I just went from prediabetic to diabetic. I started the keto diet just two days ago and when I tested my ketone levels tonight using a breath meter it showed me at 2.35, then I tested about an hour later and it showed me at 3.2. I ate a few sweet potato fries and a bite of a bagel 25 minutes ago, then retested (the breath meter says to wait 20 minutes after eating before testing) and it shows I’m at 1.25, then 10 minutes later I’m at 1.65. So my first question is, for a diabetic, does 3.2 automatically mean ketoacidosis, or, since I’m on a keto diet are those numbers okay? My second question is, if I see my numbers heading towards 3.0 again, and I want to keep them from rising that high, do I need to change something in my macros, or just drink some water, or what?
Diabetes and high ketones
Your doctor didn’t discuss this with you?
Ketoacidosis is a typically only a concern for type 1 diabetics, because of their inability to produce insulin. If you went from pre-diabetic to diabetic, aren’t you a type 2? Or are you no longer producing any insulin?
I found this item to be informative:
The “tl;dr” from the article:
Ketosis and diabetic ketoacidosis (DKA) are not the same thing. While ketosis is triggered through an extended lack of dietary carbohydrate, DKA is triggered by the exhaustion of insulin in the blood; the consequence of which is the liver over-producing fuel for the body, including ketones which, when they accumulate, can turn the blood acidic and lead to death.
Very rare in type 2, so I understand.
My doctor is always concerned whenever presented with a fasted urine sample from me, because it always contains ketones. And every time I explain ‘yes, because I haven’t eaten anything since yesterday’. And then she remembers that that’s okay, and gives me a break.
I’ve had type 1 for many years and have never had DKA, thank goodness. I gather that it’s rare in type 2 patients. In the absence of exogenous insulin, type 1s have no chance of any of their own insulin (because it’s not there) mopping up the high blood glucose that is causing the body to source its energy from its fat supplies to survive and therein creating ketones. It is my understanding that type 2s aren’t in this kind of danger.
Not at all. That reading is well within the range for nutritional ketosis. Diabetic ketoacidosis doesn’t become a concern until you reach 10.0 or above, and even then, the real trouble starts at more like 20.0. If your pancreas is still producing any insulin at all, you need have no concerns about diabetic ketoacidosis. It is Type I diabetics, whose pancreas produces no insulin at all, who need to worry. Type II diabetics are still producing insulin, it’s just that they’ve become so insulin-resistant that they need to secrete lots of it. In some ways, it’s the opposite to the problem Type I’s have.
Your ketone production will be high for the next several weeks, as your body adjusts to using ketones as fuel in preference to glucose, but once your muscles fully adapt to fat-burning, the production of ketones will likely go down somewhat, as the liver begins to match production better to demand.
P.S.—If your doctor has you on a type of drug called an SGLT2 inhibitor, then you might have to worry about something called euglycaemic ketoacidosis, but this is a known side effect, and your doctor should be monitoring you.
You’ve got to be patient, the adjustments and positive effects take a little time. You’re in the major adaptive period now, your body needs a little time to adjust to burning fat efficiently. That’s’s why doctors give things a few months before seeing you again. You’ll be fine, the hard part was actually making the change.
While this is true, @PaulL, he did reference using a breath meter.
If you want to test your ketones because of concern about DKA then I would suggest a blood meter. I don’t know how the breath meter correlates, but you can’t just compare numbers from different systems.