Chris DeWald: Ketones

Column by Chris DeWald
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I had the wonderful experience of being the research rat for ketones last night. This reminds me of the Keystone Cops with the Keystone Cops being your blood glucose meter.

According to, ketone test checks for ketone in your blood or urine. Ketones are substances that are made when the body breaks down fat for energy. Normally, your body gets the energy it needs from carbohydrate in your diet. But stored fat is broken down and ketones are made if your diet does not contain enough carbohydrate to supply the body with sugar (glucose) for energy or if your body cannot use blood sugar (glucose) properly.

A blood test is the most accurate method of measuring ketones. It is recommended for all people with diabetes whenever symptoms of illness are present, such as nausea, vomiting, or abdominal pain. These symptoms are similar to symptoms of high blood sugar and may mean you have diabetic ketoacidosis, a potentially life-threatening condition.

Life-threatening? All right now, you have my direct attention. I have a precision blood/glucose meter that was issued to me at the veterans clinic. This brand of meter measures your blood glucose and also warns you that it has detected ketones. I can assure you the word KETONE flashes when it is detected.

Ketoacidosis is associated with acute hyperglycemia, a severe insulin deficiency, and a disruption of the body’s acid-base balance. Excess ketones and glucose are dumped into the urine by the kidneys in an effort to flush them from the body. This causes increased urination, thirst, dehydration, and a loss of electrolytes. The affected person may also experience symptoms such as rapid breathing, shortness of breath, a fruit-scent to the breath, nausea, vomiting, fatigue, confusion, and eventually coma.

Some signs and symptoms of ketoacidosis include:
– increased urination, excessive thirst
– dehydration, loss of electrolytes
rapid breathing, shortness of breath
– a fruit-scent to the breath
– nausea, vomiting
– fatigue
– confusion
– sometimes coma

My blood glucose started at 399 mg/dl. The blood glucose goal range for most adults with Type 1 diabetes is 70-150 mg/dl. Therefore anything above 150 mg/dl is usually considered “high.” The meter was flashing “KETONE”. I went to my handy dandy computer to see if this was serious. If you have read this so far, you would see it is. I could not find my password or user name in my head. Well, had the confusion part. I was steadily drinking bottles of water and my mouth was dry as cotton. I was fatigued but I am always fatigued from the strokes. I was in trouble.

I have access to insulin and started my injections to help get rid of the excess sugars. For two hours, my readings would not go under 350 mg/dl and keytones flashed away with each test. After 4 hours, I got it under 275 mg/dl and the keytones stopped. In between this, I went to the ER because I could not get my numbers down and keytones can be deadly. The local ER was filled to capacity. So I stayed in a no parking zone outside and every 50 minutes, tested myself and injected insulin. Why? There was an ER line of patients and I figuered if I passed out, someone would report me or leave a ticket on my dead carcass.

Once I saw my keytones were not flashing anymore, I drove home. Did I say drove? Bad decision people out there. My pride would not allow me to call 911 and I should have. Besides that, I would have a direct inside look at the attending ER staff. Remember, don’t be “dead” wrong.

In the final analysis, my blood glucose came down to 141 mg/dl after 9 hours and “96” units of novolog insulin. This morning I am fine and in normal range.

In close, I pass on to you a lesson from

Ketones present in excess in the body – and can be dangerous even in people without diabetes. It is never “OK” for a person with Type 1 diabetes to have ketones. It is important to distinguish between the significance of ketones in somebody with type 1 diabetes versus in someone without diabetes. If a nondiabetic person goes for a “long enough” period of time without food, they will produce less insulin than normal for them and it would not be surprising if modest levels of ketones appear in the blood. However, in somebody with type 1 diabetes, the presence of ketones signifies a dangerously low level of insulin.

Like the “low fuel” light on your car means you are almost out of gas, ketones mean you are almost out of insulin. Normally it takes VERY Insulin is the “key” that allows glucose into our cells for energy.We need energy 24 hours a day, every minute of the day. Even if we eat zero carbohydrates for a whole day, our bodies need a constant supply of insulin.

If we don’t have enough insulin, then our bodies can’t get enough energy. We start breaking down fat and muscle for energy. When fat and muscle are burned for energy, ketones are produced. Ketones (the term we use loosely to describe the keto-acids acetoacetic acid and beta-hydroxy-butyric acid) – are a breakdown product of fat which is dangerous when LITTLE insulin to turn off ketone production. Although blood glucose levels are usually high if you have ketones, the ketones are not caused by high blood glucose levels. Ketones tell us about the insulin level in the blood. In most cases, blood glucose levels are high when people have ketones. But ketones may be present with a normal blood glucose level.

Ketones are a sign that our bodies are not getting enough energy from glucose. If we are not getting enough energy, lactic acid can build up in our tissues and in the blood. Ketones are also an acid; the more ketones in the blood, the more acid in the blood.

Did I scare you? I hope so. I scared myself. Always talk to your physician and call 911 for emergencies.

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