Type 1 Diabetics Ketosis vs DKA?
alsunrise
Posts: 386 Member
This may be a stupid question, but I don't know the answer so I have to ask....
How do you know if ketones are from Ketosis or DKA? Is it judged based on your BG leves?
How do you know if ketones are from Ketosis or DKA? Is it judged based on your BG leves?
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Replies
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"The combination of high blood sugar and high ketone levels can upset the normal acid/base balance in the blood and become dangerous."
https://ketogenic-diet-resource.com/ketoacidosis.html1 -
tcunbeliever wrote: »"The combination of high blood sugar and high ketone levels can upset the normal acid/base balance in the blood and become dangerous."
https://ketogenic-diet-resource.com/ketoacidosis.html
So for instance if my daughter has a 'trace' or 'small' amount of ketones, but has a normal blood sugar, then that would mean she is in ketosis, right? And we don't need freak out that she's going to go into DKA?...0 -
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tcunbeliever wrote: »"The combination of high blood sugar and high ketone levels can upset the normal acid/base balance in the blood and become dangerous."
https://ketogenic-diet-resource.com/ketoacidosis.html
So for instance if my daughter has a 'trace' or 'small' amount of ketones, but has a normal blood sugar, then that would mean she is in ketosis, right? And we don't need freak out that she's going to go into DKA?...
I think it might be important to note that your 11 year old daughter who I will guess you are asking about is TYPE 1 DIABETIC. Correct? Your profile indicates she is type 1 diabetic.
A lot of well intended "generic answers" get tossed around in this and all forums....0 -
DKA occurs when *both* ketones *and* blood glucose are high.
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tcunbeliever wrote: »"The combination of high blood sugar and high ketone levels can upset the normal acid/base balance in the blood and become dangerous."
https://ketogenic-diet-resource.com/ketoacidosis.html
So for instance if my daughter has a 'trace' or 'small' amount of ketones, but has a normal blood sugar, then that would mean she is in ketosis, right? And we don't need freak out that she's going to go into DKA?...
I think it might be important to note that your 11 year old daughter who I will guess you are asking about is TYPE 1 DIABETIC. Correct? Your profile indicates she is type 1 diabetic.
A lot of well intended "generic answers" get tossed around in this and all forums....
@kpk54 ...........I did, in the title. I labeled the thread with type 1 in it....0 -
@midwesterner85
I think it's all about how extreme the levels are DKA has HIGH Bg and ketones. Normal ketosis has moderate BG (typically) and the ketones will not be super high.0 -
Assuming you are trying to determine at home, the best method is to use a blood ketone meter.
Since you are using ketone urine strips now, you don't have real accurate information. Urine strips let you know there are ketones, but that doesn't answer the question about whether those ketones are nutritional ketosis, starvation ketosis, or DKA. There are many reasons for this - It may be lower than reality early because urine lags quite a bit. After months or years, you have more ketones than the strips indicate, but have been in ketosis for so long that your body is very efficient at using ketones (not spilling much). Or they may be higher than reality in the event of dehydration, low urine output. When BG is high (over 225 mg/dl), osmotic diuresis occurs and you will likely have a whole lot of urine output and become dehydrated as a result. Once again, high urine output means the urine strips read lower than true numbers.
The simple answer is that you need a blood ketone meter if you want to determine at home whether you are in a ketosis or DKA level. Technically you need more testing since DKA isn't just very high ketone levels, it is a bunch of other physiological changes as well. But you can be pretty close to certain at home based on symptoms and blood ketone levels.
The more complicated answer is that you most likely are not in DKA if it is showing as just small on urine sticks. DKA levels would almost certainly be dark purple. That isn't 100%, of course, so there remains some risk. If asymptomatic and BG's are within a normal range, then I don't sweat it.
*I realize this is your daughter, so "you" is to be taken generically. Also, (disclaimer here) consider that I'm not a physician and as far as this thread is concerned, I'm just another type 1 diabetic with a couple decades of experience.5 -
midwesterner85 wrote: »Assuming you are trying to determine at home, the best method is to use a blood ketone meter.
Since you are using ketone urine strips now, you don't have real accurate information. Urine strips let you know there are ketones, but that doesn't answer the question about whether those ketones are nutritional ketosis, starvation ketosis, or DKA. There are many reasons for this - It may be lower than reality early because urine lags quite a bit. After months or years, you have more ketones than the strips indicate, but have been in ketosis for so long that your body is very efficient at using ketones (not spilling much). Or they may be higher than reality in the event of dehydration, low urine output. When BG is high (over 225 mg/dl), osmotic diuresis occurs and you will likely have a whole lot of urine output and become dehydrated as a result. Once again, high urine output means the urine strips read lower than true numbers.
The simple answer is that you need a blood ketone meter if you want to determine at home whether you are in a ketosis or DKA level. Technically you need more testing since DKA isn't just very high ketone levels, it is a bunch of other physiological changes as well. But you can be pretty close to certain at home based on symptoms and blood ketone levels.
The more complicated answer is that you most likely are not in DKA if it is showing as just small on urine sticks. DKA levels would almost certainly be dark purple. That isn't 100%, of course, so there remains some risk. If asymptomatic and BG's are within a normal range, then I don't sweat it.
*I realize this is your daughter, so "you" is to be taken generically. Also, (disclaimer here) consider that I'm not a physician and as far as this thread is concerned, I'm just another type 1 diabetic with a couple decades of experience.
@midwesterner85
I've learned in the past couple of months that sometimes it's better to talk to someone who has a couple decades of experience vs the physician (or in our case *diabetic educators*)
Right now, we don't have her on low carb, she can have up to 75 carbs per meal, but we try not to go that high. I'm just trying to gather info, I've heard of T1Ds having good results from going keto, but it intimidates me. I don't want to do anything that might cause her to go into DKA. 1 -
midwesterner85 wrote: »Assuming you are trying to determine at home, the best method is to use a blood ketone meter.
Since you are using ketone urine strips now, you don't have real accurate information. Urine strips let you know there are ketones, but that doesn't answer the question about whether those ketones are nutritional ketosis, starvation ketosis, or DKA. There are many reasons for this - It may be lower than reality early because urine lags quite a bit. After months or years, you have more ketones than the strips indicate, but have been in ketosis for so long that your body is very efficient at using ketones (not spilling much). Or they may be higher than reality in the event of dehydration, low urine output. When BG is high (over 225 mg/dl), osmotic diuresis occurs and you will likely have a whole lot of urine output and become dehydrated as a result. Once again, high urine output means the urine strips read lower than true numbers.
The simple answer is that you need a blood ketone meter if you want to determine at home whether you are in a ketosis or DKA level. Technically you need more testing since DKA isn't just very high ketone levels, it is a bunch of other physiological changes as well. But you can be pretty close to certain at home based on symptoms and blood ketone levels.
The more complicated answer is that you most likely are not in DKA if it is showing as just small on urine sticks. DKA levels would almost certainly be dark purple. That isn't 100%, of course, so there remains some risk. If asymptomatic and BG's are within a normal range, then I don't sweat it.
*I realize this is your daughter, so "you" is to be taken generically. Also, (disclaimer here) consider that I'm not a physician and as far as this thread is concerned, I'm just another type 1 diabetic with a couple decades of experience.
@midwesterner85
I've learned in the past couple of months that sometimes it's better to talk to someone who has a couple decades of experience vs the physician (or in our case *diabetic educators*) Right now, we don't have her on low carb, she can have up to 75 carbs per meal, but we try not to go that high. I'm just trying to gather info, I've heard of T1Ds having good results from going keto, but it intimidates me. I don't want to do anything that might cause her to go into DKA.
Just be sure you are on top of what is going on with her blood glucose and properly managing her insulin -- always -- but especially during times of illness, stress, and possible dehydration.
DKA occurs when there is a *deficiency of insulin*. At the hospital, it is treated with insulin, fluid replacement, and balancing electrolytes.
I understand your concern, and it is certainly something to be aware of and educated about. I just don't want you to live in fear that it is going to spontaneously occur, simply due to the presence of ketones. That's not how it works.
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Nutritional ketosis doesn't just become DKA without some aggravating factor. Insufficient insulin is typically the culprit, which causes DKA even in people who eat SAD.
If you have not heard of Dr. Bernstein, you might want to look him up. He's a type 1 diabetic, an endocrinologist, and advocates a very low carb diet. He has books and a YouTube channel, he's in his 80's and doesn't have any complications from having type 1 for some crazy amount of time.3 -
Hi, here is the Type 1 Grit web link -- read up, and join the facebook group to ask questions about Type 1 on keto. Very helpful people. http://typeonegrit.blogspot.com/1
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midwesterner85 wrote: »Assuming you are trying to determine at home, the best method is to use a blood ketone meter.
Since you are using ketone urine strips now, you don't have real accurate information. Urine strips let you know there are ketones, but that doesn't answer the question about whether those ketones are nutritional ketosis, starvation ketosis, or DKA. There are many reasons for this - It may be lower than reality early because urine lags quite a bit. After months or years, you have more ketones than the strips indicate, but have been in ketosis for so long that your body is very efficient at using ketones (not spilling much). Or they may be higher than reality in the event of dehydration, low urine output. When BG is high (over 225 mg/dl), osmotic diuresis occurs and you will likely have a whole lot of urine output and become dehydrated as a result. Once again, high urine output means the urine strips read lower than true numbers.
The simple answer is that you need a blood ketone meter if you want to determine at home whether you are in a ketosis or DKA level. Technically you need more testing since DKA isn't just very high ketone levels, it is a bunch of other physiological changes as well. But you can be pretty close to certain at home based on symptoms and blood ketone levels.
The more complicated answer is that you most likely are not in DKA if it is showing as just small on urine sticks. DKA levels would almost certainly be dark purple. That isn't 100%, of course, so there remains some risk. If asymptomatic and BG's are within a normal range, then I don't sweat it.
*I realize this is your daughter, so "you" is to be taken generically. Also, (disclaimer here) consider that I'm not a physician and as far as this thread is concerned, I'm just another type 1 diabetic with a couple decades of experience.
@midwesterner85
I've learned in the past couple of months that sometimes it's better to talk to someone who has a couple decades of experience vs the physician (or in our case *diabetic educators*) Right now, we don't have her on low carb, she can have up to 75 carbs per meal, but we try not to go that high. I'm just trying to gather info, I've heard of T1Ds having good results from going keto, but it intimidates me. I don't want to do anything that might cause her to go into DKA.
You got some great answers and resources here. I just wanted to add that simply eating low carb or keto will not increase your T1D daughters likelyhood of DKA anymore than it would for a non diabetic person... a non diabetic person can not get DKA by the way, because they always have insulin. As long as your daughter continues to get proper insulin she cannot get DKA. Insulin is the prevention. Blood sugar is more likely to be lower and more normal on keto and low carb and that will also make DKA less likely.
I have way too much experience with DKA unfortunately. My daughter (an adult) tends to have it once or twice a year because of mismanagement or because illness like flu or infection drives blood sugar crazy high and she just can’t seem to get it down no matter how much insulin she seems to take. Even then, I think there’s some mismanagement involved due to sleeping through the day and not testing and managing things until it’s too late.
One thing to be prepared for though is that your doctor might convince you that keto or low carb can cause DKA. I say that because my daughters doctor tried to. The lady literally looked at us like my daughter was suicidal and trying to harm herself. She literally said “you will die if you eat that way” we got a new doctor and never used the word keto again. She just says she doesn’t eat a lot of carbs because it’s easier to dose correctly. She says she just eats meat and veggies.
It’s a shame she has to mislead the doctor but she doesn’t want a lecture.
Your daughter deserves normal blood sugars just like you and I have.
Please check out the Facebook group Type1Grit and also look for a documentary to come out hopefully soon called Let Me Be 83.
Best of luck to you and your daughter.0
