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Question:

From Yellowknife, Northwest Territories, Canada:

I am 40 years old and originally diagnosed Type 2 two years ago. My condition has progressively worsened, and due to results of a C-Peptide test administered in response to my increasing dependence on insulin to control my blood sugar, my doctor now feels that I am actually (and always was) Type 1, and that the condition has gradually developed over time due to successive viral attacks on my pancreas (original symptoms began suddenly two years ago and were "classic," although maybe not as severe as some Type 1's who may experience a more "instantaneous" failure to produce insulin. The difference is that my pancreas has produced progressively less and less insulin over the past two years, to the point where it is now likely not producing any).

I am 6'2", 205 lbs., am physically active, and eat a sugar and fat restricted diet. Sorry about the drawn-out pre-amble. My question is related to ketones. I often check for ketones when my blood sugar is above 15 mmol/L, and have never really noticed any (I use Ketostix produced by Bayer for vitro urine testing). This morning, I had relatively high sugars (22 mmol/L) and tested for ketones and shock of shocks, produced a reading of about 6 mmol/L of acid. The results repeated over the course two hours several times (every time I urinated, which was fairly often). I use 30 units of Ultralente before bedtime and about 15 to 20 units of Humalog (depending on my sugar level) before each meal, and normally have fairly good control. Okay, okay, I know you're all waiting with baited breath (even if it may a tinge fruity smelling) for the "question."

Should I be concerned about Ketoacidosis given the ketone reading? I've never experienced ketones before, but I can tell you, I feel like a piece of trash.

Answer:

Yes, you should be very concerned about ketones with high blood sugars and feeling ill. This is a sign that you need extra insulin immediately to prevent severe ketoacidosis. You need to contact your physician immediately.

After you get your blood sugar down, you need to figure out what precipitated the sudden decompensation of control. An infection, cold, stomach virus, or strep throat can do this. Spoiled insulin can precipitate ketoacidosis. I suggest you buy new bottles of insulin and keep the old ones to see if your blood sugars improve. There is also the small possibility that your insulin requirements increased rapidly or that you forgot an insulin dose. Rarely, ketones can occur with the rebound high blood sugar that can follow a low blood sugar. I suggest you discuss all these possible issues with your own physician.

TGL

Original posting 26 Jan 98

  
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Last Updated: Tuesday April 06, 2010 15:08:56
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