Ketoacidosis or faulty ketone meter?

(Utility Muffin Research Kitchen) #1

I got a ketone meter because I’m still in the process of a shifting diet (from low glycemic to low carb to dirty keto to traditional keto to carnivore over the last 12 months). Not overly concerned about ketosis (I prepare all food myself and know the carb content), but I hoped to get something out of it as I’m diagnosed with ME/CFS. So metabolic anormalities are to be expected but I’m not sure if they extend to ketone production.

I got the meter about a month ago and it usually showed the expected ketone levels between 1.8 and 3. However, recently I got some very abnormal readings up to 9.0 which would indicate ketoacidosis, however they changed very fast (from 9.0 to 6.0 in ~10 minutes). I didn’t eat or drink anything before the tests (which can influence the readings). Diet was normal in the days before that.
Obviously I could just have ended up with a faulty device, which may be the most probable explaination.

Ketogenic diet should prevent from ketoacidosis as this usually happens only if we eat carbs (at least diabetic ketoacidosis). However, it’s a reaction of the body if it doesn’t get enough energy into the mitochondria and ME/CFS implies problems with ATP production, so it’s at least conceivable that the ketoacidosis is real.

So I’m curious to know: Have you seen fast fluctuations in ketone levels? Any way to calibrate the ketone meter and check if it works?

#2

It was my understanding that DKA typically only occurs under an absence of insulin. That insulin is the “turn off switch” that tells the liver to stop producing glucose and ketone bodies. That’s why DKA usually involves high glucose and high ketones – the liver is busy producing both types of fuel for the body, with nothing to tell it to stop.

(Utility Muffin Research Kitchen) #3

Exactly. The process is not well understood https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199956/

DKA happens in the presence of high glucose levels (250 and higher IIRC), however such high levels have never been observed with a ketogenic diet from glyconeogenesis. In fact I remember a doctor saying at a conference that they have treated several thousand T2D patients with KD and they haven’t had a single case of ketoacidosis.

Toxins are mentioned but I can’t find anything better than nondescript abstracts (https://www.ncbi.nlm.nih.gov/pubmed/22998993). Presumably there are other triggers for the massive ketone production, but we don’t know what they are.

(squirrel-kissing paper tamer) #4

Do you have symptoms of ketoacidosis? What is your blood glucose?

(Utility Muffin Research Kitchen) #5

No idea. I’m not a diabetic so I don’t measure blood glucose. With the drop of HbA1C I never saw the point, it is down to 5.0 from 5.7 a year ago. (I was an undiagnosed prediabetic though, HOMA was 1.7 when I last measured after half a year of dirty keto.) Last fasting glucose was high normal (105) consistent with dawn phenomen (keto diet and insulin resistance). This is due to the diet, fasting glucose was lower (<100) when I still ate carbs.

No symptoms except fatigue (obviously, due to my ME).

(Michael - When reality fails to meet expectations, the problem is not reality.) #6

If you are not Type 1 diabetic, you have zero risk of DKA. If you eat SAD and consume 500 grams of carbs per day for years, you will eventually develop insulin resistance and probably Type 2. But you will still have zero risk of DKA. You can not develop DKA in the presence of insulin, simply because insulin shuts down ketosis.

(Utility Muffin Research Kitchen) #7

Um, that’s not true. DKA is observed in T2D, and there is also AKA that happens even with low glucose stores.

(Michael - When reality fails to meet expectations, the problem is not reality.) #8

Thank you, I stand corrected.

DKA does occur in type 2 diabetes; however, it rarely occurs in the absence of a precipitating event.

Case 1

... A contrast MRI of both the thoracic and lumbar spine was ordered, and the patient was found to have a T10-T12 epidural abscess Figure 1.

Case 2

... An MRI of the left hip was ordered to evaluate for suspected osteomyelitis. Unexpectedly, it revealed left hip myonecrosis and a large loculated prostatic abscess Figure 2.

Read the Commentary of this article.

Clinical Pearls

  • DKA does occur in type 2 diabetes.
  • DKA in type 2 diabetes rarely occurs without a trigger.
  • When it does, an intensive search for the precipitating factor should be undertaken.

So I still say you are at zero risk. Insulin above a lower ‘threshold’ prevents ketosis.

Paleolithic Ketogenic Diet
(Justin Jordan) #9

Yeah, I had euglycemic ketoacidosis a couple of years ago. Body was making plenty of insulin at the time, too. I am type 2 diabetic, but my issue is insulin resistance rather than not producing enough.

In my case, it was a reaction to Invokana, which a rarish but not unknown side effect. The apparent reason for that is the drug also affects how you clear ketones. Even then, and this is typical, I needed something else to kick me over - some kind of stomach issue.

But in any case, you’d know if you had ketoacidosis. It is…unpleasant.

(Utility Muffin Research Kitchen) #10

ME/CFS is no piece of cake and what others call unpleasant may be normal for us :slight_smile: I’m not bedridden (thank god) but there were times where I had to spend almost all day in bed. But I guess I’d notice something out of the ordinary. :slight_smile:

Readings returned to the normal 2.7ish readings today, but I had a dozen abnormal readings distributed over 2-3 days. Weird. Maybe there is some substance that the meter gets mixed up with acteone that is in my breath. (I guess alcohol might fit the bill but I haven’t had any alcohol in a long time.)

(Utility Muffin Research Kitchen) #11

You’re probably right. But with a disease that has little biomarkers I’m always checking on slightly abnormal readings – sometimes this leads somewhere. I’m not terribly worried about this, but I’d still like to figure it out :slight_smile:

KA happens for T2D and alcoholics (and pregnant women), for which we can assume hepathic insulin resistance together with at least some insulin, as alcoholics don’t necessarily lack glucose control. (I am still insulin resistant btw, but probably not nearly as bad as a diabetic - last HOMA-IR was 1.7.) Not sure which enzymes are involved (we need fatty acids and carnitine of course), there must be some signal for the liver to produce ketones. With failing mitochondrial energy production it might just be conceivable that the signal is activated to increase the ketone levels. Gotta figure out the signalling.

There are a few older papers on ketone production (https://www.annualreviews.org/doi/pdf/10.1146/annurev.bi.49.070180.002143 looks promising) but I’m not sure if I want to hand over $32 for a non-guaranteed enlightenment :slight_smile:

(Windmill Tilter) #12

Doesn’t sound consistent with ketoacidosis. I don’t think it would last only for <10 mins. Does sound consistent with a bad test strip or a faulty meter.

If your A1C is 5.0, I don’t think you have much to worry about. If you’re concerned though, buy a second meter to validate the first one. It’s cheaper than a battery of blood tests, thats for sure.