Diabetes and ketones

Diabetes and ketones


Hi everyone, It’s Nalani (diabetes_pa). I’m sorry I’ve been a little MIA from YouTube
lately. I got really OCD about editing my YouTube
videos and it got to the point where it was taking me so long that I just didn’t have
the time for it. But the point of my YouTube is to get information
out to you guys so I’m hoping you’ll be patient with me as far as the editing or lack of editing
goes. I really just want to get the info out there
and hopefully I’ll get better at it with time. Anyway…let’s get to it. Today I want to talk about ketones and why
we test for them. I decided on this topic because I was literally
up all night with alarm after alarm from my CGM telling me “high blood sugar”, “high blood
sugar”, and alarm fatigue is REAL. I”m exhausted today but I thought this is
a good opportunity to teach you guys about ketones. So, what are ketones and why do we test for
them? Ketones are made when our bodies break down
fats and proteins and the byproduct of that is ketones. They’re everywhere. Cells normally run on glucose and the only
way glucose can enter our cells is with insulin. Think of insulin kind of like a transporter. Without insulin there’s no way for glucose
to get from our blood into our cells. People with diabetes who don’t have enough
insulin will tend to build up a lot of glucose in their blood, hence the high blood sugar
because there is not enough insulin pulling that glucose from the blood into the cells. What happens is when the blood glucose is
high, the cell glucose is low. Our cells need glucose in order to function
properly. Essentially our cells are starving when our
glucose in our blood is high. What happens is our bodies enter this starvation
mode and they start breaking down fat and protein and the byproduct of that is ketones. Ketones can be used directly by our cells
for fuel and they don’t need any sort of transporter to get into the cells. When blood ketones are high, this is called
ketosis. With hydration and normal blood glucose levels,
ketosis is usually not dangerous. Emphasis on usually. In fact, many diets promote ketosis because
it is an indicator of weight loss (fat being burned). It’s important to remember that ketones are
acidic and if we build up too many of them in our blood, that’s when ketosis turns into
ketoacidosis. It turns our blood acidic which can be really
dangerous for our organs. People with diabetes diabetes don’t have active
beta cells. Sorry… people with type 1 diabetes don’t
have active beta cells so there is no protective mechanism keeping them from progressing from
ketosis to ketoacidosis. It is dangerous for people with type 1 to
be in ketosis because something could easily push them over the edge into ketoacidosis. People who don’t have diabetes have functioning
beta cells and they make insulin so this helps prevent that dangerous progression. Ketosis in itself isn’t necessarily dangerous. It’s the ketoacidosis that’s dangerous. Some of these blood ketones pour into our
urine and if the blood sugars high and ketones are present this can indicate DKA so it’s
important to go the the emergency room if that happens. Physical symptoms of DKA can be excessive
urination, excessive thirst, nausea, vomiting, abdominal pain, confusion, weakness, fatigue,
shortness or breath, you name it. All of this warrants a trip to the ER. An interesting finding is that DKA has been
reported in studies testing SGLT2-inhibitors; like Jardiance, Invokanna, and Farxiga in
some type 1 patients. During these episodes, people with diabetes
had normal blood sugar levels which is really scary for us diabetics because that’s basically
what we know of as the indicator of DKA is high blood sugar levels plus ketones. For instance, if by blood sugar wasn’t high,
I wouldn’t necessarily think to check for ketones and think “hey, I’m nauseous. I should go to the emergency room I’m in DKA.” I would just think that I had a cold or something. So that’s where that can be really dangerous
and it’s important to note if you are on an SGLT2-inhibitor. SGLT2-inhibitors are more commonly used in
type 2 diabetics to prevent the absorption of glucose into the kidneys. This excess glucose is then excreted into
the urine. It’s obvious why that would help someone with
type 2 or type 1 diabetes and it is sometimes used off-label in people with type 1 diabetes
but it’s very very important to be aware that if you are on an SGLT2-inhibitor and you’re
having symptoms of DKA you can be in DKA even if your blood sugar isn’t high. The most common cause of DKA in type 1 patients
is unfortunately pump failures. All this really means is that if you’re on
a pump you need to be prepared with back up long and rapid-acting insulin. It’s important that you always keep an updated
list of your settings so that you know how to dose your insulin when you’re on the injections. And it’s usually pretty safe to dose your
basal long acting insulin as the total of your basal rate on your pump, but definitely
check with your clinician before taking that advice. Sometimes when I’m starting a new pumper or
a pumper with frequent DKA, I’ll ask them to inject half of their basal as long acting
and i’ll put the other half of their basal as their basal rate for the pump and then
slowly decrease the long-acting and increase the basal rate as a kind of insurance policy
so that if something does happen where maybe their not dosing correctly with their pump
or they get confused on how to input their infusion site then we have some back up insurance
policy insulin with that long-acting insulin to prevent them from going into DKA. So, anyway that’s really all I wanted to talk
about today. For all of you that are curious, I did not
have ketones this morning. Thank God, but I thought it would be a good
opportunity to teach about it. I love that this blog kind of helps me turn
my negative experience into a positive. Anyway, if you have questions please comment
below. Remember to consult with your clinician before
taking any of my advice on here and I hope you guys have a wonderful day full of very
little CGM alarms. Bye!

2 Replies to “Diabetes and ketones”

  1. Lately after I’ve been having high carb meals, even after I dose for it, (not on a pump, on multiple shots) my blood sugar sky rockets. It’ll go from around 120-250/300 and all the sudden I’ll get really tired and have a hard time staying awake, like I can feel myself nodding off even when I’m trying to fight falling asleep. I was just wondering what your opinion on that is?

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