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Ketone question

Discussion in 'Parents of Children with Type 1' started by cgbphp, Oct 30, 2011.

  1. cgbphp

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    Sorry only one more question for the day I swear! My son is 2yrs. old diagnosed in June of this year. When he was admitted to ICU his BG was 1071 and no ketones. Which I have heard is very rare in a BG this high. I read on here kids being in the 300s and having Ketones. Hayden is still extreamly unpredictable his blood sugars range from 50 to 400 almost on a daily basis but it is getting better. I always checked for ketones when over 300 before he went on his pump as instructed never once has he even had a small amount always negative. Now that he is pumping I check for ketones once he hits 250 still he has never had any. I was just curious if anyone had ever had this same expirience? Or knows why he doesnt seem to throw ketones? Not that I want him to I am just curious as to why even with a BG of 1071 or even 548 which is what he was last night before bed he always test negative.
     
  2. Darryl

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    It doesn't really make sense especially at dx, but I wouldn't give it much thought. All that matters now is good BG control. Ketones matter if they are medium-large, otherwise it doesn't matter if they are not there. Keep an eye out for them especially during illness.
     
  3. 3kidlets

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    Not sure of the scientific explanation for this. My daughter was in the 600s at Dx and had ketones. However, in the 19 months since her dx, she has never had ketones -even when sick (which, knock on wood, she hasn't really been sick - only a cold and a couple of ear infections). I rarely check for ketones anymore unless she runs high for a long period of time.
    I even bought one of the blood ketone meters but we've only used it twice - both times no ketones.
     
  4. aslan1994

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    My dd has never had ketones either though we've only been at this for 11 months. I don't know if she had them at dx- I had no idea what ketones were, and certainly didn't know to even ask. I'm afraid that I am becoming rather complacent about ketones - we rarely bother to check unless a high lasts for several hours or she is sick.
     
  5. skimom

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    Neither one of my kids throw ketones that often - only if they are really sick and if we can't bring down the BG after 2 or 3 corrections. They try to remember testing with any BG over 14 but it is the sustained highs that are more likely to make them test rather than the odd high bg. They do clear up fast for us too...They both did have ketones at diagnosis ( his BG was over 50 and hers was upper 30's)
     
  6. cdninct

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    My little guy had small ketones at dx despite high BG (not in the four-digits, though!), and now only has small ones first thing in the morning when sick. I don't know why he is not prone to them, but I am not complaining!
     
  7. mmgirls

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    I would venture to guess that he is srtongly honeymooning and or he has a higher basal that bolus.

    The honeymoon production of insulin or the higher basal can just be enough so that his body does not have to go to ketone production for fuel.

    My dd has had sustained highs in the 300-400's and no ketones. Yet when sick has had large ketones at a bg of 80.

    I too am sometimes very complacent with ketone checking, got a scare just last week with a bg of 250 she had 2.0 blood ketones, it was not from a lack of insulin but a lack of eating during sickness.
     
  8. MommaKat

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    This is kind of a challenging discussion. The endos who cared for my daughter when she was first transferred to Children's were surprised by how low her blood glucose was (368) given how acidic her blood was. Her ketones were off the chart, and she was lapsing into a coma. While high bg and ketone formation are related and interdependent, they are still two separate processes, so we get different scenarios - your kiddo with an incredibly high bg and no ketones, or mine with an elevated but not crazy high bg and ketones so high we nearly lost her, and everything in between.

    When our bodies lack insulin to allow glucose into cells for energy, two things happen. The one we're all familiar with - the amount of glucose in the blood stream increases because it's not getting into the cells. Second, the body starts to break down fat cells for energy (and protein - but fat's the important one here). Fat is meant to be broken down in starvation states, but for a price. The problem with breaking fat down for energy is the toxic byproducts, acetone, acetoacetate, and beta-hydroxybutyrate - or ketones. These are incredibly acidic, and as the ketone levels rise, our body tries really hard to dilute and get rid of them (the drinking and peeing), and when it gets really bad, also tries to get rid of them through slow heavy breathing (fruity breath and kussmal breathing.) Ketoacidosis happens when the amount of ketones in the body is high enough to lower the pH (acid / base balance, lower means more acidic - our bodies should be close to neutral.) Most of our body, especially the central nervous system, can't operate properly in an acidic pH, so it needs to be corrected quickly. (Believe it or not, the kidneys and respiratory system constantly work together to achieve an acid base balance. Every time we breathe out we're blowing off acid in the form of carbon dioxide!)

    There are so many factors at play that it's hard to tell why some people end up with ketones, and others don't. Some level of ketone production is natural, but usually not detected. Illness and injury lead to increased ketone production because our body has higher energy demands and ramps up metabolism. Starvation diets lead to ketone production that can become dangerous (Atkins diet and hcg, for example). Diets come to mind because I completely missed the link between the amount of weight my dd lost before Dx and the increased thirst / voiding. (I'd made an appointment because she was drinking and peeing so much, but we ended up in the hospital four days before hand.)

    In your case, your ds's body may not have resorted to metabolizing fat cells as much, so showed no ketones. Keep in mind, while high bg and ketone production may both occur because of a lack of insulin leading to the need for energy from fat cells, other things cause fat metabolism as well. Someone might not be eating enough, have normal or low bg, and still produce ketones, or we could just have a higher metabolic need due to illness, injury, allergy and the body uses whatever it can to meet demand. As for lack of ketone production in your ds now, it doesn't seem like one high bg would result in his body resorting to fat cells for energy, and even with a string of highs, if the body needs energy and does metabolize some fat, ketones have to accumulate before they register as trace, small, etc. It's an awesome thing that he's not showing detectable ketone production since that's what we don't want. The super high bg is something the endo in the hospital mentioned when I asked about my dd's low seeming bg. I've since read this as well, but need to learn more. He mentioned that insulin production might decrease slowly in some patients, but decrease suddenly in others, and when that happens can result in really high blood glucose levels like your sons.

    The body, the science behind what happens, and especially the why behind it all is so amazing. I'm not sure we ever get to know exactly why everything happens. For me, what's most amazing is that our kids go through this, and we have all the incredible innovations and therapies thanks to scientific discovery that allow them (and us) to recover, and live normal lives (with some help).

    As for ketones, we hadn't seen any since diagnosis until my daughter was hurt last week. (Sadly, we both distinctly remember the smell and knew before we tested that she was making ketones.) We've had both high bg in the 200s and some low 300s and moderate ketones. Of course, she ended up with a hole in her leg, so I understand why both are happening. Her body's energy demands for healing, immune response, and pain has been significantly higher, so it's using the reserves like it's supposed to. Controlling bg and ketones was certainly difficult this last week (but improving), and I was reminded of the importance of balancing my attempt to decrease the two. Sick day care instructions are now taped to the fridge! :rolleyes:
     
    Last edited: Oct 31, 2011
  9. MommaKat

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    I was thinking about how challenging it is for us as parents (new ones like me anyway) to understand ketones and how to manage them. I know from experience (both work and with dd) that even medical staff don't fully get the relationship between bg and ketones.

    When dd was admitted to ICU, the endo team made it very clear they weren't in a hurry to get my dd's bg down, they were more concerned about slowly dropping it and getting the ketone level down as the acidosis posed the immediate threat. The ICU nurse, however, basically felt he was the brains of the operation and determined to get her bg down to normal range overnight so he could send us packing in the morning. In those first 24 hours, I learned the importance of continuing to provide carbs / glucose (IV in this case) AND insulin so her body could stop forming ketones and reverse the acidosis.

    Because of the RN's ego, her acidosis increased, her coma worsened, etc. (I also learned that it's not a good idea to boldly threaten the ICU nurse from hell, but at least he was reassigned for nights two and three, after a major lecture from the attending endo.)

    Later that week, the endo we were assigned to at the clinic said my dd must have been prediabetic or diabetic for a really long time to have such a high ketone level. Thank goodness one of the endos who admitted dd made a point of telling me that wasn't necessarily true. He pointed out that dd's metabolism, diet, changes in diet, activity levels, and so many other things came into play that led to the level of ketoacidosis she was in. She'd had an appendectomy just two months before diagnosis, a string of birthdays (hers included) in the weeks leading up to Dx, and food poisoning to boot. Any or all of these might have caused more ketone production than normal.

    I didn't realize until recently that he saw how much I blamed myself for dd being so sick. His mini lecture on the lack of understanding around the issue of ketones and management by healthcare providers has provided a great deal of healing. As it relates to the OP, some times I think we need to step back and recognize that we're trying to understand things people with medical degrees struggle with. Don't apologize for asking questions, and take a minute to recognize how very much you're doing to understand and help your ds!! :cwds:
     
  10. sugarmonkey

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    Phillip has never had ketones. He was 504 at diagnosis. Has hit HI more than I'd like, especially since puberty hit. I test for ketones whenever he's over 270 twice in a row. He's never been positive for ketones. I don't know why. Just wanted to tell you your boy's not the only one.
     
  11. MamaBear

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    I think that's a very good point. We are dealing with quite alot that many folks with an MD or RN behind their names do not understand, and it's so hard sometimes. I've been revisiting the guilt lately. It still bothers me that I didn't know how sick he was.:(

    In the year since diagnoses, my son has only ever had trace ketones a few times, and small once. We tested for every high number when we first came home, probably still out of fear that he'd slip back into DKA. Now we rarely test. If he has several very high numbers in a row I will test. On occasion if he has a super high number (398 tonight. Guess my count for caramel apples was way off :eek: :( ) or if he has an upset stomach,he will ask if we can test. Thankfully it usually comes to nothing.
     
  12. cgbphp

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    Thanks everyone again for the quick responses and helpful info. I can't say enough that I don't know what I would do without this site!
     
  13. Lee

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    We never, ever had ketones for the first 2+ years, now she gets them just about anytime she hits 400.
     
  14. Gsmama

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    We didn't have ketones at dx with a BG over 1000. We rarely get ketones even after 4 years. I only see them when very very sick ie. vomiting and even those are usually .7 or lower.
    Everyone is different.
     
  15. Amy C.

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    We don't test for ketones with high blood sugar, unless he is sick. Even if he had ketones, all he needs is more insulin -- which is what he gets in the correction.
     
  16. mom24grlz

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    Ashleigh has never had ketones either. I check on the Ketone meter if she goes above 250 and the highest she has ever gotten was 0.2. Which is still considered negative.
     
  17. mmgirls

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    how do you know if a high blood sugars is not from a failing site if you do not check ketones? Because when ketones are present usually it takes a bigger correction.
     
  18. Amy C.

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    If he has a couple of high blood sugars in a row, the site is changed and correction given. For my son, the standard correction works. He doesn't usually need more.

    Even with a site failure, he doesn't get ketones. It seems he gets enough insulin to prevent them from developing.

    One time he forgot to put his pump on when he went to bed and had ketones 6 hours later. Even then, he didn't need more insulin than the standard correction.
     
  19. BCot

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    My son has had diabeted for 5 1/2 years and has never had ketones with high blood sugar. The only times we have to deal with them is whenever he has a stomach bug and is unable to keep any food down. Then, we are dealing with ketones and low blood sugar. Not fun.
     

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