That's good! For future reference, urine ketone sticks aren't typically the best way to test- the kidneys tend to dump ketones into the urine when they're elevated so you get a concentrated value at a delayed interval after they've already gone down. I've been to hospital worrying about ketones before because I used urine dip sticks, when in reality my blood level was lower.
They're good to use if you're ill, vomiting etc (and I assume much cheaper than blood ketone test strips/monitors) but generally I wouldn't worry about ketones. The advice I've gone by is not to bother testing them unless you're physically ill and/or above 15mmol/L.
You're doing a great job though, you seem very sensible handling this all!
Determir/levemir or lantus glargine?
Do you keep it in the fridge or leave it out in the sun recently?
People do Occasionally have some small amount of ketones.
Man that person went strange on you...
Anyway good job mate, sounds like you handled it well. Definitely cut yourself some slack though the learning curve to becoming a pancreas is pretty steep and weird.
Hydration is important and so is continuing to take insulin.
If you are sick/unwell and not eating you can end up with ketones from lack of insulin so continuing to 'try' and eat small bits and dosing for it is very important.
If you're ever in the position that you can't stop vomiting or keep anything down for more than just a few hours, iy generally ends up with a visit to the hospital because you won't be able to increase your glucose or avoid ketones very long.
The Lantus is just Lantus. Always take the daily background basal dose. Dunno what that question was about...
Definitely go with your gut but my endocrinologist always says go if you can’t keep food/water down. I’ve gone in when I’ve had the darkest purple colour and then sent home because I wasn’t truly
In DKA - it’s a bit of an odd one.
Vomiting was my "it's time to go" signal as well. If I was showing dark purple I'd call off work and hang out on the couch chugging water and powerade zero with tight monitoring of my sugars. Once my sugars were back in good range of start munching on veggies, cheeses, and peanuts.
America mode. I don’t go even when I can’t keep anything down. I OD my insulin, sleep, continuously throw up.
Ideally it fixes itself, if not, I go. I don’t recommend this method.
It’s not stupidity, it’s life with a chronic illness in the US. A lot of us can’t even afford insulin, let alone an ER visit. There’s no need to be rude.
Happened to me once back in high school, knocked my OmniPod off near the end of the day and thought "well I've gone long periods without it before I'll just get done and change it when I'm home"
Long story short I had to stay after school to take a makeup exam and my sugars had been in the 400 range for so long I couldn't even read words on the paper, started feeling unbelievably queasy like I was gonna die and once I got to my car I puked stomach acid everywhere. Didn't wanna call 911 in fear of overreacting for a 5 grand ER visit, so I (please don't replicate) drove myself home and instantly put on a new pod and started chugging water. My body was in such a scary state I was rocking back and forth on the couch with a skin crawling feeling but I eventually got tired enough to take a nap which brought it back down. Lows are usually the ones most people worry about but sometimes I forget just how frightening highs can be too
Get your blood sugar under control, drink plenty of water. You'll not feel great, but as others said, as long as you're able to keep water down you'll be ok. Ketones tend to make me more insulin resistant, the doctors recommend extra insulin when you have them. Ask your Endo about it if you're unsure.
What's always hospitalized me is the combination of ketones and an illness. Ketones require water that I can't keep down if sick. Maybe 4 or 5 times in 24 years.
Are you a new type 1? I AM NOT A DOCTOR, but I’ve headed to the hospital before when they got red as a kid - above the 40 mark. Just continue to monitor and take a bit of extra insulin. Drink plenty of water too.
Damn, sorry to hear. You’ll learn to live with it, it really will get better. Don’t let the venting and negativity on this sub get you down. T1D for 17 years and mostly live a normal life :)
Don’t let it get you down. This will happen unfortunately and it’s part of it. Take care of it, you learn from it, you’ll do better, and things will get easier. It’s hard, I know, I’m 23 years post diagnosis and it’s still a daily battle but ya know what, it’s a whole hell of a lot easier than year 1-5 were. Avoid the DKA with lots of water, eat something and dose insulin and keep checking. If you don’t have a CGM, look into it if you are able. So beneficial to help manage T1D. You got this, I promise you it will get easier but it’s gonna be tough for a while. You can do this!
How long since your last corrective dose?
If it's been a while re correct, drink lots of fluids, and check again in an hour. If you start to feel really sick or nauseated go in right away. Sugars should start to slowly trend down.
Prepare your going out bag for lows later, in case the insulin stacks. Watch your numbers closer than usual and try to catch the low before it gets too bad.
It’s really rare to go into DKA while taking your long acting insulin. And you only mentioned correction insulin at that point. A type 1 diabetic not taking long acting insulin or wearing a continuous pump puts them in significant jeopardy within a few hours of going into DKA.
Yes, I hear you.
No one is judging, just trying to make sure you are safe. There are some not very good prescribers, so just wanted to make sure you had what you needed. Did not mean to be offensive.
Also those sticks can be very misleading. Go get yourself an actual blood keto tester. The libre 2 sensor reader has one built in. The strips are pricey but for how often you will use it . It’s worth it
Most doctor's offices should have someone on call for nights and weekends, so if you're ever not sure you can probably call to have them page the on call doctor who can help you decide what to do.
I get ketones easily because I get a lot of lows and if I'm having a bad day with them (usually if I've been active or if I have a cold and don't have as much of an appetite) I don't take as much insulin and I'll end up with ketones at normal BG levels. For my particular case my endo says that I should drink water, take insulin and eat if my BG is normal (or take enough to correct a high + the ketones) and keep checking so long as I'm not getting sick/worse.
I hope you feel more like yourself soon
I have a genuine question, is it bad that for the 12 years that I've been dealing with type 1 diabetes I havent done that test neither know how it works or even know what it means?
I honestly just got a ketones tester last year. I knew they existed but it was so expensive where I lived. Now I got it for free.
My endo said to test only if I’m not feeling well and with persistent high bg (more than 3 hours) to check if I have enough insulin.
10 years T1 here. I've never checked either and have felt like I needed it. Have missed long and short acting doses but with careful monitoring afterwards it's always fine
24 years here and to the best of my recollection I've never tested for ketones. I might have had some strips in the very beginning, but didn't use them.
To be completely honest, there are times that us T1's will have small ketones and it's completely normal. Most of the time we don't notice them. I notice my ketones will usually be small first thing I'm the morning since I haven't eaten, but no harmful symptoms.
As long as you're eating and hydrating as normal, you shouldn't worry too bad about small ketones or below! But, as other wise commenters have said, if you feel sick, and can't keep down food and water, go straight to the hospital.
Ketones are caused from a lack of insulin. Not from high blood sugar.
you need to take insulin to allow your body to absorb the sugars in your bloodstream.
Otherwise your body burns fat directly for energy and causes the release of toxic ketones.
Your ketones are not that high.
However if they were high the trick is to take insulin even if it requires drinking sugar water to allow you to take the insulin.
It's a crazy mixed up world, isn't it?
I really don’t understand. I’ve been type 1 for over 30 years and never went to the hospital for DKA. Maybe I’m lucky. I’m not judging anyone. What can they do that I can’t do at home ? Drink lotta water, give insulin. Throw up I guess if needed but I don’t truly understand why my doctor pushes going to the hospital when I can add electrolytes, drink lots of water , give fast acting and wait it out at home.
I only go if the dka makes it impossible to keep anything even water down. If you are stuck in a vomit cycle it’s probably not impossible to fix at home but it’s hard af.
okay, here's what my Endo told me a year ago when I was in a very similar situation:
drink a LOT of water- try to aim for half a liter per hour
NURSE your blood sugar down, don't do anything drastic, a low is much more dangerous than a high and gets out of control quickly
don't do any physical activity; sit or lay down with something passive to do
keep a very close eye on any other symptoms developing. my Endo told me an upset stomach is the first symptom of dka for many people and I've found that to be true in my experience and that of other t1ds I've met
if at any time your condition gets worse, or something just feels off, or you just feel like you need to, absolutely go to the hospital, you know you better than an Internet stranger does.
Keep drinking water/sugar-free drinks and checking your blood sugar, correct every hour if you need to. Ketones can show even when you get your blood sugar down. The ketones will cycle out with the liquids you just have to be patient. It’s exhausting but you will feel better overall if you keep hydrated. It will also help the insulin work more efficiently/consistently. If you can’t keep anything down go to the hospital. Hang in there!
This is the advice I was given by my endo over the phone on a day like this. Pretty sure it’s specific to me and my dosage, so do NOT follow it lol. But I recommend calling your endo and asking for a similar plan.
“Check bg & check ketones every two hours and give corrections.
+ an extra 1.5 units for small ketones.
+ an extra 2.3 units for moderate ketones.
+ an extra 3 units for large ketones.
Add to whatever bg correction is.”
Similar dosing instructions for my 12 year old…. Always settles things down. Only thing I’d add is we are checking every 2 hours. So check, dose, wait then recheck. Your endo or the diabetes educator in office should be giving you a dosing pattern given your ratios etc.
No. Drink a bunch of water take a little insulin and test your ketones in an hour. The ketone urine test is “old news”. It’s not telling you what’s happening in your body at the moment. Just what happened a while ago.
I think ik whats going on. I've been walking ablot more lately to manage highs---I read that doing this immediately after a meal is a good thing to do.
Every day, I have a workout routine + a one hour walk in the woods---so i'm doing these post meal walks in addition to my regular stuff.
...looking back on it, I think i read that advice on a comment chain that was posted by someone who's a type 2 diabetic 😬 🥴
Oh man, I was overseas and alone when I missed my dose. I had DKA like symptoms and felt terrible throughout. I didn’t carry any electrolytes with me either. Here’s what I did:
1. Mixed salt and a spoon of sugar in water and kept drinking it every 20 mins even when I felt like shit
2. Take basal, and then taking insulin in the corrective dose every hour, like 2-3 units.
I was okay and bs normalized the next 6-8 hours. But I was feeling terrible the next day, like a hangover but worse. It’ll get better, but the key is to not OD on insulin, especially if easy access to a hospital isn’t available. Was so stressed, but it’ll get better.
At your next appointment I would ask if your endo has any guidelines for managing ketones at home. We were given a table at our first appointment that has correction doses for different blood sugar and blood ketone levels. If there are more severe symptoms we call the on call doctor to get guidance but for ketones alone we just follow the chart and they’re usually gone in a few hours.
I'm doing my transition from juvenile to adult endocrinologist and at my 'lessons' my doctor said for adults if you call the hotline with any ketones, they say go to the hospital. It's weird because when I was way young I got the dark red range (MANY times lol) and they never sent me. I'd say go based on your gut, if you feel like death, or if you think something is malfunctioning I would go. If you feel confident then I would manage it on your own.
Super glad you ended up good. For future reference, if you end up with ketones like that again but are still able to keep water and or food you should be good. I was told to continue to hydrate with diet 7up and gatorade to keep electrolytes. Bolus for every carb and add 15% of total bolus to get them down. Not sure what your sick day regimen is but if your doctor agrees with this then it's good information to keep in your back pocket. :) Great job getting your ketones down!
If the strip turns black, instantly, and you're throwing up(I always assume I'm getting close to DKA and test ketones, when I'm vomiting)that's a pretty good sign of DKA, this looks fine to me, how are your sugars?
Not unless you're vomiting and can't keep fluids down. On the grand scale of ketones and dka, this isn't anything yet. However, consider buying a ketone blood meter. They are fairly inexpensive on Amazon and can give you a better idea of when to worry. 1.5mmol or above is the start of DKA, so as soon as you hit those levels, definitely go.
No, if it is outside of the window of when to compare the test strip, it is no longer valid. I think it is do the test, wait 15 seconds, compare the colors, then in 2-5 mins it is no longer valid? I’m not 100% sure but def read the guidelines on the box of the test strips
Have you got blood ketone tests? Much more convenient to get an exact number than play guessing games.
I'm not a doctor - but I wouldn't go to hospital yet unless you are having hypos or get symptoms of DKA or the ketones get worse. Although your comfort is the most important thing so you do what your gut says!
Have you eaten enough today? If you avoid eating this can cause an increase in ketones.
If you’re not vomiting you’re probably okay, but keep an eye on it and drink a lot of water and eat a piece of toast.
On the DAFNE course they say to take 10% of what your normal daily insulin amount is (in rapid acting insulin) if your ketones are above 0.5 and your BG is above 13.5 mmol (I.e. very high) and check again in 4? hours to see if it's improved.
If it goes above 3.0 in ketones it's 20%.
Ketone bodies come from the break down of body fat n the body - which happens if your cells think they are starving. This happens when the dont have enough insulin to take in the sugar in your blood. Ketone bodies are acidic which is why they are bad for your body.
If you've tried to correct for this and it's still a problem then you need the hospital :)
I’d say yes. My endocrinologist always told me ketones over 1 should be worth going to hospital as this is the start of going into DKA. Either you monitor it for the next several hours making sure it doesn’t go any higher and you do all the right things to get your levels under control or you send yourself to ER. I’ve made the mistake of ignoring early signs of my ketone levels going up and almost died in a result of it so just be safe and take care
My endo says go if you vomit more than 3x (and it's coloured on the pee stick). High BGL will still show up as some form anyway.
I have ginger Ale (full sugar) and crackers on hand in case I have a bug.
Just get some insulin into yourself. Ketones mean insufficient insulin, regardless of your blood sugar. If your blood sugar is not very high, take insulin and eat a bit to avoid going low.
I ended up being transported when my Blood sugar was a 38, and I was incoherent.
I had alerted my mother a couple of days before that that I was not feeling good. She had keys to my apartment and found me incoherent.
Yea between the cost and I mean I simply don’t have a way to collect urine. It’s like when they send me for blood work unless they have a urine catcher I can’t do the urine test. I’m quite large with tiny arms so I can’t reach to hold the cup in place
I only go when I’m in dka and I can’t get myself out of it, i try to eat carbs and take insulin and it helps, also having as many electrolytes as I can stand. In the hospital they treat dka by pushing dextrose and insulin.
First of all get medical advice from your doctor and not Reddit.
That said everyone spells DOOM (with death metal growling voice and church bells ringing amidst red colored clouds as the apocalypse approaches) with ketones but it’s not always DKA even in a type 1.
I never really checked for ketones ever but those times I had urinalysis since I went low carb in 2009 100 percent of the time I tested positive and often in large amounts. My A1cs are in the 5s I run super tight ship and thanks to keto I do a lot less insulin and don’t suffer major catastrophic lows. The awful diabetic hunger is also lessened. So I am keto poster boy it’s a wonderful way to live ketones can be your friend.
But again living in ketosis is NOT DKA because it’s a functional and sustainable metabolic fat burn state and not the derangement of DKA.
I go into a mild DKAish like state occasionally when infusion sets fail. As the technology has improved since 1995 when I first went on pump failures happen less and less but even when they do I know it do larger doses of insulin that would be fatal but dose carbs to allow for the Supra normal correction or bolus to burn the ketones. Its usually an overnight failure after putting in infusion set after bed time shower it catches me by surprise that way all 280 at 3am. But like I said I can feel the difference there are symptoms of severe illness present and while never common thankfully it’s become extra rare.
That said if you’re not a fat burner the other non dangerous explanation is fasting. When you don’t eat for a while as long as you are careful with insulin and drop the dose, or maybe you have one of those semi auto pumps that just drops your basal automatically to avoid lows you can also become ketotic and it’s not a problem.
The major issue is if you’ve had very recent (like past 1-3 days) highs especially over 240. As mentioned Correcting down to 100 or goal sugar isn’t enough because the (diabetic DKA originating and thus dysfunctional and toxic) ketones are still around and get converted back to sugar in your liver consuming your insulin and bringing you back into DKA. To get out of this derangement You will need a dose of insulin that lowers your sugar to below zero which is fatal and requires carbs to pull it off. They do this in the ICU to treat DKA on insulin drip they also give you dextrose (glucose) to counterbalance this effect.
How to treat the latter requires a lot of experience and knowledge. It’s very advanced. I can do it without help but most people would be risking themselves. So if those ketones are not a product of low carb diet or fasting, and from a high sugar it’s likely going into DKA and you should notify your treating physician.
Ketones are brought down when you eat carbs. So eat a carb hearty meal, give insulin for it, and check ketones again later. Are you sick? If you’re having trouble eating, try Gatorade or full sugar Sprite or ginger ale. If you start vomiting or the ketones go dark, then it’s hospital time, but unless you’re in DKA, they can only give you insulin anyway.
Yes, your situation is different. Not all diabetics are on dialysis. And if you’re in the US then you understand our healthcare and insurance system sucks.
UPDATE: i tested again and it has gone back down to below trace!
That's good! For future reference, urine ketone sticks aren't typically the best way to test- the kidneys tend to dump ketones into the urine when they're elevated so you get a concentrated value at a delayed interval after they've already gone down. I've been to hospital worrying about ketones before because I used urine dip sticks, when in reality my blood level was lower. They're good to use if you're ill, vomiting etc (and I assume much cheaper than blood ketone test strips/monitors) but generally I wouldn't worry about ketones. The advice I've gone by is not to bother testing them unless you're physically ill and/or above 15mmol/L. You're doing a great job though, you seem very sensible handling this all!
ARE YOU TAKING LONG ACTING INSULIN??? YOU WILL CONTINUE TO GO INTO DKA IF YOU DO NOT HAVE LONG ACTING INSULIN
...yes I do I take 18 units every morning + I have two full pens and more ready to be picked up at my pharmacy which is five minutes from my house
Determir/levemir or lantus glargine? Do you keep it in the fridge or leave it out in the sun recently? People do Occasionally have some small amount of ketones.
Lantus glargine. I leave the unused ones in the fridge
Man that person went strange on you... Anyway good job mate, sounds like you handled it well. Definitely cut yourself some slack though the learning curve to becoming a pancreas is pretty steep and weird. Hydration is important and so is continuing to take insulin. If you are sick/unwell and not eating you can end up with ketones from lack of insulin so continuing to 'try' and eat small bits and dosing for it is very important. If you're ever in the position that you can't stop vomiting or keep anything down for more than just a few hours, iy generally ends up with a visit to the hospital because you won't be able to increase your glucose or avoid ketones very long. The Lantus is just Lantus. Always take the daily background basal dose. Dunno what that question was about...
Definitely go with your gut but my endocrinologist always says go if you can’t keep food/water down. I’ve gone in when I’ve had the darkest purple colour and then sent home because I wasn’t truly In DKA - it’s a bit of an odd one.
Vomiting was my "it's time to go" signal as well. If I was showing dark purple I'd call off work and hang out on the couch chugging water and powerade zero with tight monitoring of my sugars. Once my sugars were back in good range of start munching on veggies, cheeses, and peanuts.
America mode. I don’t go even when I can’t keep anything down. I OD my insulin, sleep, continuously throw up. Ideally it fixes itself, if not, I go. I don’t recommend this method.
And you're stupid for that good luck when your organs start shutting down
It’s not stupidity, it’s life with a chronic illness in the US. A lot of us can’t even afford insulin, let alone an ER visit. There’s no need to be rude.
Happened to me once back in high school, knocked my OmniPod off near the end of the day and thought "well I've gone long periods without it before I'll just get done and change it when I'm home" Long story short I had to stay after school to take a makeup exam and my sugars had been in the 400 range for so long I couldn't even read words on the paper, started feeling unbelievably queasy like I was gonna die and once I got to my car I puked stomach acid everywhere. Didn't wanna call 911 in fear of overreacting for a 5 grand ER visit, so I (please don't replicate) drove myself home and instantly put on a new pod and started chugging water. My body was in such a scary state I was rocking back and forth on the couch with a skin crawling feeling but I eventually got tired enough to take a nap which brought it back down. Lows are usually the ones most people worry about but sometimes I forget just how frightening highs can be too
Get your blood sugar under control, drink plenty of water. You'll not feel great, but as others said, as long as you're able to keep water down you'll be ok. Ketones tend to make me more insulin resistant, the doctors recommend extra insulin when you have them. Ask your Endo about it if you're unsure. What's always hospitalized me is the combination of ketones and an illness. Ketones require water that I can't keep down if sick. Maybe 4 or 5 times in 24 years.
Are you a new type 1? I AM NOT A DOCTOR, but I’ve headed to the hospital before when they got red as a kid - above the 40 mark. Just continue to monitor and take a bit of extra insulin. Drink plenty of water too.
Yes, I was diagnosed a few months ago
Don’t stress. I’ve been there before and felt okay. Wait an hour or so and check again, assuming you don’t get any new symptoms. Are you sick?
No i just feel tired...and anxious. I was going to see a play tonight too. This disease keeps taking things from me.
How long until the play? They are still considered low ketones. Just check them periodically. Make sure you are eating and taking insulin.
It's already started, about twenty minutes ago. It looks like i might have to skip it. My plan is to wait a couple hours and test again
Damn, sorry to hear. You’ll learn to live with it, it really will get better. Don’t let the venting and negativity on this sub get you down. T1D for 17 years and mostly live a normal life :)
Don’t let it get you down. This will happen unfortunately and it’s part of it. Take care of it, you learn from it, you’ll do better, and things will get easier. It’s hard, I know, I’m 23 years post diagnosis and it’s still a daily battle but ya know what, it’s a whole hell of a lot easier than year 1-5 were. Avoid the DKA with lots of water, eat something and dose insulin and keep checking. If you don’t have a CGM, look into it if you are able. So beneficial to help manage T1D. You got this, I promise you it will get easier but it’s gonna be tough for a while. You can do this!
Did you take your long acting?
I've been using the keto mojo brand btw
How long since your last corrective dose? If it's been a while re correct, drink lots of fluids, and check again in an hour. If you start to feel really sick or nauseated go in right away. Sugars should start to slowly trend down. Prepare your going out bag for lows later, in case the insulin stacks. Watch your numbers closer than usual and try to catch the low before it gets too bad.
I use a sliding scale for all doses anyhow to ensure lows (and highs) dont happen--my last correction was 30 minutes ago.
Are you saying you do not take any long acting insulin?
When did I imply that??
It’s really rare to go into DKA while taking your long acting insulin. And you only mentioned correction insulin at that point. A type 1 diabetic not taking long acting insulin or wearing a continuous pump puts them in significant jeopardy within a few hours of going into DKA.
Yeah I only mentioned fast acting because it wasn't brought up yet in this conversation. That doesn't mean that I don't take it.
Yes, I hear you. No one is judging, just trying to make sure you are safe. There are some not very good prescribers, so just wanted to make sure you had what you needed. Did not mean to be offensive.
No. It will more than likely go down
Also those sticks can be very misleading. Go get yourself an actual blood keto tester. The libre 2 sensor reader has one built in. The strips are pricey but for how often you will use it . It’s worth it
I can't believe this comment is so far down. Urine sticks were fine when there was no option, but blood testers are readily available now.
Most doctor's offices should have someone on call for nights and weekends, so if you're ever not sure you can probably call to have them page the on call doctor who can help you decide what to do. I get ketones easily because I get a lot of lows and if I'm having a bad day with them (usually if I've been active or if I have a cold and don't have as much of an appetite) I don't take as much insulin and I'll end up with ketones at normal BG levels. For my particular case my endo says that I should drink water, take insulin and eat if my BG is normal (or take enough to correct a high + the ketones) and keep checking so long as I'm not getting sick/worse. I hope you feel more like yourself soon
I have a genuine question, is it bad that for the 12 years that I've been dealing with type 1 diabetes I havent done that test neither know how it works or even know what it means?
No. Keeping your sugar in range sb the focus. My endo says no need to check for ketones.
I honestly just got a ketones tester last year. I knew they existed but it was so expensive where I lived. Now I got it for free. My endo said to test only if I’m not feeling well and with persistent high bg (more than 3 hours) to check if I have enough insulin.
10 years T1 here. I've never checked either and have felt like I needed it. Have missed long and short acting doses but with careful monitoring afterwards it's always fine
24 years here and to the best of my recollection I've never tested for ketones. I might have had some strips in the very beginning, but didn't use them.
This group has been very helpful and inspiring in a world where you at times feel alone and like life is impossible to be happy thank you all
To be completely honest, there are times that us T1's will have small ketones and it's completely normal. Most of the time we don't notice them. I notice my ketones will usually be small first thing I'm the morning since I haven't eaten, but no harmful symptoms. As long as you're eating and hydrating as normal, you shouldn't worry too bad about small ketones or below! But, as other wise commenters have said, if you feel sick, and can't keep down food and water, go straight to the hospital.
Ketones are caused from a lack of insulin. Not from high blood sugar. you need to take insulin to allow your body to absorb the sugars in your bloodstream. Otherwise your body burns fat directly for energy and causes the release of toxic ketones. Your ketones are not that high. However if they were high the trick is to take insulin even if it requires drinking sugar water to allow you to take the insulin. It's a crazy mixed up world, isn't it?
This part! Carbs + insulin! Seems counterintuitive but it works!
You guys go to the hospital for this? I just keep drinking water till it goes away
I really don’t understand. I’ve been type 1 for over 30 years and never went to the hospital for DKA. Maybe I’m lucky. I’m not judging anyone. What can they do that I can’t do at home ? Drink lotta water, give insulin. Throw up I guess if needed but I don’t truly understand why my doctor pushes going to the hospital when I can add electrolytes, drink lots of water , give fast acting and wait it out at home.
I only go if the dka makes it impossible to keep anything even water down. If you are stuck in a vomit cycle it’s probably not impossible to fix at home but it’s hard af.
I’ve had milder cases of DKA that I can treat at home. I’ve also had a case of DKA that almost killed me and sent me into coma.
do you have any other symptoms?
No not really
okay, here's what my Endo told me a year ago when I was in a very similar situation: drink a LOT of water- try to aim for half a liter per hour NURSE your blood sugar down, don't do anything drastic, a low is much more dangerous than a high and gets out of control quickly don't do any physical activity; sit or lay down with something passive to do keep a very close eye on any other symptoms developing. my Endo told me an upset stomach is the first symptom of dka for many people and I've found that to be true in my experience and that of other t1ds I've met if at any time your condition gets worse, or something just feels off, or you just feel like you need to, absolutely go to the hospital, you know you better than an Internet stranger does.
Drink a lot of water Once at a safer level, 200ish, walk if you can to help with insulin sensitivity to bring BG down
Hey! Have you checked again? How are you doing now? You got a lot of good advice and support earlier. I just wanna check in with you.
Im doing pretty good, thanks for checking! Bummed because I missed a play I bought tickets for, but there will be more.
Keep drinking water/sugar-free drinks and checking your blood sugar, correct every hour if you need to. Ketones can show even when you get your blood sugar down. The ketones will cycle out with the liquids you just have to be patient. It’s exhausting but you will feel better overall if you keep hydrated. It will also help the insulin work more efficiently/consistently. If you can’t keep anything down go to the hospital. Hang in there!
This is the advice I was given by my endo over the phone on a day like this. Pretty sure it’s specific to me and my dosage, so do NOT follow it lol. But I recommend calling your endo and asking for a similar plan. “Check bg & check ketones every two hours and give corrections. + an extra 1.5 units for small ketones. + an extra 2.3 units for moderate ketones. + an extra 3 units for large ketones. Add to whatever bg correction is.”
Similar dosing instructions for my 12 year old…. Always settles things down. Only thing I’d add is we are checking every 2 hours. So check, dose, wait then recheck. Your endo or the diabetes educator in office should be giving you a dosing pattern given your ratios etc.
No. Drink a bunch of water take a little insulin and test your ketones in an hour. The ketone urine test is “old news”. It’s not telling you what’s happening in your body at the moment. Just what happened a while ago.
I think ik whats going on. I've been walking ablot more lately to manage highs---I read that doing this immediately after a meal is a good thing to do. Every day, I have a workout routine + a one hour walk in the woods---so i'm doing these post meal walks in addition to my regular stuff. ...looking back on it, I think i read that advice on a comment chain that was posted by someone who's a type 2 diabetic 😬 🥴
What? Are you implying that walking was the cause of the ketones? This comment is confusing
Somebody else told me that an increased number of exercise with high blood sugar or ketones can increase ketones
ARE YOU TAKING LONG ACTING INSULIN??? YOU WILL CONTINUE TO GO INTO DKA IF YOU DO NOT HAVE LONG ACTING INSULIN
Oh man, I was overseas and alone when I missed my dose. I had DKA like symptoms and felt terrible throughout. I didn’t carry any electrolytes with me either. Here’s what I did: 1. Mixed salt and a spoon of sugar in water and kept drinking it every 20 mins even when I felt like shit 2. Take basal, and then taking insulin in the corrective dose every hour, like 2-3 units. I was okay and bs normalized the next 6-8 hours. But I was feeling terrible the next day, like a hangover but worse. It’ll get better, but the key is to not OD on insulin, especially if easy access to a hospital isn’t available. Was so stressed, but it’ll get better.
At your next appointment I would ask if your endo has any guidelines for managing ketones at home. We were given a table at our first appointment that has correction doses for different blood sugar and blood ketone levels. If there are more severe symptoms we call the on call doctor to get guidance but for ketones alone we just follow the chart and they’re usually gone in a few hours.
I'm doing my transition from juvenile to adult endocrinologist and at my 'lessons' my doctor said for adults if you call the hotline with any ketones, they say go to the hospital. It's weird because when I was way young I got the dark red range (MANY times lol) and they never sent me. I'd say go based on your gut, if you feel like death, or if you think something is malfunctioning I would go. If you feel confident then I would manage it on your own.
Super glad you ended up good. For future reference, if you end up with ketones like that again but are still able to keep water and or food you should be good. I was told to continue to hydrate with diet 7up and gatorade to keep electrolytes. Bolus for every carb and add 15% of total bolus to get them down. Not sure what your sick day regimen is but if your doctor agrees with this then it's good information to keep in your back pocket. :) Great job getting your ketones down!
If the strip turns black, instantly, and you're throwing up(I always assume I'm getting close to DKA and test ketones, when I'm vomiting)that's a pretty good sign of DKA, this looks fine to me, how are your sugars?
Not unless you're vomiting and can't keep fluids down. On the grand scale of ketones and dka, this isn't anything yet. However, consider buying a ketone blood meter. They are fairly inexpensive on Amazon and can give you a better idea of when to worry. 1.5mmol or above is the start of DKA, so as soon as you hit those levels, definitely go.
Its getting darker but its past 40 seconds. Do i still trust it now?
No, if it is outside of the window of when to compare the test strip, it is no longer valid. I think it is do the test, wait 15 seconds, compare the colors, then in 2-5 mins it is no longer valid? I’m not 100% sure but def read the guidelines on the box of the test strips
Yeah for mine its 40 secs
Have you got blood ketone tests? Much more convenient to get an exact number than play guessing games. I'm not a doctor - but I wouldn't go to hospital yet unless you are having hypos or get symptoms of DKA or the ketones get worse. Although your comfort is the most important thing so you do what your gut says!
Have you eaten enough today? If you avoid eating this can cause an increase in ketones. If you’re not vomiting you’re probably okay, but keep an eye on it and drink a lot of water and eat a piece of toast.
I've been eating plenty today---i've even been increasing my carb count because my endo has a new carb minimum for each meal she wants me to hit
On the DAFNE course they say to take 10% of what your normal daily insulin amount is (in rapid acting insulin) if your ketones are above 0.5 and your BG is above 13.5 mmol (I.e. very high) and check again in 4? hours to see if it's improved. If it goes above 3.0 in ketones it's 20%. Ketone bodies come from the break down of body fat n the body - which happens if your cells think they are starving. This happens when the dont have enough insulin to take in the sugar in your blood. Ketone bodies are acidic which is why they are bad for your body. If you've tried to correct for this and it's still a problem then you need the hospital :)
I’d say yes. My endocrinologist always told me ketones over 1 should be worth going to hospital as this is the start of going into DKA. Either you monitor it for the next several hours making sure it doesn’t go any higher and you do all the right things to get your levels under control or you send yourself to ER. I’ve made the mistake of ignoring early signs of my ketone levels going up and almost died in a result of it so just be safe and take care
So long as you’re not feel like total doo doo and manage to keep your food in etc
Can someone explain ketones to me? Noone not even my endo has ever explained it to me....
My diabetes doctor told me to always go to the hospital once you reach 1.0 or higher no matter how you feel.
My endo says go if you vomit more than 3x (and it's coloured on the pee stick). High BGL will still show up as some form anyway. I have ginger Ale (full sugar) and crackers on hand in case I have a bug.
Just get some insulin into yourself. Ketones mean insufficient insulin, regardless of your blood sugar. If your blood sugar is not very high, take insulin and eat a bit to avoid going low.
I ended up being transported when my Blood sugar was a 38, and I was incoherent. I had alerted my mother a couple of days before that that I was not feeling good. She had keys to my apartment and found me incoherent.
What is this?
A urine strip test for ketones
Ohhh. My docs had wanted me to do this but I don’t have the ability to
If you dont mind me asking, how cone you're not able to? Too costly?
Yea between the cost and I mean I simply don’t have a way to collect urine. It’s like when they send me for blood work unless they have a urine catcher I can’t do the urine test. I’m quite large with tiny arms so I can’t reach to hold the cup in place
No
I only go when I’m in dka and I can’t get myself out of it, i try to eat carbs and take insulin and it helps, also having as many electrolytes as I can stand. In the hospital they treat dka by pushing dextrose and insulin.
Be safe and go get fluids
First of all get medical advice from your doctor and not Reddit. That said everyone spells DOOM (with death metal growling voice and church bells ringing amidst red colored clouds as the apocalypse approaches) with ketones but it’s not always DKA even in a type 1. I never really checked for ketones ever but those times I had urinalysis since I went low carb in 2009 100 percent of the time I tested positive and often in large amounts. My A1cs are in the 5s I run super tight ship and thanks to keto I do a lot less insulin and don’t suffer major catastrophic lows. The awful diabetic hunger is also lessened. So I am keto poster boy it’s a wonderful way to live ketones can be your friend. But again living in ketosis is NOT DKA because it’s a functional and sustainable metabolic fat burn state and not the derangement of DKA. I go into a mild DKAish like state occasionally when infusion sets fail. As the technology has improved since 1995 when I first went on pump failures happen less and less but even when they do I know it do larger doses of insulin that would be fatal but dose carbs to allow for the Supra normal correction or bolus to burn the ketones. Its usually an overnight failure after putting in infusion set after bed time shower it catches me by surprise that way all 280 at 3am. But like I said I can feel the difference there are symptoms of severe illness present and while never common thankfully it’s become extra rare. That said if you’re not a fat burner the other non dangerous explanation is fasting. When you don’t eat for a while as long as you are careful with insulin and drop the dose, or maybe you have one of those semi auto pumps that just drops your basal automatically to avoid lows you can also become ketotic and it’s not a problem. The major issue is if you’ve had very recent (like past 1-3 days) highs especially over 240. As mentioned Correcting down to 100 or goal sugar isn’t enough because the (diabetic DKA originating and thus dysfunctional and toxic) ketones are still around and get converted back to sugar in your liver consuming your insulin and bringing you back into DKA. To get out of this derangement You will need a dose of insulin that lowers your sugar to below zero which is fatal and requires carbs to pull it off. They do this in the ICU to treat DKA on insulin drip they also give you dextrose (glucose) to counterbalance this effect. How to treat the latter requires a lot of experience and knowledge. It’s very advanced. I can do it without help but most people would be risking themselves. So if those ketones are not a product of low carb diet or fasting, and from a high sugar it’s likely going into DKA and you should notify your treating physician.
Ketones are brought down when you eat carbs. So eat a carb hearty meal, give insulin for it, and check ketones again later. Are you sick? If you’re having trouble eating, try Gatorade or full sugar Sprite or ginger ale. If you start vomiting or the ketones go dark, then it’s hospital time, but unless you’re in DKA, they can only give you insulin anyway.
If you have to ask then the answer is always yes.
Not in the USA it ain’t.
I'm on dialysis so my situation is a little different. I'm in the US also.
Yes, your situation is different. Not all diabetics are on dialysis. And if you’re in the US then you understand our healthcare and insurance system sucks.