Skip to main content

A Wake Up Call



Hey all you PWD (people with Diabetes) out there...let me ask you something: do you really understand the whole ketone thing? And I mean, actually, truly, deeply understand what its all about?

Maybe you’re wondering where this is coming from. It almost seems ketones have slipped to the back of our consciousness, in the same vein as purgatory or Birkenstocks. I will admit, I test my ketones less often than I switch out my lancet (ok, two of my New Year’s resolutions noted). And I always thought ketones were directly related to high blood sugar, as I had always been directed to test them while I’m sick or over 250. So, it was to my complete and utter surprise when the friendly FAA-doctor’s nurse called me over after my urine test.

“You are showing large ketones in your urine,” she said, with that look in her eyes that says “you’re one of those Diabetics that doesn’t test their blood sugar and its always high and you are wanting to get cleared to fly a plane, are you crazy?!” I responded quickly, “Are your strips within date? I have had them give wonky answers if I use them past the expiration date.” She gladly offered up the bottle and allowed me to confirm their in-date-ness. I pulled out my CGM and showed her the flat line at 135 for nearly 4 hours. I even did a quick actual blood meter test to confirm the CGM wasn’t out to lunch. 121 was the reading on the meter.

I found myself in an extremely unknown and uncomfortable place. “My blood sugar is fine,” I thought, “but I am showing large ketones, not just moderate…large, dark purple.”

“What does that mean?” I said, bewildered.

“Well,” she said matter-of-factly, “it means your body is in a state of ketosis.”

No shit.

I nervously walked back to the exam room, a little scared. What the heck was going on here? I still wasn’t sure I believed her test strips and vowed to pick up a fresh bottle on my way home.

When the doctor came in he seemed extremely pleased with all the results the nurse had gathered, good eyesight, ok weight, great blood pressure. And eventually he got to the ketone issue. “Have you been trying to lose weight?” he said.

“Well, sure, I feel like I’m always trying to lose weight,” I answered.

“That’s probably why we saw some ketones in your urine.”

Hmmm…now I was starting to put the puzzle together, but I didn’t want to waste his time, so we finished up and I drove straight to the pharmacy, and as promised picked up a fresh bottle of ketone test strips. Sure enough as I compared the strip to the bottle at home, her strips weren’t lying. There I was with a blood sugar of 115 and large ketones.

I quickly sent a message to my endocrinologist at Vanderbilt to explain the situation and in the mean time scoured Google.

Both paths led to one probable solution: that I was burning fat, and therefore passing ketones. It wasn’t a result of not having enough insulin, it was due to a deficit of carbs and my body burning fat as energy.

This makes sense to me now, but it obviously didn’t when I was sitting there scared to death that something bad was happening inside my body. I guess when I was first diagnosed ketones were only equated with “bad” and I never truly understood what their presence meant or could mean in different circumstances.

I do now, and I also understand the importance of staying on top of these issues we sometimes file away in the recesses of our Diabetes consciousness.  

Comments

  1. Great post, April.

    I too have always associated ketones with highs, although the whole atkins phase the world went through recently did help me learn that burning fat throws ketones.

    Did you know that ibuprofen can also lead to false positives?

    I used to sometimes test my ketones after basketball and would get moderate purples. I always thought that it was from working out so hard and burning up a bunch of fat. Turns out it was probably from my dose of vitamin "I(buprofen)" I had taken before playing.

    I should clarify that I don't have any actual medical data to prove that, just something I heard/read somewhere. Coupled with my experiences, I think I believe it.

    ReplyDelete
  2. So I need to ask a question - one that I'm somewhat embarrassed to ask given that I probably should know the answer myself: "Is that bad?"

    And, on a related note, I remember seeing a TV commercial several years back for weight-loss program that followed a high-protein, low-carb diet. They demonstrated the use of Ketostix (OK, not the actual peeing on a stick part!) and the overexcited announcer exclaimed "The purple color means it's working..."

    There could be some misinformation out there, and that could be really dangerous. I still don't even understand it fully. Thanks for helping to explain some of it with your story!

    ReplyDelete
  3. This to Scott E, I'm April's mother and I asked her the same thing. Is this BAD? Her answer was "probably in the long run". I too thought keyones were to be worried about with a high. Who would have thought?

    ReplyDelete
  4. Another point I should make is that I have increased my water intake about 3-fold since "the incident" and have not seen any moderate-large ketones since. Apparently this is a way to dilute them (in that they are probably still there, but ...diluted). I plan to discuss this face-to-face with my endo in a couple weeks, I will blog about what happens! I'm so happy to hear that I'm not the only one that didn't know this could happen.

    ReplyDelete

Post a Comment

Who has two thumbs and loves comments? Nerdy April!!! Type one out and hit publish!

Popular posts from this blog

The road to curing Type 1 Diabetes

From the moment of diagnosis, the road is rough, the learning curve is steep and the stakes are literally life or death. The map is less-than-helpful - paths originating from virtually every corner, coalescing at a center point (aka "diagnosis") and bursting back outwards - some paths cross and wrap around each other but others are isolated. And even with all of these roads, most of the territory is uncharted - how did we all get here and how will we all exit? Where are the obstacles we haven't found yet? Which passage holds the key to unlocking the solution?

On any given day I feel pretty isolated with this disease - I'm the only T1D in my group at work, the only one in mission control, the only one in my family. I go through the logistics of calling insurance companies, ordering supplies, changing sites and troubleshooting malfunctions mostly on my own. Even those pesky carbs really only get counted in my brain, no group think for a meal bolus here. But there is b…

Hot OJT

Last week I had the chance to mentor a newly certified ADCO trainee - the NASA process is called "Hot On-The-Job-Training", or Hot OJT. What makes it "hot" you ask? Well, essentially I am hands off - he is sitting at the console, working all the plan reviews and updates, making calls to other flight controllers and to the flight director, reacting to anomalies and preparing material for the shift handover. My job is to act as the fault tolerance - a backup ADCO of sorts.

Tuesday was his last official day and by Wednesday morning he was in the backroom sending commands to ISS in preparation for the docking of a three-person Soyuz.


The beauty of this system is the gradual buildup in responsibility. There is a subtle shift from student, to subject matter expert, to fresh operations trainee to advanced trainee and finally to certification and real-time operations flight controller - the process takes two years on average and is considered by many to be enough specializ…

International Travel with Type 1 Diabetes

Whew! Back from one international trip and on to another next week! I will admit my eyes roll every time I get the "we're gunna need to pat you down" talk at TSA, but international travel is a whole different animal. I thought it might be fun to see what goes through my brain and into my bags for these types of trips!


I wouldn't be a NASA Flight Controller if I wasn't good at planning, the key to international travel as a T1D is PLANNING!

3 months prior

Assess supplies. Mine come in 90-days supplies so I like to inventory at least 3 months prior and make a plan to order more early if the trip is going to coincide with the end of my 90-day stock. In my experience supply companies are usually pretty good about adjusting orders as needed if you tell them the reason for the early request - just mention you have an international trip coming up and want to make sure to have plenty of supplies (and backups!) in time. Request a loaner insulin pump. It's likely the comp…
01 09 10