Skip to main content

Ketones Part 2



After a great new pump training class (hello Animas ping!) and my best A1c yet, 6.9 (down from 7.5 last time, and completely attributed to my handy dandy CGM), I was anxious to get in the exam room to ask my doctor all about my recent ketone episode.
She had a residency nurse with her and they carefully examined my numbers and trends. I was internally delighted when I heard phrases like, “Wow, those are really in-line” and “I’m not sure what to tweak at this point” spilling from their teacher-student type conversation. It helped having Chris there to show we were a united team in this Type 1 mess, and I think the new nurse picked up on how much Chris is a part of my Diabetes solution.
But anyway, back to the ketone thing. I interrupted Dr. C as she went through the normal barrage of questions, “Any pain? Any change in weight? Any swelling or numbness?”
“I do have a question about ketones,” I said, implying the rest of my health stats had remained the same.
She answered, “Go ahead,” with a slightly confused look on her face.
I explained my episode at the FAA doctor, spilling large ketones with a perfect blood sugar and a flat line on my CGM.
“I will be honest with you,” she said, “We don’t even push the ketone thing anymore.”
“What do you mean? When I was diagnosed it was hammered in to my parents and I to test anytime a blood sugar is over 250 or I’m sick. My mom even ordered those strips with the rest of my prescriptions!” I said.
“The thing is, ketone testing is extremely inaccurate. Ketones are just proteins breaking down, and they can show up in urine from eating a meal with a lot of protein or eating low carb or really a number of other reasons. There really is no reason to be worried that large ketones were showing up in your urine on that day. In fact, it doesn’t make much sense for them to be testing ketones anyway.” [To which, I replied in my head, “Nothing surprises me, it’s the freaking FAA for goodness sakes!”]
“OK, that makes me feel a lot better about it,” I responded.
She continued to update my prescriptions and we talked about how much I like the CGM.
Chris treated me to Cheesecake Factory on the way home in response to my 6.9 A1c, and my blood sugar never rose over 160 the whole night, cheesecake and all.
I’m so thankful for the professionals at Vanderbilt who go above and beyond to make Diabetes a little bit easier. And now you really know that truth about ketones!

Comments

  1. So whatdya know... you learn something new every day! I'll still plan on checking ketones when my BG is super-high for no reason (maybe with my new blood ketone meter which gives a number that I have no idea how to interpret), just to see if my pump site may have not been delivering insulin for the last few hours.

    But this is really good to know. Thank you for that!

    ReplyDelete
  2. How interesting!

    So I would guess that the theory behind us testing ketones when we're really high would be to just give us a good indication on whether we're high because our insulin delivery system is having problems versus being high from miscounting carbs or something?

    But if we're high from eating a whole cow, then it might produce false positives. :-)

    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