Ketone Body Metabolism
Ketone body metabolism includes ketone body synthesis (ketogenesis) and breakdown (ketolysis). When the body goes from the fed to the fasted state the liver switches from an organ of carbohydrate utilization and fatty acid synthesis to one of fatty acid oxidation and ketone body production. This metabolic switch is amplified in uncontrolled diabetes. In these states the fat-derived energy (ketone bodies) generated in the liver enter the blood stream and are used by other organs, such as the brain, heart, kidney cortex and skeletal muscle. Ketone bodies are particularly important for the brain which has no other substantial non-glucose-derived energy source. The two main ketone bodies are acetoacetate (AcAc) and 3-hydroxybutyrate (3HB) also referred to as β-hydroxybutyrate, with acetone the third, and least abundant. Ketone bodies are always present in the blood and their levels increase during fasting and prolonged exercise. After an over-night fast, ketone bodies supply 2–6% of the body's energy requirements, while they supply 30–40% of the energy needs after a 3-day fast. When they build up in the blood they spill over into the urine. The presence of elevated ketone bodies in the blood is termed ketosis and the presence of ketone bodies in the urine is called ketonuria. The body can also rid itself of acetone through the lungs which gives the breath a fruity odour. Diabetes is the most common pathological cause of elevated blood ketones. In diabetic ketoacidosis, high levels of ketone bodies are produced in response to low insulin levels and high levels of counter-regulatory hormones. Ketone bodies The term ‘ketone bodies’ refers to three molecules, acetoacetate (AcAc), 3-hydroxybutyrate (3HB) and acetone (Figure 1). 3HB is formed from the reduction of AcAc i Continue reading >>
What Causes High Ketones In A Canine?
A dog with a high level of ketones in his urine suffers from a condition known as ketonuria, usually resulting from a buildup of these substances in the dog's blood. A ketone is a type of acid, which, if allowed to accumulate in the blood, can lead to ketoacidosis, a potentially fatal condition. The main health conditions that can cause high ketone levels in a canine are starvation and diabetes. A dog's body breaks down the food that he eats into sugars, also called glucose, that the cells of the body use for energy. The dog's pancreas then produces the hormone insulin to regulate the amount of glucose that the body will absorb. If the insulin to regulate the glucose is insufficient, typically due to chronic diabetes mellitus, the body breaks down alternate sources of fuel for its cells; a dog's body that is starved of nutrition will do the same. One of these sources is the fat stored in the dog's body. When the body breaks down this fat, it produces as a by-product toxic acids known as a ketones. These ketones then build up in the dog's blood and also his urine, leading to ketoacidosis. Always consult an experienced veterinarian regarding the health and treatment of your pet. A dog suffering from high ketone levels in his blood and urine exhibits symptoms of weight loss, vomiting, increased thirst, decreased appetite, increased urination, lethargy, low body temperature and yellowing of the skin and gums, according to PetMD. The dog's breath may also have a sweet, fruity smell due to the presence of acetone caused by ketoacidosis, says VetInfo. To properly diagnose high ketone levels and ketoacidosis in your dog, a veterinarian will take blood tests and a urinalysis, which will also check your dog's blood glucose levels. Depending on the dog's physical condition, hospit Continue reading >>
Type 1 Diabetes: What Are The Symptoms?
What Is Type 1 Diabetes (Juvenile)? Type 1 diabetes is a chronic condition that usually starts in childhood, but can occur in adults (30 to 40-year-olds). In type 1 diabetes, the pancreas produces very little insulin. Insulin helps cells in the body convert sugar into energy. When the pancreas cannot make enough insulin, sugar starts to build up in the blood, causing life-threatening complications. Individuals with type 1 diabetes must take some form of insulin for the rest of their lives. Unusual Thirst Symptoms Unusual thirst is a very common symptom of type 1 diabetes. This condition causes the kidneys to remove excess sugar in the blood by getting rid of more water. The water is removed through urinating, causing dehydration and dehydration causes you to drink more water. Weight Loss Symptoms Patient with type 1 diabetes develop unintentional weight loss and an increase in appetite because blood sugar levels remain high and the body metabolizes fat for energy. Disrupted glucose metabolism also causes patient to feel a lack of energy and drowsy for extended periods Excess urination also cause weight loss because many calories are leaving the body in urine. Skin Problems Symptoms The disruption in glucose metabolism in patient with type 1 diabetes causes skin changes. Type 1 diabetics are at a higher risk for bacterial infections and fungal infections. Poor blood circulation in the skin may also occur. Patient with type 1 diabetes are often infected with fungal infections caused by the yeast Candida albicans. Common fungal infections include athlete's foot, vaginal yeast infection in women, jock itch, ringworm, and diaper rashes in babies. Diaper rash caused by the yeast Candida albicans can spread to other areas of the body such as the stomach and legs. Other Dangero Continue reading >>
Sick Day Management Tips When Your Child Has Type 1 Diabetes
Having a sick child can be challenging—getting time off work and securing a last-minute doctor's appointment isn't always easy. But when your sick child also happens to have type 1 diabetes, it presents a separate set of complications relating to insulin and blood glucose (blood sugar) management. This article covers some important considerations to keep in mind the next time your child with type 1 diabetes feels under the weather. Checking Blood Glucose and Ketones Even the most common ailments, such as a cold or flu, can cause your child's blood glucose levels to rise. Plus, some over-the-counter medications can cause blood glucose levels to increase even more. Complicating matters, your child's blood glucose levels may actually drop too low if he or she is vomiting or has stopped eating. You just can't be certain how an illness will affect your child's blood glucose—that's why it's important to check their levels more often than you normally would. A general guideline to shoot for is to check their blood glucose every 2 to 3 hours, but remember—that's a guideline. Your child may require more or fewer checks, depending on your health care professional's recommendations. In addition to checking blood glucose levels, you also need to check for the presence of ketones in the urine. In people with type 1 diabetes, common illnesses can lead to diabetic ketoacidosis, a condition characterized by acidic blood caused by the release of too many ketones. Ketones are released when your body doesn't have enough insulin, so it's important to check your child's urine regularly (usually every 4 hours) until there are no ketones detected. If ketones are still present, that's a sign that your child needs more insulin. There are 2 ways to check ketones: using urine ketone strips Continue reading >>
Expecting The Best: Diabetes, Pregnancy, And Blood Glucose Control
by Laura Hieronymus, RN, MSEd, CDE and Patti Geil, MS, RD, LD, CDE Pregnancy can be a special and exciting time in a woman's life. The anticipation begins as soon as you hear the words: “You're expecting a baby.” Once you've gotten used to the amazing news, you may wonder about such things as whether the baby will be a boy or a girl, when the baby is due, and, perhaps most important, what you need to do in the meantime to make sure the baby stays healthy and develops normally. All women feel a certain amount of anxiety and sometimes even fear about how pregnancy will affect them, and whether their baby will be healthy and normal. Women with diabetes are no different, but they do have one more thing to be concerned about: maintaining control of blood glucose levels. This is true whether a woman has type 1 or type 2 diabetes before becoming pregnant, or whether she is diagnosed with a condition called gestational diabetes during pregnancy. The good news is that if a woman who has diabetes (of any type) learns as much as she can about managing her blood glucose, and puts that knowledge into practice, she can have a healthy pregnancy and a healthy baby. Blood glucose control essential Optimal blood glucose control is important throughout pregnancy, both for the mother's health and the baby's. Glucose in a mother's blood crosses the placenta to her baby, affecting the baby's blood glucose level. (The placenta, a flat circular organ, links the unborn baby to the mother's uterus, to provide oxygen, nutrients, and the elimination of wastes.) The baby begins making its own insulin around 13 weeks gestation. If the baby is constantly exposed to high levels of glucose, it is as if the baby were overeating: The baby produces more insulin to absorb the excess glucose, resulting Continue reading >>
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Diabetes And Illness
It is very important to know how to cope with illness if you have diabetes or know or care for somebody with diabetes. If in doubt, always seek advice from your doctor or nurse straightaway. Any illness or other type of stress will raise your blood sugar (glucose) levels, even if you are off your food or eating less than usual. People with diabetes are unable to produce more insulin to control the glucose level. The increased glucose level can make you become very lacking in fluid in the body (dehydrated). Acting quickly and following advice helps to keep your glucose levels in the normal range or only slightly high. Because it can sometimes be very difficult to control your blood glucose levels, treatment in hospital may be needed. Hospital treatment may also be needed if you become very dehydrated. What happens to my diabetes when I am unwell? When a person with diabetes is unwell the sugar level in the blood tends to increase. This can happen even with a very mild illness such as the common cold. The blood sugar (glucose) may go up even if you are not eating properly or are being sick (vomiting) or have loose or watery poo (diarrhoea). The increase in blood sugar may make you very lacking in fluid in the body (dehydrated). What should you do when you are unwell? Contact your GP or practice nurse for advice if you are not sure. You may also need treatment for the illness that is making you feel unwell. If you check your blood sugar (glucose) levels then these checks should be more regular. A practice nurse or district nurse can help with checking blood glucose levels, especially if you don't usually check them regularly. Continue eating as normally as possible. If you don't feel like eating, replace your solid food with soup, milk, ice cream, fruit juice, sugar or hon Continue reading >>
Diabetic acidosis is a life-threatening condition that can occur in people with type 1 diabetes. Less commonly, it can also occur with type 2 diabetes. Term watch Ketones: breakdown products from the use of fat stores for energy. Ketoacidosis: another name for diabetic acidosis. It happens when a lack of insulin leads to: Diabetic acidosis requires immediate hospitalisation for urgent treatment with fluids and intravenous insulin. It can usually be avoided through proper treatment of Type 1 diabetes. However, ketoacidosis can also occur with well-controlled diabetes if you get a severe infection or other serious illness, such as a heart attack or stroke, which can cause vomiting and resistance to the normal dose of injected insulin. What causes diabetic acidosis? The condition is caused by a lack of insulin, most commonly when doses are missed. While insulin's main function is to lower the blood sugar level, it also reduces the burning of body fat. If the insulin level drops significantly, the body will start burning fat uncontrollably while blood sugar levels rise. Glucose will then begin to show up in your urine, along with ketone bodies from fat breakdown that turn the body acidic. The body attempts to reduce the level of acid by increasing the rate and depth of breathing. This blows off carbon dioxide in the breath, which tends to correct the acidosis temporarily (known as acidotic breathing). At the same time, the high secretion of glucose into the urine causes large quantities of water and salts to be lost, putting the body at serious risk of dehydration. Eventually, over-breathing becomes inadequate to control the acidosis. What are the symptoms? Since diabetic acidosis is most often linked with high blood sugar levels, symptoms are the same as those for diabetes Continue reading >>
> Handling Diabetes When You're Sick
Whether your head feels like it's stuffed with cotton because you have a cold or you're spending a lot of time on the toilet because of a stomach bug, being sick is no fun for anyone. For people with diabetes, being sick can also affect blood sugar levels. The good news is that taking a few extra precautions can help you keep your blood sugar levels under control. When you get sick — whether it's a minor illness like a sore throat or cold or a bigger problem like dehydration or surgery — the body perceives the illness as stress. To relieve the stress, the body fights the illness. This process requires more energy than the body normally uses. On one hand, this is good because it helps supply the extra fuel the body needs. On the other hand, in a person with diabetes, this can lead to high blood sugar levels. Some illnesses cause the opposite problem, though. If you don't feel like eating or have nausea or vomiting, and you're taking the same amount of insulin you normally do, you can develop blood sugar levels that are too low. Blood sugar levels can be very unpredictable when you're sick. Because you can't be sure how the illness will affect your blood sugar levels, it's important to check blood sugar levels often on sick days and adjust your insulin doses as needed. Your diabetes management plan will help you know what to do when you're sick. The plan might tell you: how to monitor your blood glucose levels and ketones when you're sick which medicines are OK to take what changes you might make to your food and drink and diabetes medications when to call your doctor In addition, people with diabetes should get the pneumococcal vaccine, which protects against some serious infections. You should also get a flu shot every year. These vaccines may help you keep your dia Continue reading >>
What Are Ketones?
What are ketones and what causes them? Ketones are the result of the body burning fat for energy or fuel. For a person with diabetes, ketones are often the result of prolonged high blood sugar and insulin deficiency. Without the right amount of insulin, glucose starts to build up in the blood stream and doesn't enter the cells. The cells burn fat instead of glucose, and ketones form in the blood and spill into the urine. Some causes of high blood sugar are: Missing an insulin dose or skipping some oral medications. A disconnected or blocked insulin pump tube. Being sick with the flu. High levels of stress. Eating more carbohydrates than your medication covers. What are the signs that I should test for ketones? Symptoms of high blood sugar include frequent urination, frequent thirst, blurry vision, dry mouth, vomiting, and fatigue. There are several scenarios that should prompt a test for ketones. If your blood sugar is over 240 mg/dl for two tests in a row. When you are ill. When your blood sugar is over 240 mg/dl and you are planning on exercising. If you are pregnant, you should test for ketones each morning before breakfast and whenever blood sugars are elevated. How do I test for ketones? There are two ways to test for ketones - by testing your urine or your blood. Ketones appear first in the blood stream and are later present in the urine, so testing your blood for ketones is the best way to check for an early problem. To check urine for ketones, you must collect a urine sample or dip a ketone test strip into a fresh stream of urine. After waiting for the time suggested by the ketone strip manufacturer, you compare the color strip to the chart on the bottle. The darker the color, the higher the amount of ketones in the urine. At this time, there are just a few mete Continue reading >>
Fifteen Fast Facts About Ketones
Fifteen Fast Facts About Ketones by Stephen Ponder, MD (download link for pdf format) Ketones are chemical by products when fat tissue is consumed for energy. They are produced in all mammalian life forms. A small amount of ketones are created each day in every human being when they sleep and haven’t eaten for a few hours. Just like there are no unicorns in the land of diabetes, there is no y in ‘KETONES’. Ketones are actually a family of chemicals which possess qualities of weak acids. Under normal conditions they don’t disrupt body chemistry. This only happens when they’re produced in large amounts such as in persons with uncontrolled type 1 diabetes. Ketones are themselves an energy source for human tissue. The brain can use ketones during periods of fasting or starvation. The creation of ketones in humans is largely controlled by the balance between insulin and anti-insulin hormones, better known as stress hormones. Under normal conditions, it takes about one tenth of the amount of insulin to suppress ketone formation than it does to control sugar levels in the blood. This is why blood sugar levels can be very high in diabetics but ketones still be low or negative. When treating excess ketones, they can be metabolized back to other useful substances by the body when insulin is present, exhaled through the lungs (acetone) or excreted in the urine. Maintaining good hydration is one way to rid the body of ketones. But having sufficient insulin present to stop excess ketone formation is essential. Insulin therapy will control blood sugar levels faster than it will clear away excess ketones. This is why they take longer to eliminate when both sugar levels and ketones are high in the bloodstream. Know your diabetes sick day rules well! Ketones and other byproduc Continue reading >>
What Are Ketones?
Ketones are an acid remaining when the body burns its own fat. When the body has insufficient insulin (or cannot use sufficient insulin), it cannot get glucose (sugar) from the blood into the body's cells to use as energy and will instead begin to burn fat stores. When the body is burning too much fat, it may cause ketones to become present as by product shown in your urine. Burning fat instead of glucose can lead to a condition called ketosis. It can make you feel poorly, with lack of energy. If you have healthy or low BMI it can also be dangerous as you may also lose too much weight. Testing for ketones Your urine is usually tested for ketones during your diabetes clinic appointments. You may also be tested for ketones if you have been taken into hospital with high blood sugar levels. Ketones are detected by testing the urine with a dip stick. They are measured on a scale with 0 being lowest and 4++ being the highest. The test sticks can be purchased from a pharmacy or online and in some cases you may be prescribed test strips for home testing for if you get blood sugar levels over a certain level. Your diabetes midwife will usually complete ketone tests when you attend clinic appointments, so it is not necessary to purchase dip sticks for home use unless you're advised to by a medical professional. Blood ketones can also be tested and are much more accurate than the urine dip sticks. Type 1 diabetics may be given ketone blood testing monitors. Why are ketones common in ladies diagnosed with gestational diabetes? Ketones can be detected when you have not eaten for a long period of time and may be found in samples taken in the morning due to fasting overnight. It is common for mothers with gestational diabetes to develop ketones due to limiting too many carbohydrates f Continue reading >>
Diabetic Ketoacidosis Treatment
Diabetic ketoacidosis is a life-threatening medical condition that is a complication of diabetes mellitus that is not in control. It is more common among type 1 diabetics that have no insulin but it can also be seen in severe cases of type 2 diabetes. In diabetic ketoacidosis, there are ketones in the bloodstream and urine because the fat in the body is broken down with ketones as a byproduct. Diabetic ketoacidosis occurs when the body isn’t making enough insulin by the pancreatic islet cells. In a normal person, insulin is secreted by the pancreas in response to elevated blood sugar levels. The insulin helps glucose (sugar) to enter the cells to be used as cellular fuel. If insulin is absent, the body breaks down fatty acids to be used for fuel. Ketones build up in the urine and blood, leading to the condition known as diabetic ketoacidosis. The main cause is being a type 1 diabetic who has not taken enough insulin. Symptoms of Diabetic Ketoacidosis The signs and symptoms of diabetic ketoacidosis can come on suddenly, within a day or so of having no insulin. When signs and symptoms do show up, the patient may have any or all of the following symptoms: Confusion Breath that smells fruity Shortness of breath Tiredness or weakness Pain in the abdomen Nausea and vomiting Increased frequency of urination Being excessively thirsty Clinical signs that the individual has diabetic ketoacidosis includes have extremely high blood sugar levels as well as elevated levels of ketones in the urine. Causes of Diabetic Ketoacidosis The main source of cellular fuel is glucose. All of the cells of the body rely on glucose to make energy to allow the cells to function in whatever capacity they happen to be in. When insulin is lacking, the body is unable to use glucose as fuel. These caus Continue reading >>
Ketoacidosis Versus Ketosis
Some medical professionals confuse ketoacidosis, an extremely abnormal form of ketosis, with the normal benign ketosis associated with ketogenic diets and fasting states in the body. They will then tell you that ketosis is dangerous. Testing Laboratory Microbiology - Air Quality - Mold Asbestos - Environmental - Lead emsl.com Ketosis is NOT Ketoacidosis The difference between the two conditions is a matter of volume and flow rate*: Benign nutritional ketosis is a controlled, insulin regulated process which results in a mild release of fatty acids and ketone body production in response to either a fast from food, or a reduction in carbohydrate intake. Ketoacidosis is driven by a lack of insulin in the body. Without insulin, blood sugar rises to high levels and stored fat streams from fat cells. This excess amount of fat metabolism results in the production of abnormal quantities of ketones. The combination of high blood sugar and high ketone levels can upset the normal acid/base balance in the blood and become dangerous. In order to reach a state of ketoacidosis, insulin levels must be so low that the regulation of blood sugar and fatty acid flow is impaired. *See this reference paper. Here's a table of the actual numbers to show the differences in magnitude: Body Condition Quantity of Ketones Being Produced After a meal: 0.1 mmol/L Overnight Fast: 0.3 mmol/L Ketogenic Diet (Nutritional ketosis): 1-8 mmol/L >20 Days Fasting: 10 mmol/L Uncontrolled Diabetes (Ketoacidosis): >20 mmol/L Here's a more detailed explanation: Fact 1: Every human body maintains the blood and cellular fluids within a very narrow range between being too acidic (low pH) and too basic (high pH). If the blood pH gets out of the normal range, either too low or too high, big problems happen. Fact 2: The Continue reading >>
How To Treat Ketoacidosis
Immediately drink a large amount of non-caloric or low caloric fluid. Continue to drink 8 to 12 oz. every 30 minutes. Diluted Gatorade, water with Nu-Salt™ and similar fluids are good because they help restore potassium lost because of high blood sugars. Take larger-than-normal correction boluses every 3 hours until the blood sugar is below 200 mg/dl (11 mmol) and ketones are negative. It will take much more rapid insulin than normal to bring blood sugars down when ketones are present in the urine or blood. Often, one and a half to two times the normal insulin dose for a high blood sugar will be necessary. Higher insulin doses than these will be needed if there is an infection or other major stress. If nausea becomes severe or last 4 hours or more, call your physician. If vomiting starts or you can no longer drink fluids, have a friend or family member call your physician immediately, then go directly to an emergency room for treatment. Never omit your insulin, even if you cannot eat. A reduced insulin dose might be needed, but only if your blood sugar is currently low. When high blood sugars or ketoacidosis happen, it is critical that you drink lots of fluid to prevent dehydration. Take extra amounts of Humalog, Novolog or Regular insulin to bring the blood sugars down. Children with severe ketoacidosis lose 10-15 % of their previous body weight (i.e., a 60 lb. child can lose 6 to 9 lbs. of weight) due to severe dehydration. Replacement of fluids should be monitored carefully. The dehydration is caused by excess urination due to high blood sugars and is quickly worsened when vomiting starts due to the ketoacidosis. The start of vomiting requires immediate attention at an ER or hospital where IV fluid replacement can begin. If only nausea is present and it is possible Continue reading >>
Tests For Ketones - Topic Overview
A ketone test checks for ketones in your blood or urine. Ketones are substances that are made when the body breaks down fat for energy. Normally, your body gets the energy it needs from glucose (sugar). If your body cannot use glucose for energy-for example, if your body doesn't make or use insulin-ketones are formed. You might also have ketones if you are not eating enough carbohydrates and your body uses fat for energy instead. Your body wants to get rid of ketones through urine. Ketones are most common in people who have type 1 diabetes. It is an early sign that there is not enough insulin, and blood sugar may be dangerously high. This can lead to diabetic ketoacidosis, a very serious medical problem. Blood ketones can be tested using some blood sugar meters. You can test your urine for ketones by using specially prepared tablets or plastic strips. Continue reading >>