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ketones-how to treat???

Discussion in 'Parents of Children with Type 1' started by valerie-k, Jan 19, 2012.

  1. valerie-k

    valerie-k Approved members

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    As stated in a few of my threads, we have been battleing ketones hot and heavy for the last month and a halfish and so.

    The cause usually is becouse the set comes out in the middle of the night, so I know the cause, lack of insulin. Once or twice is was pump related, matt has it set to vibrate. Unfortunately, a tornado wouldnt wake him up unless shrapnel hit him, and even then, it would be iffy. He sleeps hard, and flip floppy. He is all over that bed.

    So, and I think I am doing it wrong, I take blood sugar, and input that so the pump does a correction. Then I start to give him high carb things to eat/drink... coke being his drink of choice to put more insulin into him. We play this game, drink, carb, drink, carb to get more insulin in him.

    Is there a set amound of extra insulin I should just give him without carbs? I fear that, what if he then goes very low. At least with the food, I know the insulin is going to keep him up.

    basically, how do you treat for ketones, at least, when the ketone is something that you know why its there... Not so much a sick ketone but a lack of insulin ketone. (I guess I would also like to know how you would also treat for a sick ketone as well.:eek: )

    I got some IV prep to put on the sets, to hopefully advert them from coming out at night, and will see about the other sticky stuff to use by calling minimed for samples.
     
  2. emm142

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    If BG is high and ketones are high, I correct the high BG and do a 200% temp basal until BG is down. I DO NOT push carbs if BG is already high.

    If BG normal and high ketones I push carbs and bolus for them.

    If BG low and high ketones I drink carb fluids and correct BG down when it gets over 200.
     
  3. cm4kelly

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    Keytones

    I am certainly not a pro here, so I will be interested to see what other people post.

    To treat keytones due to lack of insulin, you can quickly change the site and put in blood sugar for a correction. Then you should only follow with sugar free liquids - preferably water to flush the keytones.

    You could also choose to give a manual shot to get it in his system more quickly. You can program this information into his pump, so it is aware what insulin is on-board.

    With keytones, I usually check my son's blood sugar every hour to make sure it is going back down. Keytones take some time to clear - but keep pushing liquids.

    I would not give other food or drinks that would required more insulin until the numbers are way down.

    Where is his site placed when it comes out during sleep? Are you using tape to put over the site - that can help too. Good luck!
     
  4. zoomom456

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    When you test for ketones, are you testing blood urine? We find urine ketones to be hours behind blood ketones.
     
  5. StillMamamia

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    First you have to identify which type of ketones you're treating.

    For high BGs with ketones, there will be insulin resistance, so you have to add more insulin, either by using higher temp basals and/or giving more insulin with the correction. Usually a shot is needed as well, along with a site change.

    For starvation ketones (with normal or low BGs), you have to back off the insulin somewhat til the BGs normalize.

    I think what you can do for now is to:
    - get any tape which will keep the set in place overnight. You may want to try a different infusion set as well, to compare "stickiness";
    - test overnight more often

    See if there are morning ketones. Sometimes it will be because of poor insulin absorption due to a site failure or low basal settings. Sometime it can be due to a rebound - low BGs somewhere during the night, and rebound happening - the body was forced to turn to fat for energy, since there were no carbs eaten.

    You have to be careful about overtreating lows. Some test, treat, wait 15mins, test, treat, wait 15mins. I personally wait 20-30mins.

    PS - I do let my kid eat if he has high BGs and ketones, if he really wants to. What I do is cover those carbs more aggressively and do aggressive higher temp basals. Not ideal, but it has happened. Usually he's cooperative about this. We use toasted bread in these instances.
     
  6. valerie-k

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    blood ketones, so I know the exact number.
     
  7. Amy C.

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    I have my son change the site, do a correction, plus 20% of the TDD. His ketones are usually gone after a couple of hours.

    I don't see the need to give extra food.
     
  8. zoomom456

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    Just making sure and trying to eliminate the quick easy fix first:)
     
  9. Amy C.

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    Until you get a handle on his site coming off, I would consider using some Lantus as the basal. It seems like this has been going on for a while and you are at wit's end to resolve and your child is missing school. Having half or more of the basal given with Lantus would prevent the development of ketones until you get things under control.
     
  10. MomofSweetOne

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    Our only experience with ketones have been caused by heat stress. Since her BGs were normal, we just had to flush with water to get the ketones washed out.

    But, Gary Scheiner said in a T1U class that to clear ketones more quickly, insulin should be injected directly into muscle rather than fat. I'd definitely try it if high BGs were causing the ketones.
     
  11. Flutterby

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    If we have high bg, we don't bother with carbs, we give extra insulin and do a temp basal. How much of each all depends on how high the ketones are. Ketones will use the insulin first before the bg will get a chance to use it. I find ketones, especially high ones, incredibly stubborn for the first two corrections, by the third they are usually on their way down. I'd worry about feeding carbs with such high ketones.. ketones that high make the stomache hurt, adding food may not be a good idea. Also, first correction should be with a syringe, just to make sure the insulin goes in.. its possible to get another site issue right after the first one, if he's not getting insulin well through his pump the issue could become serious quickly.
     
  12. L101418

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    For high BG with blood checked ketones due to lack of insulin we do:

    small or moderate: normal correction + 10% TDD
    large: normal correction + 20% TDD
    we do not give extra carbs
    recheck
    recheck
    recheck

    If BG normal or BG low w/ ketones we do the same as Emma
     
    Last edited: Jan 19, 2012
  13. melissajm

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    This is what I would do too until you figure out how to handle the issue with his sites.
    I would check with his doctor to figure how much basal to give through the pump and how much with lantus.
     
  14. JackyH

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    For the type of ketones you are talking about I absolutely always give a shot, then change the site. I calculate the correction required and then give half again. This method clears the ketones within a couple of hours. Also give him water to drink. Never carbs.

    I do check overnight so I will usually catch and fix this at the 3am check. By morning he is back to normal and ready for school having no idea of what went on in the night.

    I hope you figure it out.
     
  15. Style mom

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    Same as everyone else for high BG plus ketones: insulin and no carbs.
     

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