Ketones

I hadn’t thought a lot about ketones until a week ago when they hit with a vengeance. Ketones are a yucky thing produced when blood sugars are high for a prolonged period of time. They are the bodies reaction to the high blood sugar. You can have different levels of ketones in your system, depending on how high the blood sugar has been and how your body decides to react to it. The ketone test describes the amounts as: none, trace, small, medium, and large.

Whenever my blood sugar has run high, I have simply corrected until it came down. Correction doses are doses of insulin only to bring the blood sugar down (not as a part of eating something with carbohydrates in it). In the past, my blood sugar has usually come down pretty predictably. I’ve only tested for ketones once or twice before in my 7-year tenure as type I diabetic. And those two tests were just to see what happened. Both tests came out ‘none.’

On the Sunday before Memorial day, I was running between 300-450 all day. I was at home and munching on treats all afternoon, so I assumed I wasn’t giving myself enough insulin to cover what I was eating. Each time I’d test, a high number would appear on the screen. I felt okay, so I just kept eating and correcting assuming it would eventually make it’s way back into my desired range (between 80-120).

I tested before bed that evening and it came back as 350. I corrected one last time before bed, which freaked me out a little as I was risking going low while sleeping, but I figured if I didn’t give myself a correction dose, I’d wake up with a blood sugar of 1 billion. In the middle of the night I woke up feeling like a train had hit me. I was very nauseated. I tested again at 1:00am and was at 370. The (pretty large) correction dose had done nothing. In fact, my sugar was higher than it was before the dose. I started flipping out.

I am a part of some diabetic groups on Facebook. A favorite is called I Hate Diabetes (Type 1). A rather aptly named group, most people come with questions, concerns, and to complain heavily about the disease. I’ve read various posts about people experiencing ketones and ketoacidosis. Mostly stories of them having to go for a stint in the hospital. Thus, when my blood sugars weren’t coming down, I knew I had ketones.

I tested my ketone levels and they came back as “moderate.” It was the darkest color I had ever seen on the test, and started dreading a visit to the hospital. I looked up treatment for moderate ketones. Half the websites said: GO TO THE HOSPITAL. The other half said: drink lots of water, keep giving large correction doses, and keep testing blood sugar and ketones until they both come down. Water flushes ketones out of the system. Such a simple, but powerful treatment to a yucky thing.

So I made my first post to I Hate Diabetes and described my situation. The consensus among members and fellow T1Ds was similar to my Google results: half said GO TO THE HOSPITAL. The other half said treat it yourself for a couple hours and if it’s still terrible THEN GO TO THE HOSPITAL.

Over the course of 2 hours, I drank about 7 glasses of water, tested my blood sugar 10 times, and tested for ketones 5 times. I gave myself approximately 40 units of insulin to correct the high blood sugars. That’s a TON of insulin. For a Thanksgiving meal, I have given myself 25 from a pen at most. My insulin pump won’t let me give a single dose of more than 20 (you’ve got to split it up into 2 separate doses to bypass it). Basically, it’s a ton of insulin. Even 10 units of insulin given to a non-diabetic could kill them.

I started feeling better once I was at 120 with trace ketones. At 3:30am, I flopped down in bed–exhausted from the ordeal. After only one minute, my mouth started watering and I knew I was going to throw up. I leaped out of bed and dashed to the bathroom where I had the most violent and glorious vomits of my life. They broke blood vessels all around my eyes; the ‘gin blossoms’ lasting three days. After ralphing, I finally felt just right. So I passed out a second time–making it until morning.

And then I woke up low.

2 thoughts on “Ketones”

  1. It seems like every single time I have ketones I go low shortly after.

    My rule of thumb for hospital visits is to go if I start vomiting everything up. If I can’t keep fluids down I give up and go. Luckily in 19 years that’s only happened once 🙂

  2. Phew. Had a similar situation recently, also overnight. I determined, after many hours around 400, my pod had failed or become dislodged and so I changed it. Took another 7 or 8 hours to get down below 200. Haven’t felt that sick in my 29 years. I always try to imagine “what if” scenarios where I’m stranded somewhere with no access to a new pod or to insulin, like I’m trapped on a stranded train or boat and I wonder how many hours do I have until consciousness fades away. I think I have an idea of the answer now.

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