Thursday, January 24, 2013

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!

2 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!

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  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. :-)

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