Yes. “Sick day rules”, despite their name, really should be called “ketoner ules” because they relate to how much extra insulin you need if you’ve got high BG and high ketones.
I test for ketones if I have a high BG that isn’t coming down, if I’m feeling really unwell (at any time) or if I’m sick or have an infection. If I’m eating low-carb I’ll usually have small amounts of ketones under normal circumstances, maybe 0.6 to 0.8 mmol/L. If I have a pump site that’s failed or have ketones because I’m sick, my ketones will be 2.0+ mmol/L. According to my endocrinologist, ketones of 3.0 mmol/L and above are a risk factor for DKA and indication that you should seek medical attention. I usually respond with extra insulin and a site change if my ketones are 1.0 mmol/L and above and I also have high BG and am feeling sick.
Before I went on the pump I only checked for them if I was sick (and yes, often did have them). Also, when I was taking a SGLT-2 inhibitor for a short time I checked ketones at least once a day.
It’s because ketones can occur for very different reasons. If you are losing a significant weight for any reason, you probably have trace ketones (urine), because they get produced when your body metabolizes fat. Getting them from a ketogenic diet or weight loss is really different than from insufficient insulin (which becomes much more possible when sick), which is what can lead to diabetic ketoacidosis.
We only check (using strips) when he is sick. Over the last two years, that means 6-8 times. It works well as an indicator on when to work toward injecting extra insulin as has been mentioned.
I’m not trying to say that other people should be sick with ketones or that the ketogenix diet is bad. I was just saying I don’t understand it. I need to do some research if I want to understand it which I probably won’t do so I shouldn’t have mentioned it at all
I recognize that there are times where ketones aren’t bad for you. I guess I should some day look up the science behind why I feel so crappy when I have ketones and why someone else may not because they have them for another reason. Especially because some people in this thread have said that ketones that are unhealthy are possible even when your blood sugar is lower.
I guess I would’ve expected that ketones wouldn’t make you feel crappy until you had ketoacidosis or high levels of ketones. I only had trace amounts so it seems strange that I was so affected.
I think that some people adapt to the ketones when they are living a ketogenic life. But almost everyone probably feels bad with Large ketones, and assuming you aren’t acclimated to it, feeling bad at the small level probably isn’t unique.
Years ago I tried the atkins diet for a bit, couldn’t stand the feeling associated with the ketones and quit after three days.
You can have ketones for lots of reasons. Fasting, exercise, eating low-carb, dehydration, lack of insulin. Many of the above are normal and ketones occur at low levels in everyone, with or without diabetes. It’s the last point that’s specific to people with diabetes, particularly Type 1. And in my experience, lack of insulin (with ketones) feels horrible. The feeling of having little to no insulin in your bloodstream feels awful
And (to me) feels quite a bit worse than a high caused by a miscalculated bolts where you still have sufficient insulin that your cells aren’t starving f.
@Katers87, my point was more that having ketones may feel different depending on the reason why you have them as well as the level of ketones. You might feel differently with trace ketones if you had them for a different reason (and it’s possible you’ve had them before for a different reason but not realized it because you had no cause to test for them).
Also to feel ok eating a ketogenic diet and running a consistent level of measurable ketones for days or weeks on end, you usually have to consume very high amounts salt/electrolytes and drink a ton of water, way more than usual—lots of people do feel flu-like at first, especially if they don’t adequately make those adjustments, so I think the idea that folks feel ok with it (without significant adaptations and adjustment time) is largely untrue.
@Katers87, I second what @cardamom said - whether or not you feel bad with ketones has to do with why the ketones are there. I had trace to small ketones my entire last pregnancy (pregnancy-related, not d related), and I felt awful because I was pregnant, but not because of the ketones.
The first week or two of a very low-carb diet feels awful precisely because people aren’t used to the ketones (at least that’s my understanding). But if you can get past the first week or two, and your body adapts to running on ketones (instead of glucose), then it feels GREAT. I’m currently not eating a low-carb diet and really need to get back on track (BGs are horrible, energy levels are horrible), but I’m dreading the acclimation phase where my body switches over to ketone-burning mode…
I know for me, when I’ve done keto, drinking a couple of large mugs of liberally salted chicken broth a day made a huge difference in how I felt—without that, it feels awful at first. However much salt you imagine “eating more salt” to be, what’s needed is probably more than that (especially if you’re used to minimizing salt)—I wouldn’t have realized how much except my friend who is much more familiar with keto was like, more… MORE… and it worked.
How many carbs did you eat on the keto diet @cardamom? My friend is on that diet, and he says he can only eat around 25 grams of carbs a day. He has to eat a lot of fatty foods and some protein. He actually loves the diet, and he’s lost a bunch of weight.
I didn’t realize diabetics could safely be on the keto diet, though I’ve heard that Bernstein recommends restricting your carb intake to 30 grams.
To be honest, I did not carefully count my carb totals or monitor my ketones at all, since I wasn’t really aiming to get into ketosis, just to eat low carb to manage blood sugars, which it was remarkably effective at. I just ate really low carb as much as possible, ending up dosing some for protein/fat, and figured it must have been kicking me into some mild ketosis since in addition to my blood sugars being really flat and TDD going down, I definitely needed the extra salt/hydration. I’m guessing I was probably around 25-30g. I found doing low-ish carbs (probably not keto) in combination with calorie tracking to be most effective for weight loss for me though—without calorie tracking, regardless of carb counts, I did not lose much weight. I did not find it super low carb sustainable in the long run only because I value being able to eat socially/eat out sometimes and to eat a variety of food, but I still sometimes go back into it to reset my blood sugar control.
My friend on keto says that he also really needs to be tracking calories in order to actually lose weight. He did say that he had to eat a lot of fat to still be healthy on a keto diet.
I couldn’t do this kind of diet. I love wine too much
Having a couple glasses of wine would be half my daily carb intake!
To be honest, cutting down on my drinking also helped me lose weight—I enjoy beer, wine, and spirits/cocktails, but went from more regularly having them to only very occasionally, and that saves a lot of calories. My then girlfriend went from drinking a lot of beer very regularly (probably easily 5-6 a day) to drinking almost none and dropped a ton of weight. It’s increasingly hard for me to justify the calories and carbs of beer (especially since I like good beer if I’m going to drink it)—it’s like eating a whole bunch of (delicious) bread with some booze on top.
Haha. Yes! That is exactly how I see beer- except for the delicious part. I’ve never really been a fan. It wreaks havoc on my blood sugars if I have more than one beer so I quickly decided it wasn’t worth it to me.
Well, I didn’t do a blood ketone test, so anything is possible. However, I was able to reduce my ketone level within 1.5-2 hours, so I would think that would indicate that they probably weren’t that high? I never went to the emergency room. This study indicates that blood and urine ketone levels are correlated at low values.
