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100 with large ketones

Discussion in 'Parents of Children with Type 1' started by Traci, Jun 22, 2012.

  1. Traci

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    I just want to cry. Our vacation starts this weekend. Ds11 woke up this morning throwing up. His bg was 136 with trace urine ketones. An hour later, he's 100 with large ketones. He's not still throwing up, seems to feel fine, but still has large ketones.

    He's had breakfast and drank a low carb small Gatorade (7 carbs). I bolused for breakfast, not for the Gatorade, and started him on another Gatorade. I ran to the store for a regular sprite, set a +25% temp basal (increased basal by 25%), and have not bolused for the sprite yet--trying to get him up.

    I'm totally freaking out because we are supposed to be leaving the country! I know he needs more insulin, but I can't risk him going too low, so I've got to get him up more. Vicious cycle!

    Am I forgetting anything?
     
  2. hawkeyegirl

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    Do you have a ketone meter? Urine ketones are hours behind, so in this situation a ketone meter makes it much easier to assess what is actually going on now.
     
  3. Amy C.

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    Insulin brings helps with ketones. Give him food to eat or drink along with insulin. Urine ketones are hours after they happened, so there may not be a problem.

    Could be starvation ketones, which go away quickly. No other symptoms show this isn't really a problem
     
  4. Lee

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    Those large ketones were probably from when he was throwing up and not a current reflection of what is happening now.

    If he feels better, then the ketones are probably clearing up.
     
  5. Sarah Maddie's Mom

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    I'd be careful not to go overboard on giving insulin for ketones IF bg is not high. You may be seeing starvation ketones, not ketones that precede DKA. Starvation ketones need carbs to clear, and not extra insulin.

    Good luck!
     
  6. Traci

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    Thank you all so much!. I do not have a blood ketone meter, but this incident will be the catalyst for me to get one! We seldom have ketones, and even when we do, they are site related and resolve quickly. I've never had him low with large ketones!

    Starvation ketones? I mean, I've heard of them, but never experienced them before. He ate supper last night and even had a little ice cream after. Middle of the night bg was 156. So very strange. Obviously, I need to get up to speed on this possibility. Could he have starvation ketones even if he ate last night?

    He's up to 255 now thanks to the Sprite. I gave a one unit correction (pump suggested 1.3) and ketones are negative. He feels fine. Endo suggested we get zofran for our trip in case it is a stomach bug.

    I do think the vomiting was from the ketones...we've never dealt with that either. That's one of the worst parts of this blasted disease! Always something new and different to figure out...even after all these years. Thank you for coming to my rescue!
     
  7. hawkeyegirl

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    I hope everything is smooth sailing from now on! Have a great vacation! :)
     
  8. Traci

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    Thank you! It's been an eventful week so far. I'm going to certainly NEED a vacation after all this.
     
  9. MomofSweetOne

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    Is it hot where you live? My daughter doesn't run ketones with illness (or at least hasn't to this point), but a couple hot days brings them with nice BGs like your son's.
     
  10. hdm42

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    Having zofran on hand for "just in case" is a good idea, IMHO.

    Hopefully it was just a fluke and starvation ketones. Definitely get a ketone meter. Much easier to be dealing with real-time numbers than color changes that can be hours behind.

    Have a great vacation!:)
     
  11. Lee

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    Call your endo and ask if they can give you one before you go looking to buy one - you might just get lucky.
     
  12. StillMamamia

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    Hope things are better now!

    Starvation ketones just mean that there are not enough carbs to provide energy, so the body will turn to burning fat for energy, hence producing ketones. If you see ketones after awakening previous to eating, and BGs are ok or tredning low, it's usually starvation ketones, and like AMy C. pointed out, they usually clear once the body has carbs for energy.

    During tummy bugs or anything hindering carb absorption, the body will also burn fat, and produce ketones, and BGs may trend low.

    Not the same with hyperglycemia induced ketones. There you have to be more aggressive with the insulin dosage.
     
    Last edited: Jun 22, 2012
  13. ecure

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    I'm usually 0.1 mmol/l ketone before my breakfast.. It's pretty low.. As I heard under 0.6 mmol/l it's green level. It's a normal ketone level for fasting..
    Moreover if you have a long fasting time it may induce more high level of ketone. As I heard some people sustain a less long time fasting time than the average people.

    I recently learned a more unkown thing...
    Do you know hypoglycemia could produce ketone?

    quotation:
    A high level of ketones in the blood, ketosis, is thus a normal response to hypoglycemia in healthy people of all ages.
    source:http://en.wikipedia.org/wiki/Ketotic_hypoglycemia


    So if you have rebound from hypo to hyper, it may induce some ketones in your blood as well ..

    Let me know if you notice it...
     
  14. GaPeach

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    Insulin helps to clear ketones. Once you got his BG up, I would have given the recommended dosage plus at least .25 more (maybe even .50 if the ketones were being stubborn.)

    We found that having powered gatorade on hand is a good practice. With low BG and high ketones, we mix the gatorade 3X normal strength. Then a little sip will raise BG more and insulin can be given to clear ketones.

    I hope you have a wonderful trip and D will be nice to you. No ketones and no vomiting!!!
     
  15. Nancy in VA

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    Yeah, you can't be afraid to give insulin if there are really ketones. The ketones STEAL the insulin so it doesn't get to the BG to bring it down to the low level. And, if you're especially worried, you can do hourly BG checks.

    Whenever Emma is sick, she gets major starvation ketones, regardless of BG. I think her body uses so much extra energy to fight the illness that her body burns fat to fight it because she doesn't have enough carbs - when she was really little and sick, we would have to wake her up overnight and give her a snack and an insulin dose, just to give her carbs to keep away the ketones.
     

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