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Diabetic Ketoacidosis

in the clinic Diabetic Ketoacidosis Prevention Diagnosis Treatment Practice Improvement CME Questions page ITC1-2 page ITC1-5 page ITC1-9 page ITC1-14 page ITC1-16 Section Editors Christine Laine, MD, MPH Barbara J. Turner, MD, MSED Sankey Williams, MD Science Writer Jennifer F. Wilson The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including PIER (Physicians’ Information and Education Resource) and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP’s Medical Education and Publishing Division and with the assistance of science writers and physician writers. Editorial consultants from PIER and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult and other resources referenced in each issue of In the Clinic. CME Objective: To provide information about the prevention, diagnosis, and management of diabetic ketoacidosis. The information contained herein should never be used as a substitute for clinical judg Continue reading >>

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Popular Questions


    I find that testing at night my sticks are much darker. I also read in ATkins to test later in the day. Often in the AM the sticks are the lightest for me.
    However, I dont understand how my sticks are turning, butI dont seem to be losing very fast. It might be just water retention.. I hope!

    Pounds lost: 14.0







    Gigi, thanks for the valuable info on Ketosis.
    Everyone should consider several things before giving up drinking the water. First, test first thing in the morning before eating or drinking anything. Second, give up all artificial sweetners or things with them it it. If you are still not in ketosis after a few days, then look at what carbs you have been consuming. Maybe you are one of those people who are very carb sensitive. Try a couple of day with meat, eggs and green veggies.
    As the article says make sure your sticks are fresh.
    The Waist Management Team
    Low Carbing with Atkins Team! www.sparkpeople.com/myspark/groups_i
    Doxie Lovers www.sparkpeople.com/myspark/groups_i

    current weight: 148.0






  3. GIGIX068

    I was under the understanding that the ketostix will not measure accurately when we drink a lot of water. Your urine is too diluted to get a good result. I test in the morning.
    Here is a copy and paste with a lot more information than you asked for--but it might be helpful. After I read it I understood that because of the volume of water I drink that it is not registering but I am still in ketosis.
    What are ketones?
    Ketones are a normal and efficient source of fuel and energy for the human body. They are produced by the liver from fatty acids, which result from the breakdown of body fat in response to the absence of glucose/sugar. In a ketogenic diet, such as Atkins ... or diets used for treating epilepsy in children, the tiny amounts of glucose required for some select functions can be met by consuming a minimum amount of carbs - or can be manufactured in the liver from PROTEIN. When your body is producing ketones, and using them for fuel, this is called "ketosis".
    How will ketosis help me to lose weight?
    Most reducing diets restrict calorie intake, so you lose weight but some of that is fat and some of it is lean muscle tissue as well. Less muscle means slowed metabolism, which makes losing weight more difficult and gaining it back all too easy. Ketosis will help you to lose FAT.
    Being in ketosis means that your body's primary source of energy is fat (in the form of ketones). When you consume adequate protein as well, there's no need for the body to break down its muscle tissue. Ketosis also tends to accelerate fat loss --- once the liver converts fat to ketones, it can't be converted back to fat, and so is excreted.
    But, isn't ketosis dangerous?
    Being in ketosis by following a low carbohydrate diet is NOT dangerous. The human body was designed to use ketones very efficiently as fuel in the absence of glucose. However, the word ketosis is often confused with a similar word, ketoacidosis.
    Ketoacidosis is a dangerous condition for diabetics, and the main element is ACID not ketones. The blood pH becomes dangerously acidic because of an extremely high blood SUGAR level (the diabetic has no insulin, or doesn't respond to insulin .... so blood sugar rises ... ketones are produced by the body to provide the fuel necessary for life, since the cells can't use the sugar). It's the high blood sugar, and the acid condition that is so dangerous. Ketones just happen to be a part of the picture, and are a RESULT of the condition, not the CAUSE. Diabetics can safely follow a ketogenic diet to lose fat weight ... but they must be closely monitored by their health care provider, and blood sugars need to be kept low, and stable.
    How do the ketone test strips work, and where can I get them?
    Ketone urine-testing strips, also called Ketostix or just ketone sticks ... are small plastic strips that have a little absorptive pad on the end. This contains a special chemical that will change colour in the presence of ketones in the urine. The strips may change varying shades of pink to purple, or may not change colour at all. The container will have a scale on the label, with blocks of colour for you to compare the strip after a certain time lapse, usually 15 seconds. Most folks simply hold a strip in the flow of urine. Other folks argue that the force of the flow can "wash" some of the chemical away, and advise that a sample of urine be obtained in a cup or other container, then the strip dipped into it.
    The chemical reagent is very sensitive to moisture, including what's in the air. It's important to keep the lid of the container tightly closed at all times, except for when you're getting a strip to take a reading. Make sure your fingers are dry before you go digging in! They also have an expiry date, so make note of this when you purchase the strips ... that's for the UNopened package. Once opened, they have a shelf-life of about 6 months -- you may wish to write the date you opened on the label for future reference.
    Ketone test strips can be purchased at any pharmacy, and are usually kept with the diabetic supplies. In some stores they're kept behind the counter, so if you don't see them on the shelf, just ask the pharmacist; you don't need a prescription to buy them.
    I'm following Induction strictly; why won't my strips turn purple?
    Ketones will spill into the urine ONLY when there is more in the blood than is being used as fuel by the body at that particular moment.
    You may have exercised or worked a few hours previously, so your muscles would have used up the ketones as fuel, thus there will be no excess. You may have had a lot of liquids to drink, so the urine is more diluted. Perhaps the strips are not fresh, or the lid was not on tight and some moisture from the atmosphere got in.
    Some low carbers NEVER show above trace or negative even ... yet they burn fat and lose weight just fine. If you're losing weight, and your clothes are getting looser, you're feeling well and not hungry all the time .. then you are successfully in ketosis. Don't get hung up on the strips; they're just a guide, nothing more.
    Will I lose weight faster if the strips show dark purple all the time?
    No. Testing in the darkest purple range all the time is usually a sign of dehydration -- the urine is too concentrated. You need to drink more water to dilute it, and keep the kidneys flushed.
    The liver will make ketones from body fat, the fat you EAT, and from alcohol --- the ketone strips have no way of distinguishing the source of the ketones. So, if you test every day after dinner, and dinner usually contains a lot of fat, then you may very well test for large amounts of ketones all the time. However this does not indicate that any BODY fat was burned.
    The strips only indicate what's happening in the urine. Ketosis happens in the blood and body tissues. If you're showing even a small amount, then you are in ketosis, and fat-burning is taking place. Don't get hung up on the ketone sticks.
    Does caffeine affect ketosis?
    This is questionable. There ARE a few studies that suggest caffeine may cause blood sugar to rise, with consequent effect on insulin ... The studies involve consuming 50 gm glucose orally, followed by a dose of caffeine. This is quite different from a low carber, who is consuming only 20 gm carbs, in the form of high-fiber vegetables, spread throughout the day.
    Many low carbers continue to enjoy caffeine-containing beverages with no serious impact on their weight-loss efforts. However, there are some sensitive individuals ... and persons who are extremely insulin resistant may need to restrict or even eliminate all caffeine. If you have been losing successfully then find your weight loss stalled for a month or two, and you are following your program to the letter, you might consider stopping all caffeine for a while, to see if that will get things started again.
    Will drinking alcohol affect ketosis?
    No and yes. The liver can make ketones out of alcohol, so technically, when you drink you'll continue to produce ketones and so will remain in ketosis. The problem is ... alcohol converts more easily to ketones than fatty acids, so your liver will use the alchol first, in preference to fat. Thus, when you drink, basically your FAT burning is put on hold until all the alcohol is out of your system.
    This rapid breakdown of alcohol into ketones and acetaldehyde (the intoxicating by-product) ... tends to put low carbers at risk for quicker intoxication ... especially if no other food is consumed to slow absorption.
    Atkinscenter Official Website ... FAQ page, (select Ketosis)
    Ketosis ... from the Low Carb Diet and Exercise List
    Ketosis and Lipolysis ... from Low Carb Retreat
    I believe Gary Taubes!
    Week 1-8 pounds
    Week 2-5 pounds

    Pounds lost: 13.0






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