This is fascinating and I also read @Bradford has experienced this…what do you do when they have ketones AND ARE ALSO LOW??? I don’t even get how that’s possible…
Ketones form when the body has INSUFFICIENT insulin, it cannot get glucose from the blood into the body’s cells to use as energy and will instead begin to burn fat. The liver converts fatty acids into ketones which are then released into the bloodstream for use as energy.
How is it possible to get ketones when you obviously have TOO MUCH insulin going into the body???
When they’re low and high on ketones, you feed em lots of carbs and LOTS and LOTS OF INSULIN and let them continuously sip water. That’s the key – the carbs are necessary to help clear the ketones… ketones are generated when your body is lacking either insulin or the carbohydrates to generate energy. So once you have carbs in your system your body naturally suppresses its ketone generation. Until you have those carbs, your body will have that incentive to keep producing ketones.
The other issue is if they’re low because they have a tummy bug AND they have ketones, then that’s an issue where you might really need to take them to the hospital. Because while glucagon mini doses can bring up the low, glucagon also stimulates ketone production – and when they have ketones they need insulin to clear it, but food will not bring them up enough. In our scenarios he’s been low because he was at altitude or because we saw he had ketones when he woke up, way overbolused for breakfast and then he came down, but his body still didn’t have enough time to clear out the ketones, which really just takes time. So that’s a situation where the answer is easier – just feed carbs, feed insulin, feed water.
I find checking ketones really valuable in regards to pump sites. If I’m high and suspect I have a bad site, I can check ketones and if they’re high, I pull the site. If I have low ketones, I know that the site must be working and that I probably just need more insulin.
As to low BG and high ketones, this can happen if you’re sick, need extra insulin due to the illness, but can’t eat and especially if you’re vomitting and getting dehydrated (which increases ketones). The solution is to give extra insulin, extra fluids, AND extra carbohydrates. At least that’s a basic outline of what I’ve been taught.
How is it possible to get ketones when you obviously have TOO MUCH insulin going into the body???
Also remember that the amount of insulin you need to keep blood sugar level does NOT necessarily correlate to the amount you need to suppress ketone generation. They are tightly connected systems but not completely identical. So you can have a mismatch between your body’s needs for insulin in terms of BG management AND in terms of ketone suppression. Just very weird.
Wow, this is amazing and I never knew it. Thanks for my daily dose of “I don’t know ■■■■ about diabetes!” Wow…this is just incredible to read…my mind is literally blown and I never ever considered that it was even possible to have high ketones WHILE being low. Your explanation makes so much sense but I’ll have to print it out and stick it somewhere so I actually can remember it!
Let me add some water to the mill here. Ketones are a serious symptom that things are VERY wrong. My kid was diagnosed in DKA with high ketones and we almost lost him. Ketones mean you must be VERY aggressive in (a) bringing him down as asap come what may and (b) keep him super hydrated.
One example where you would totally change behavior with ketones: If Liam has been high for a while (250+), throwing up, you are not able to keep him well hydrated and he has ketones, you should now be looking at the emergency room as one of your options every time you consider your choices.
All this information I’ve received has definitely given me a good basis for knowing when I need to use the strips, when I need to be worried, and what actions I need to take. I appreciate all the info!!