7, 2010 at 7:37am

There are some common misunderstandings about ketones. Ketones are generated when your body burns fat. Everybody burns fat, every day. Our bodies can utilize either glucose or ketones for energy. When we need energy our body will at times convert fat into ketones and use those ketones to fuel our energy needs. This is just our bodies natural way of storing energy for long term use and then utilizing it. Perfectly normal. When you have excess, uneeded ketones, they are excreted when you pee. When you test for ketones, you are seeing the excess that your body dumps. It is not measure of your blood ketone level. If you use a blood test for ketones, that would measure circulating ketones. You may have circulating ketones, but not excreted ketones. Remember, you only excrete uneeded ketones. And remember, ketones are a natural process, so with a normal blood sugar, you would expect to see them. So what triggers fat mobilization and ketone generation? Well, falling blood sugar levels between meals for one. Another is exercise. And even just walking demands energy.

Now how is that different then ketones from DKA? Well, just like I described above, in DKA, your body mobilizes fat to generate ketones for energy. It turns out that enables the uptake of both glucose and ketones. No insulin, no uptake of glucose or ketones. In DKA your body is in a spiral screaming for energy, your liver is dumping blood sugar, converting protein to glucose and your liver is also converting body fat into ketones all in a desparate attempt to provide energy. But the glucose and ketones cannot be taken up, so they build up to dangerous levels in your blood and since you have excess ketones, they are dumped.

So the upshot. When you have insulin on board and a relatively normal blood sugar (70-200), you can be almost guaranteed that observed ketones are just a product of your normal metabolism. When you have high blood sugar (coupled with insulin deficiency), observed ketones may well be the onset of DKA and you need to get right on top of things. And remember, if you are not eating enough, low carb or not, your body is going to burn fat (and generate ketones) in order to fuel your existance.

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Permalink Reply by Krystal Parker on May 7, 2010 at 7:51am

I can understand the normal metabolic reasoning but with these ketones I have glucose in my urine even with the normal bgs and I have tested postive for ketones in my blood with normal bgs. I could just be a freak. it wouldnt be the first time. I once was admitted to the hosp in DKA at 43 because I I overcorrected when high and was already in DKA. So it wouldnt suprise me to just have crazy metabolic breakdown. I dont think I am eating to few of calories I eat around 1800 calories a day. Sorry if I sound argumentitive. I wonder if it may have something to do with working nights?

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Permalink Reply by Brian (bsc) on May 7, 2010 at 8:03am

You should not have glucose in your urine with a blood sugar of 100-150 mg/dl unless you have kidney issues. If you have had a recent high (like 300 mg/dl an hour ago) and corrected, then the glucose in your urine may simply be leftover from glucose that spilled during your high.

If not, then I would assume you may have a meter problem and it would be prudent to take immediate action based on that worse case scenario. If you have an alternate meter available, I would use it to try to confirm your blood sugar. If you have a site failure and your meter is messed that is like double "not good."

And no, you are not being argumentative, just properly cautious.

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Permalink Reply by Tim on May 7, 2010 at 8:27am

When you test your bg, you get your bg right now. But sugar or ketones in urine, they can be from 4, 8 hours ago, at least as long ago as the last time you peed.

And you don't have to go up to 300 mg/dl to spill sugar... for most people it starts around 180, but the threshold is actually variable person to person and situation to situation. I was diagnosed well before home bg testing so I know all about urine testing! Most docs today are so young they don't remember such prehistoric times. I remember one doc who insisted that I must have an A1C from diagnosis to compare with... I tried to convince him that I was not diagnosed with an A1C, but by peeing on testape and having it turn jet black.

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Permalink Reply by Brian (bsc) on May 7, 2010 at 8:33am

I don't doubt you are right, but most people don't dump glucose at those levels. My endo harps on me to replace my meter every 6 months. I've had a few go bad, some batteries, some just bad. If the meter has drifted badly it would explain the observations and I think it would still be prudent to check it out.

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Permalink Reply by Stephen Gilbert on May 9, 2010 at 12:15am

I don't spill keytones until i'm well over 350. I hardly ever have trouble with keytones... but when i do, it throws a wrench into things as my Novolog just does NOT work. I can take 15 units of the stuff and have my bg drop ZERO. (I know this cause it's happened)

I don't know near as much as i should about keytones though... i just know they make the D hard to manage :/

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Permalink Reply by Krystal Parker on May 9, 2010 at 10:27pm

I spill glucose around 175. but when I have ketones I am very sensitive to my insulin.

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Permalink Reply by Elizabeth on May 9, 2010 at 4:41am

The stress hormone cortisol can interfere with the action of insulin, so your equation of stress = ketones/sugar spilling makes sense, but it's weird that you aren't experiencing higher blood sugars as a result. Maybe you're a little bit insulin resistant too? Maybe you should get your cortisol levels checked to see if you have Cushing's Syndrome (high cortisol)?

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Permalink Reply by Brian (bsc) on May 9, 2010 at 5:08am

High blood sugars alone causes insulin resistance. I am sure that other things just make it worse, but it may just take a much higher than expected correction bolus (i.e. your ISF drops from like 50 to 10) to bring down a very high blood sugar.

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Permalink Reply by Krystal Parker on May 9, 2010 at 10:35pm

I met my doc in ER yesterday over this because they just werent flushing and my sugar was 408. by the time I got there it was down to 108 but I had high glucose and ketone in my urine so he dug a little deeper and found I had a severe sinus infection that is what was causing the fluctuations. He told me I had ketones because my sugar was getting so darn high and I am catching it and bringing it down but they arent flushing out due to my neurogenic bladder so they are still there hours after it comes down. He wanted to admit but sent me home on antibiotic and several other things and told me to drink lots of fluids and cath more than normal to keep coming out instead of sitting in my bladder. Anyway I crashed last night down to 23. it took an hour to bring me up and get me oriented. Call the doc he said my fever must've broke and the antibiotic was starting to work so I didnt need as much insulin.

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