What To Do If You Have Ketones
I woke up pretty late today, around 11am. I really didn’t feel like getting up at all because I was still really tired. I was woken up by a ringing house phone that I ignored, then a cell phone with my husband on the other end. Then my mom coming downstairs to get the laundry and reminding me that we were going out today. (I live in my parents basement apartment.) “Ok, Ok… I am getting up” I tell her. I took in a big yawn and stretch of the arms. Then I actually got up out of my bed. I felt weird but I just thought it was because I got out of the bed too quickly. I tried to lick my lips together, but I had no saliva in my mouth - it was like the Mojave desert in there. I went to the bathroom to wash up because now my mom was getting antsy and rushing me. Don’t you just love getting up like that? Anyway, I started to feel a bit nauseated after about 20 minutes. I know these symptoms all too well. Dry mouth, Nausea = High blood sugar or Ketones. So, I checked my blood sugar. 3 2 1 334. Oh boy. Ok, umm… how did this happen? I didn’t really eat anything high carb last night? I went to bed with a pretty decent number and I just changed my infusion set. I don’t feel sick. My pump site isn’t hurting. It really boggled my mind. I felt my heart race a bit and started feeling panicky, and my breathing was getting heavier. Can you say panic attack? I always get a little paranoid though, it’s just my thing. Anyway, I told myself “Ok, Gina just calm down, you know what to do.” So I did my thing. I went back into the bathroom and grabbed my Ketostix to check my urine for Ketones. This is something I do when I have an unexpected high blood sugar with nausea. My urine test came out with Large, the highest level. Ugh. Ketones on the back of the bottle start out w 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 >>
Diabetic Ketoacidosis Symptoms
What is diabetic ketoacidosis? Diabetic ketoacidosis, also referred to as simply ketoacidosis or DKA, is a serious and even life-threatening complication of type 1 diabetes. DKA is rare in people with type 2 diabetes. DKA is caused when insulin levels are low and not enough glucose can get into the body's cells. Without glucose for energy, the body starts to burn fat for energy. Ketones are products that are created when the body burns fat. The buildup of ketones causes the blood to become more acidic. The high levels of blood glucose in DKA cause the kidneys to excrete glucose and water, leading to dehydration and imbalances in body electrolyte levels. Diabetic ketoacidosis most commonly develops either due to an interruption in insulin treatment or a severe illness, including the flu. What are the symptoms and signs of diabetic ketoacidosis? The development of DKA is usually a slow process. However, if vomiting develops, the symptoms can progress more rapidly due to the more rapid loss of body fluid. Excessive urination, which occurs because the kidneys try to rid the body of excess glucose, and water is excreted along with the glucose High blood glucose (sugar) levels The presence of ketones in the urine Other signs and symptoms of ketoacidosis occur as the condition progresses: These include: Fatigue, which can be severe Flushing of the skin Fruity odor to the breath, caused by ketones Difficulty breathing Type 2 Diabetes Diagnosis, Treatment, Medication What should I do if I think I may have, or someone I know may diabetic ketoacidosis? You should test your urine for ketones if you suspect you have early symptoms or warning signs of ketoacidosis. Call your health-care professional if your urine shows high levels of ketones. High levels of ketones and high blood sug Continue reading >>
When To Worry About Ketones
“Your blood sugar is over 250. We’ll have to test for ketones, just to make sure you’re not spilling any.” The nurse stuck a label featuring my name and date of birth onto a plastic cup. “The bathroom is down the hall and to the right,” she said. By now, I was familiar with the drill, having experienced it a handful of times in the past: Provide urine sample to endocrinologist and keep my fingers crossed that it’s negative. Fortunately, it was—no ketones spilled. Though we often toss the word ketones around when we talk about diabetes, there tends to be confusion about what ketones are and when they’re dangerous. What are ketones? Ketone bodies are produced by the liver and are byproducts of fat metabolism. They occur when muscles in the body (which normally uses glucose as fuel) begin to use fat instead. This can happen when a person restricts carbohydrates (i.e., following a ketogenic diet—see below), eats too little, or feels ill. Simply put, ketones are markers of fat burning in the body. People with diabetes need to be concerned about ketones, though, because they can be a sign of a life-threatening condition. The presence of ketones makes the blood acidic and can result in an illness known as diabetic ketoacidosis (DKA), which occurs when blood sugar levels are very high. DKA can be caused by not getting enough insulin, and it may occur prior to a diagnosis of type one diabetes. DKA symptoms of concern include a dry mouth, blood sugar levels greater than 240 mg/dL, strong thirst, and frequent urination. Without treatment, these symptoms can worsen into confusion, extreme fatigue, flushed skin, fruity-smelling breath, nausea, vomiting, stomach pain, and difficulty breathing. The most serious effects include swelling in the brain, loss of conscio Continue reading >>
Ketones And Children With Type 1 Diabetes – What’s Important?
What are ketones and when do you check for them in children with type one diabetes? This is a common question I get! I think when children are diagnosed, this a frequent part of the education that is easily forgotten or misunderstood due to the overwhelming amount of information being taught. So let’s look at why we would check ketones, how to check them, what the colors on the strips mean, and what to do if ketones are present. Why Check Ketones: When someone with type 1 diabetes does not not get enough insulin, their blood sugar levels rise, so the body is forced to use fat for energy. When fat is used for energy for an extended period of time, ketones develop. Ketones are a waste product of fat. If someone with type 1 diabetes does not get enough insulin, diabetic ketoacidosis (DKA) can develop. The length of time it takes and how high one’s blood sugar are varies, however DKA can occur in a few hours. Symptoms of DKA: high blood sugars ketones in blood and urine nausea, vomiting, and abdominal pain confusion lethargy (tired, sluggish, weak) difficulty breathing unconsciousness DKA is a very serious and life threatening situation. Speak with your health care providers to determine how you are to treat ketones and when you are to go to the emergency room. When to check ketones: Your doctor can tell you exactly, but usually when your blood sugars are over 250, especially if the blood sugar is not responding to insulin and remaining high after the second blood sugar check. Always check ketones when your child is sick, even if blood sugar numbers are not high. Anytime your child has nausea and vomiting, check ketones. How to check ketones: Ketones can be checked by using ketone urine strips. To check ketones, urinate on a strip, or collect urine and dip stick into ur Continue reading >>
Type 1 Diabetes In Adults: Diagnosis And Management
High blood glucose (hyperglycaemia) that is not treated can lead to a serious condition called diabetic ketoacidosis (or DKA for short). It is caused by the build‑up of harmful ketones in the blood. People with type 1 diabetes are at risk of DKA. You may be advised to test for ketones in your blood or urine as part of sick-day rules. Your blood ketones may be measured by a healthcare professional if it is thought you might have DKA. If you have DKA you will need emergency treatment in hospital by a specialist care team. This will include having fluids through a drip. Questions to ask about DKA Continue reading >>
When You Need To Go To The Emergency Room With High Blood Sugars
My uncle, like all his family, was a bit of a cheapskate. He hated to spend money unless it was absolutely necessary. He was thin and active, having only recently given up a career as a singer and dancer performing weekly on a nationally televised variety show. So when he felt unwell one weekend night, he turned down his wife's suggestion that she drive him to the emergency room and told her he'd wait til Monday when he could see his family doctor. Why waste all that money on an ER visit that was probably unnecessary? As it turned out, he didn't need to see his doctor on Monday. He died that night. He was a few years younger than I am now and the fatal heart attack he experienced was the first symptom he had of our family's odd form of inherited diabetes. But this is why, even though I've inherited the family "cheap" gene, if there's any possibility something dangerous is going on, I head for the ER. Usually it is a waste of money. I was in a small car accident a few weeks ago that left me with nerve pain running up and down my arms and legs. I sat for four hours at our local ER, saw the doctor for five minutes, and was sent home. The diagnosis, whiplash. The treatment, wait and see if it gets worse. The bill? Over $900. I went to the ER because I'd called my family doctor's office and they told me to. Whiplash usually resolves on its own, but occasionally it can cause swelling in your neck that can kill you. I'm not equipped to judge what kind I had, and unlike my uncle, I wasn't about to gamble. So with this in mind, you can understand my reaction when a stranger contacted me recently, after reading my web page, and told me that his blood sugar, which had been normal until very recently, was testing in the 500s on his meter except when his meter wasn't able to give hi Continue reading >>
How To Keep Your Child With Diabetes Out Of The Hospital Or Er
1. Keeping your child (or you) with diabetes out of the hospital Webinar August 19, 2014 Stephen W. Ponder MD, FAAP, CDE Baylor Scott & White Healthcare 7:30-9:00PM Central Standard Time 2. Housekeeping notes… This Webinar IS being recorded for future playback. I hope you reviewed the Prewebinar background materials I posted to Slideshare and You Tube. This slide deck will be posted to Slideshare too Links to all resources will be put on my Facebook page: “The Power Within by Stephen Ponder MD, FAAP CDE” Submit your questions during the webinar and the moderator will collect them for our Q&A at the end. This Webinar will end promptly at 9PM CST The next Webinar is scheduled for Tuesday October 28th 2014 from 6:30-7:30PM CST: Topic “Travelling with Diabetes” by Dr. Matthew Stephen. 3. This area of the patient/parent brain needs some help DEALING WITH ANNOYING THINGS OTHERS SAY CENTRE INSULIN AND CARB CALCULATOR 4. 6 things you should remember… 1) How type 1 diabetes works 2) Importance of water 3) Dual role of insulin (on/off role) 4) Most carbs become sugar 5) Exercise is a form of stress 6) Our brains run on sugar 5. Your “toolkit”… A method to check BG A method to check ketones (urine or blood) Access to liquids (carb and non-carb) Carbs (fast and slow acting) Glucagon for injection Insulin and a way to deliver it reliably Anti-nausea medicine? Your wits (and maybe a phone) 6. “The process” 1) Get the necessary facts 2) Identify immediate needs 3) Prioritize your actions 4) Do your actions 5) Repeat the cycle as needed 6) Don’t stop until job is done 7. Common problems in type 1 diabetes Missed insulin dose(s) Insulin dose reversals Surreptitious insulin doses Outdated/damaged Continue reading >>
Diabetes: Safety Alerts And Emergencies
Diabetes is a slow, steady illness that can turn serious very quickly. If you have diabetes, you should prepare yourself for a diabetic emergency. In a way, you're like a person living on a fault line who plans ahead for an earthquake. But you have an advantage: Instead of just preparing for a possible disaster, you can take steps to prevent it. Your doctor can tell you if you are at risk for a diabetic emergency. If you're in danger, you'll have to learn how to minimize the risks and how to respond to the worst-case scenario. For starters, you should wear an alert bracelet or other form of I.D. that will inform medical personnel of your condition. You should also set aside a stash of extra diabetes supplies in your home in case you can't make your regular shopping trips because of a blackout, flood, blizzard, or some other unforeseen problem. Items you may want to consider for your emergency pack include a cooler or other cold storage container with pre-made ice for keeping insulin and other supplies in case of an electrical outage; emergency glucose to treat hypoglycemia; a spare battery for your glucose test meter; canned food and several gallons of bottled water; flashlights and extra batteries; candles and matches; and, if you take insulin, extra insulin, syringes, lancets, blood test strips, and (if necessary) insulin pump supplies, according to the association Children with Diabetes. Common emergencies Extreme high blood sugar (hyperglycemia) Read about how to prepare for the most common diabetes emergencies: Like everyone else with diabetes, you have days when your blood sugar is a little higher than you'd like it to be. Usually, you can bring the levels back down with a little more exercise, a little less food, or a small change in medications (as directed by a Continue reading >>
When you’re unwell, you need to take extra care. As a person with diabetes, when you are sick your body’s increased production of stress hormones will cause your blood glucose levels to rise. Make sure you keep a list of contact numbers for your doctor, Credentialled Diabetes Educator, hospital and ambulance by the phone. If possible, have a friend or relative come and regularly check on you. You can also see our information sheets on sick days with type 1 type 2 diabetes in our Publications and Resources section. When you’re sick, you should continue to take your usual dose of insulin. Never stop taking or reduce your insulin dose. Sometimes when you are sick you may need more insulin or extra doses of insulin. Contact your doctor or Credentialled Diabetes Educator if your illness lasts for more than one day, or if you vomit more than three times in a day, to discuss whether your insulin needs to be changed. Eat according to how you feel and what food you can tolerate. If you can’t eat your usual meals, make sure you have small low-fat snacks at regular intervals throughout the day (for example, toast, crackers, boiled rice, soup, low-fat custard or ice-cream). If you can’t eat food, have sips of fluid every few minutes. Include carbohydrate drinks (such as fruit juice or lemonade) if your blood glucose level is below 15 mmol/L or unsweetened fluids (such as soda water or diet lemonade) if your blood glucose level is above 15 mmol/L. High blood glucose levels, vomiting and diarrhoea can all lead to dehydration. You will need to drink more, but it is important what you should drink, based on your blood glucose levels. If your blood sugar level is more than 15 mmol/L then you should drink unsweetened fluids like water, clear soups, weak tea, or diet lemonade. I Continue reading >>
What Are Ketones?
Ketones are harmful chemicals which your body produces when there is too little or no insulin Ketones are harmful chemicals which your body produces when there is too little or no insulin. When you detect ketones in your body, it is a warning sign that your blood glucose level is too high and you need to bring it down immediately. How to Check for Ketones? The easiest way to check for ketones is to use a urine or blood ketone test. Your doctor or nurse can advise you on which ketone test to use. Most ketone test kits come in packages of strips or individually wrapped strips (which can be kept longer). To get accurate results from ketone tests, follow instructions carefully. If you are not sure, always ask your doctor or nurse to show you. Here’s how most urine ketone tests work: First, check that the strips are not beyond their expiry date. Collect a sample of your urine in a clean container. Place a strip in the urine sample. Alternatively, pass it through your urine stream. Shake off excess urine from the strip. Wait for the strip to change colour. Compare the strip to the colour chart on the strip bottle to get an indication of the amount of ketones in your urine. Record your results When to Check for Ketones? Check for ketones if you have any of these symptoms: your blood glucose is 14 mmol/L or higher fatigue constant thirst or a dry mouth frequent urination blurry vision (as if you’re looking through a dirty window) vomiting diarrhoea have trouble breathing When to Seek Help? If the ketone test shows small or trace amounts of ketones, it could mean that ketone is starting to build up in your Continue reading >>
What Are Ketones, And Why Are They Important To Diabetes Self-management?
All blood tests are tools. Some are to diagnose diabetes, some are to help you manage your diabetes on a daily or long term basis and some are to keep you safe. People with diabetes are told about blood testing and how important testing is to manage their blood glucose. It is a critical part of diabetes management. Whether it is done in the physician’s office or the patient’s home it is an invaluable tool, Unfortunately a very important test, ketone testing is often not taught or taught only to people with type 1 diabetes. This test can be life saving and should be part of every person with diabetes knowledge and skills. It is simple and if you have diabetes you should know about it. What Are Ketones? When the body is unable to burn glucose it burns fat and this produces a chemical called ketones. This occurs when there is too little insulin for the amount of glucose in the body. Possible causes for this could be: Experiencing stress or illness such as fever, Having an infection. Omitting or taking too little insulin Eating more food than planned Improper storage of insulin If left untreated, ketones continue to rise and can result in a condition called Diabetic Ketoacidosis, or DKA. This condition is quite serious and requires immediate medical attention. DKA is the most common cause of hospitalization and death among children and young adults with diabetes, and the leading cause of adverse events for insulin pump users. Why Measure Blood Ketones? Studies suggest that most, if not all emergency department and hospital admissions beyond initial diabetes diagnosis could be prevented if people better managed their diabetes care and knew the warning signs when ketoacidosis was developing. Blood ketone testing provides a rapid, accurate, and early warning sign that keto Continue reading >>
Diabetes Care In The Hospital: It Ain't Pretty
Two ER visits within two days, thanks to a severe low blood sugar and then non-budging high blood sugars. Both are enough to make anyone with diabetes cringe. But then there's the fact that these experiences themselves highlighted how the urgent care establishment is ill-equipped to deal with diabetes. And it gets even more troublesome. I've long believed that we PWDs (people with diabetes) aren't going to get quality care in the emergency room if we end up there. From the Diabetes Community stories I've heard, opinions of medical professionals in the diabetes world, and my own experiences visiting ERs on a few occasions through my life, that is what I have come to believe. Sure, it may be more sarcastic than serious to say "the ER is trying to kill me," but there's certainly some real-world trauma weaved into that comment. The recent dual ER visits that my mom experienced reaffirm this, and I just want to share this story as a way to call out for whatever change can hopefully materialize ... I'm not happy with what happened in the ER relating to my mom last week. But more than that, it scares me that this type of thing could happen to any of us. What Happened? First, it's important to remember that my mom has been living with type 1 since the age of five -- which means it's now about 55 years. She hasn't had an A1C above 6% in at least a decade, and from what I have seen she doesn't often go above 160 for any extended period of time. She has had insulin reactions before, and they've been severe in some cases, but they typically don't last very long and we've all been able to manage them. Early on a recent Sunday morning, my didn't wake up from a hypoglycemic reaction. My dad awoke to her beeping Dexcom G4 continuous glucose monitor (CGM), and it showed that she was und Continue reading >>
What Is Diabetic Ketoacidosis?
Having diabetes means that there is too much sugar (glucose) in your blood. When you eat food, your body breaks down much of the food into glucose. Your blood carries the glucose to the cells of your body. An organ in your upper belly, called the pancreas, makes and releases a hormone called insulin when it detects glucose. Your body uses insulin to help move the glucose from the bloodstream into the cells for energy. When your body does not make insulin (type 1 diabetes), or has trouble using insulin (type 2 diabetes), glucose cannot get into your cells. The glucose level in your blood goes up. Too much glucose in your blood (also called hyperglycemia or high blood sugar) can cause many problems. People with type 1 diabetes are at risk for a problem called diabetic ketoacidosis (DKA). It is very rare in people with type 2 diabetes. DKA happens when your body does not have enough insulin to move glucose into your cells, and your body begins to burn fat for energy. The burning of fats causes a build-up of dangerous levels of ketones in the blood. At the same time, sugar also builds up in the blood. DKA is an emergency that must be treated right away. If it is not treated right away, it can cause coma or death. What can I expect in the hospital? You will need to stay in the hospital in order to bring your blood sugar level under control and treat the cause of the DKA. Several things may be done while you are in the hospital to monitor, test, and treat your condition. They include: Monitoring You will be checked often by the hospital staff. You may have fingersticks to check your blood sugar regularly. This may be done as often as every hour. You will learn how to check your blood sugar level in order to manage your diabetes when you go home. A heart (cardiac) monitor may Continue reading >>
The Scary Experience Of Diabetic Ketoacidosis
Today, we’re excited to share with you another guest blog from Katie Janowiak, who works for the Medtronic Foundation, our company’s philanthropic arm. When she first told me her story about food poisoning and Diabetic Ketoacidosis (DKA), I knew others could benefit from hearing it as well. Thanks Katie for your openness and allowing us to share your scary story so that the LOOP community can learn from it. Throughout this past year, I’ve had the honor of sharing with you, the amazing LOOP community, my personal journey and the often humorous sequence of events that is my life with T1. Humor is, after all, the best (and cheapest) therapy. Allow me to pause today to share with you the down and dirty of what it feels like to have something that is not the slightest bit humorous: diabetic ketoacidosis.You are hot. You are freezing. You are confused. You are blacked out but coherent. You go to talk but words fail you. Time flies and goes in slow motion simultaneously. You will likely smell and look like death. In my instance, this was brought on by the combination of excessive vomiting and dehydration caused by food poisoning and the diabetic ketoacidosis that followed after my body had gone through so much. In hindsight, I was lucky, my husband knew that I had food poisoning because I began vomiting after our meal. But I had never prepped him on diabetic ketoacidosis and the symptoms (because DKA was for those other diabetics.) Upon finding me in our living room with a bowl of blood and bile by my side (no, I am not exaggerating), he got me into the car and took me to emergency care. It was 5:30 p.m. – and I thought it was 11:00 a.m. The series of events that led up to my stay in the ICU began innocently enough. It was a warm summer night and my husband and I walke Continue reading >>