Monday, January 7, 2013

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.