Ketone - Scary or Not Scary?

**** I am not a health care professional nor do I have anything that looks remotely like a medical degree. So take anything I say with a pinch of salt.

For this piece I have combined information I found on;  Diabetes Daily written By Ginger Vieira on January 4th, 2016, from Beyond Type 1 WRITTEN BY: Kyla Schmieg, BSN, RN and from The Type 1 Diabetes Network Australia Type 1 Diabetes Starter Kit

When I was diagnosed in 1993, I don’t remember hearing the word ketone back then. In fact, I don’t think I hear it until the early 2,000’s. Remember, diabetes education didn’t exist in Ireland before then - not to my recollection anyway.

In my 23 years with type 1 diabetes I have never tested for ketones. Firstly I don't often get sick. And secondly, when I’m sick I take all the recommended actions that deal with both being sick and flushing out ketones.

However, I hear a lot of talk about ketones and began to think that, maybe, I'm a bit too relaxed about them and need to know a bit more.

So, first, what is a ketone?

When our body can’t access glucose, it looks to burn fat for energy. Burning fat results in ketones.   

“Ketones build up can lead to Diabetic Ketoacidosis (DKA). Signs of DKA include nausea, vomiting, abdominal pain, fruity or acetone (think nail polish remover) breath, rapid breathing, flushed skin, and lack of energy.“ http://beyondtype1.org/ketones-the-6-must-knows/

Why are they so scary?

Ketones usually build up in a person with diabetes if they do not have enough insulin taken and can be fatal.

If ketones happen “too much too fast, it is not natural and it’s important to understand that ‘normally’ produced ketones are very different from ketones that develop due to insulin deficiency.

Moderate or large amounts of ketones in your body are very dangerous. They upset the chemical balance of the blood and lead to a condition called diabetic ketoacidosis or DKA. Some people also experience fast and heavy breathing and exaggerated beating of their heart. It is scary! If you experience DKA, you need to go to hospital to be rehydrated and monitored while the ketones in your body reduce to a safe level.

Many people with type 1 diabetes have never had an episode of ketoacidosis, but you may have already experienced DKA during diagnosis. Unfortunately, DKA is life threatening, so you need to understand what it is and what to look out for.” (from the Type 1 Diabetes Network’s Starter Kit page 37)

OK, I’ve got it so far.

This much is easy to follow but when I started hearing about the different type of ketones that were I got a bit lost. Especially when I heard that you can have ketone when you are not sick and have normal blood sugar levels. Until I did this research, I didn’t know if that was a “freak-out” or “not-to-freaky-out” situation.

Different types of ketones.

Illness-Induced Ketones

Illness-induced ketones can be very dangerous for a person with any type of diabetes. People with diabetes who are sick, especially with an infection, a stomach bug, or the flu should always test their ketones while they are sick.

A mild illness can cause low level ketones that are usually not life-threatening or severely serious. If ketones are at low levels, the general suggestion is to consume plenty of fluids and talk to your healthcare team about increasing your background insulin doses.

Even if your blood sugars appear in-range but you are producing ketones when sick, an increase in background insulin can help eliminate the ketones without dropping one’s blood sugar.

On the other hand, a person with diabetes, who is vomiting repeatedly will almost always need to get to the ER as quickly as possible. Vomiting, no matter the cause of the vomiting, will likely induce large ketones and can be life-threatening. Vomiting leads to severe dehydration which will escalate ketones further to a state of DKA.

Since severe ketosis will likely make a person extremely nauseas in addition to their illness-induced nausea, it can be nearly impossible to consume enough fluids at home to re-hydrate the body. An IV drip of saline at the hospital is essential to rehydrating the body, reducing or eliminating ketones, and stabilizing blood sugar levels.

Consult your healthcare team if you have concerns about your state of ketosis.

Starvation Ketones

Starvation ketones are simply the result of not eating enough food over the course of several hours. Both diabetics and non-diabetics can easily produce very low levels of ketones overnight, seeing a faint pink color on a urine ketone strip first thing in the morning. These are not dangerous unless, of course, this person continues to starve themselves.

Nutritional Ketones

Nutritional Ketosis is a state where the body is using ketones as a fuel source efficiently and safely. In individuals without diabetes or in those with controlled diabetes, having insulin on board to maintain healthy blood sugar levels keeps ketone production in the safe range.

This is achieved by reducing carbohydrate-intake to below 50 grams, because when glucose from food is limited, but blood sugars are still in a healthy range and enough insulin is present, the body will begin to burn body fat for fuel instead, producing low levels of ketones in the bloodstream.”

As long as blood sugars are maintained in the normal safe range with insulin, someone with diabetes can very safely be in Nutritional Ketosis.

When you’ve been in Nutritional Ketosis and not even known it:

• when you skip breakfast and don’t eat until lunch or later, your body is burning body fat for fuel and likely producing low-levels of ketones
• when babies are born, they are often in a state of nutritional ketosis for the first few days or week of life because they are consuming very little breast milk until the mother’s breast milk production ramps up
• when you eat a low-carb meal (eggs and bacon) for breakfast and don’t eat again until late lunch or afternoon…or…when you eat a low-carb breakfast followed by a low-carb lunch, your body is producing a low level of ketones until you eat a more significant serving of carbohydrates at dinner, etc.

Can you get ketones with a high blood sugar?

Ketones typically accompany high blood sugar. Ketones indicate your body needs more insulin. Most often if your body needs more insulin, it means your probably have a high blood sugar. Also, when an illness is present, your body releases hormones in response to the stress. These hormones lead to elevated blood glucose. That is why it’s recommended to test ketone levels during illness.

Can you get ketones with a normal or low blood sugar?

Ketones can also be present when your blood sugar is normal or low. These are sometimes referred to as “starvation ketones” or “nutritional ketosis.” During an illness or extreme diet change, if you have a significant decrease in carb intake, this can lead to the body using fat for energy because there are not enough carbs present to burn. Your blood sugar could remain normal or even be low in this case but your body could still be producing ketones.

From; http://beyondtype1.org/ketones-the-6-must-knows/

Conclusion

My conclusion is that, like diabetes, ketones need to be treated seriously. They are not always scary but you need to know why, when and how. And remember, if in doubt call your D-team. A quick phone call equals peace of mind.

Sources of information about ketones;

• https://www.diabetesdaily.com/blog/2014/11/dka-nutritional-ketosis-are-not-the-same/
• http://beyondtype1.org/ketones-the-6-must-knows/
• http://www.healthline.com/health/type-2-diabetes/facts-ketones#1

The Sneaky Low

I hate when the hypo just comes out of nowhere and hits you hard! It a very rare occasion that I have a hypo around lunch time. But yesterday, totally unexpected and without hardly any warning a 2.6 mmol/l (46.8 mg/dl) knocked me for 6.

I had been working upstairs doing light household chores. I decided to take a break and make some lunch because my CGM alarmed telling me that my blood sugars were 4.3 mmol/l (77.4 mg/dl) and I felt a bit on the shaky side but not much.

I threw a lunch together and sat down to check, dose & eat. WHAT!!! 2.6!!!!!! Then I realised not only was I actually shaking but I was sweating profusely. I decided to hold off on my lunch, which was low carb and protein - not a good start to treating a hypo, and I quickly chewed 3 glucose tablets.

I stepped away from my lunch to allow the glucose to kick in without obstruction from protein. I can’t believe I was that rational!!! Then again, I couldn’t figure out what I should do with my insulin dose - I should obviously reduce it a little. But should I include the glucose tablets in my carb count.

Fifteen minutes later I was still shaky but I think my brain was pulling itself together again. I checked my blood sugars again and I was 3.9 mmol/l (70.2 mg/dl), the food was sitting there waiting for me. I decided to put it out of its misery.

I took my reduced insulin dose at this point. It seemed like the right thing to do to avoid the low blood sugar rebound. I knew that the sweating had stopped because I got the chills but the shakes were still there and didn’t quite go away for about 30 minutes.

I did have to top the carbs up twice over the next two hours to keep my blood sugars in the safe zone which was another unusual circumstance for me.

The lesson learned today is to not to try to sneak household chores in before lunch! And always use diabetes lessons to avoid household chores :-D

The Great Sugar Confusion

Are you as tired as I am of hearing about sugar and all its evils?

**** I am not a health care professional nor do I have anything that looks remotely like a medical degree. So take anything I say with a pinch of salt.

The Great Sugar Confusion was originally posted on the 9th October 2013. I have taken a different spin on it this time.

Everyday, it seems like there’s another “sugar scare” story!

• -  March Call for voluntarily ban on sale of energy drinks; too much sugar
• - February High-sugar diet is as 'damaging to your brain as extreme stress or ABUSE
• - January  Sugar Crash
• - November 2015 Be Sugar Smart Campaign

And yes, I know that too much sugar is not good for us, any of us but I get so confused when I try to understand what these articles are trying to tell us and how to explain it to someone else.

I know that these pieces are written by well intentioned people, even qualified medical professionals,  who are trying to educate the masses but everytime I see one of these articles I get “irked” because I feel that the healthier foods are being branded as “bad” too.

People with diabetes, despite the truth, are taught that sugar = poison. I feel this is changing in the diabetes community but the rest of the world will continue to be stuck in this time warp for a long time to come.

So, if someone shows you an image like this ;  

and you have diabetes and are not very carb-aware, you might assume that you can’t eat any of these three items.

For me, I get confused because I don’t know if it's representative of the sugar that is added when the food is being created or if that’s what the carbohydrate becomes when digested into glucose. I don’t know if my reaction should be “Gosh, I didn’t know that!” Or “Yes, I knew that”. What, just what are you trying to tell me????

Educating the masses about the complexities of our food and how it affects us is a huge challenge. So many different approaches have been tried but haven’t really succeeded.

However, I do think that people with diabetes, especially those of us who count carbs to match insulin, have a leg up on this one. Learning to read a food label has been the best tool for me to know exactly what I’m eating, it’s even better if there are very few ingredients in it or if my food is cooked from scratch. The closer the food is to the farm the better it is. But it’s also a tool I HAVE to rely on to stay healthy and not let diabetes take me down.

It’s probably not very realistic to expect all others to scrutinise their food labels as I do. But it might be realistic to teach this in our primary or secondary schools along with how our digestive systems work? I mean that stuff has stayed with me.

This is what I remember from my 2nd year biology class.

• - starch + sugar = Carb
• - bite, chew-chew-swallow, swish-swoosh in the stomach
• - presto = glucose.
• -  Glucose floats around in the blood, gets absorbed by cells = energy.
• -  Leftover glucose get stored for a while then gets turned into fat.
• -  Done! A+ for me…. surely?

For those of you who would like a bit more science, have a look at this really good website; basic biology of digesting carbohydrates.

The Clare branch of Diabetes Ireland is hosting a Diabetes Education event will feature a dietitian who will talk about "being sugar smart”, on Tuesday, May 17th in The Temple Gate Hotel at 8pm. It's going to make for a very interesting evening and hopefully be enlightening.

A Day of Diabetes - A Not-So-Good Day!

As promised, the Not-So-Good Day of Diabetes.  When I was trying to decide which "Not-So-Good Day" experience to post about, I had too many to choose from. On this occasion I choose this one because it's not all to do with diabetes. It's the other stuff that affects diabetes or vice versa.

When I wrote this post I hadn’t had an uninterrupted night's sleep in about 4 nights. It’s my diabetes but it’s not just that. It’s the decisions I make too. Like to have 2 squares of chocolate with insulin just before bed. It’s my son having very loud dreams and it’s words in my head that need to go in a blog post that I’m compelled to record in the middle of the night.

The other night, for example, I attended our local diabetes support group meetup. I’m always wound up when I come home from those because I get to hang out with some members of my tribe. So, I have a cup of herbal tea and chat it out with hubby. I got to bed a bit later than usual. And then, I realised that I had to do an insulin pump set change. Ahhh!

About an hour later, I could hear noises, always freaky but at least I wasn’t the only adult in the house and it didn’t lead to a panic attack. After a couple of minutes of intent listening, I figured out that it was my son in the next room who talks in his dreams… very loudly. I listened for a couple more minutes to make sure he wasn’t in a terrifying battle with a velociraptor or something. He wasn’t and I tried to get back to sleep.

Another short time later, I woke up with words in my head that related to a blog post I had been working on earlier that day (not this one) and I had to come downstairs to my laptop to get them out of my head so that I could fall asleep.

So far a series of un-diabetes calamities. That is until 3am. My Continuous Glucose Monitor alarm went off to let me know I was below the low limit. Up, test, take glucose. Thankfully it was just 4.8 mmols/l (86 mg/dl) so not a hypo but a warning of a hypo.

Next up 4am, low blood sugar alarm goes off again. This time I just took glucose tabs without testing and went back to sleep.

While technically, this is a not so good night but I don’t hold out much hope for the rest of the day.

Later in the afternoon it was hypo time again. My blood sugars just would rise above 3 & 4 mmols. The result is a very queasy tummy at almost dinner time.

Being tired does not help diabetes at all.

23 year Diaversary

Today is the my diaversary of 23 years living with type 1 diabetes. 23 years and I'm still here!!! Diabetes, you still didn't get me. You can keep trying but I will keep fighting. I like watching that number get bigger. How am I going to celebrate?

Today is also my first born's 12th birthday. That's how I'm going to celebrate! :-)

There could be no better way.

Exercise is Changing Diabetes

I can take or leave cycling.... Actually, if you take one look at me you can tell that I just about tick that box for exercise. ▖✓ However, this video came up several times in my twitter and facebook feed and on the 3rd time seeing it I thought maybe there is something in that that I should see and hear.

The answer is YES there was! It’s a 7 minute video filmed by the BBC and I feel, that it is a must see for all people with diabetes. Believe it or not there are still health care professionals in Ireland telling newly diagnosed people to give up exercise, especially competitive sports with their diabetes! 

These amazing people are changing the public’s perception of diabetes all over the world. It’s so powerful to hear about how much time and effort they put into their diabetes management and still make strides competitively. Team Novo Nordisk is the only all diabetes pro cycling team on the planet.

Phil Southerland, founding member of the professional cycling Team Type 1 speaks about how in a time where children with type 1 were not encouraged to exercise his mother saw something positive in his numbers when he did.

Our very own Stephen Clancy from Limerick is a member of this diabetes cycling team that is planning to compete in the 2021 Tour de France. His voice is featured in the introduction to the NovoNordisk promotional video. Stephen was aged 19, and on the path to a successfully career in pro-cycling , when he was diagnosed with type 1 diabetes. He was told to give it up!

Thankfully, sometimes it pays off to not listen to your medical team. Please share this video and encourage our children with diabetes to not give up on their dreams because of diabetes and to inspire others.