Ketoacidosis (?)

(Malin Hallett) #1

Hello people

I just wanted to do a quick update and tell anyone interested about the last few days. After my relapse about 5 or 6 weeks ago I got straight back on keto and was doing very well. I had also introduced some fasting into my routine with some success. I measure my ketones using a breath ketone meter as I find it encouraging and interesting to see how my body reacts to different foods.

On Tuesday I got a migraine, or so I thought. I was very poorly, headache, nausea and sickness. Then it got a bit better but the next day it returned again and I slept 9-10 hours both Wednesday and Thursday night but had a super high resting heart rate and felt very unwell. I couldn’t eat much at all so did an unintentional fast between 3pm on Thursday until 1pm ish on Friday.

On Friday I still felt awful and out of interest I tested my ketones (breath meter so ppm) and it was 57 (nutritional ketosis is up to 39). I got a bit worried so ate a piece of banana but my levels kept going up until they got to 64 (ketoacidosis level), before starting to fall as I quickly ate of my daughters mini chocolate wafers. It stayed above 50 for several hours so I had some more carbs until I got under safe limit. I must have eaten in excess of 150g carbs yesterday and I assume it kicked me out of ketosis overnight but I was back in it again today (at more normal levels). If my levels had been high is isolation I wouldn’t have been particularly worried but i was because I was feeling so dreadful.

Anyway I am not sure what I am trying to say here but I thought it was interesting to share. I have eaten a few more carbs today (c50g) and have stayed in ketosis and feel OK again. I will go back to “proper” keto as of tomorrow. I am considering if I need to increase my carbs slightly once a month or so to stop this happening again (I know some people recommend this anyway so your body doesn’t forget how to burn glucose) or maybe trial a higher daily carb limit. Or it could have just been a freak event with a run down body / prolonged fast which perhaps isn’t right for me. Interested to hear thoughts.

(Bob M) #2

You probably didn’t have ketoacidosis. Did you measure blood sugar? That’s usually an indicator of ketoacidosis.

I don’t know about breath ketones, but for blood ketones, I’ve had blood ketones in supposedly ketoacidosis levels with no harm. That’s because while my ketones were high, my blood sugar was low. It’s high blood sugar AND high ketones that’s an issue.

Not sure what to do with nausea, but I’d take in more salt at least, maybe potassium, definitely magnesium. When you lower daily insulin levels, you tend to not hold onto these, and that can cause headache and the like, including high heart rate.

Personally, I’d give up trying to test ketones and foods. I tried that and with blood ketones, it never worked. Here’s a graph of a continuous blood ketone meter:

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This was the original study of a continuous ketone monitor, and they make these now for people. That is, you can buy one, though of course, they are only available overseas and not in the US. The US is always the last to get something like these (here’s look at you, over-the-counter continuous glucose monitors). But graphs from people who have them are a lot like these. If that’s what ketones look like during a day (and they look exactly like this), forget trying to see what happens for individual foods.

Anyway, if you want to ensure that what’s happening is ketoacidosis, check both ketones and blood sugar. You need high ketones and high blood sugar. (And, we’re talking HIGH blood sugar, 250–300+ in US units.)

(Malin Hallett) #3

I did have a CCM for two weeks but unfortunately not during this episode so I don’t know what my blood sugars are. I agree that it probably wasn’t ketoacidosis, but I think maybe I was on my way toward it - I did have nausea but that was probably the least severe symptom, I was very sick when I ate (i.e vomiting) , my appetite completely went (but was very thirsty) and my testing heart rate was between 88-90 when I slept whereas it’s usually around 60. I felt like I could have had a stroke at any moment, very very unwell.

(Joey) #4

Sorry to hear you felt so crummy. Hard to diagnose the specifics from afar, but unless you’re a Type 1 diabetic, given what you’ve shared the chance of it having been ketoacidosis rounds to zero.

This thread might be of interest…

(Malin Hallett) #5

Thank you for you that’s a very helpful thread!

#6

Good news is its almost impossible to get Ketoacidosis without being and out of control T1D.

(Malin Hallett) #7

So do we all think it was just a random coincidence that my ketones went that high whilst I was feeling like I was? I. E. The illness driving the ketones lower rather than the other way around?

(Megan) #8

Not sure what was happening, and no idea if breath meters are very accurate. I know the blood meter can be quite inaccurate. Also you heart rate was within the normal range, even tho it was higher than it normally is for you. Any kind of physical or emotional stress can make it rise a bit. I guess all you can do is see if it happens again? Sounds like you were feeling pretty rotten! Glad you’re feeling better now.

(You've tried everything else; why not try bacon?) #9

A diagnosis of diabetic ketoacidosis requires hyperglycaemia and serum β-hydroxybutyrate above 10 mmol/dL (symptoms don’t start until it rises to around 20 mmol/dL).

There is such a thing as “euglycaemic ketoacidosis,” seen in women on a ketogenic diet who attempt to fast during pregnancy, and people of either sex who are taking an SGLT-2 inhibitor. The solution in the first case is to avoid fasting during pregnancy and lactation (because of the heavy metabolic burden) and in the second case is to stop taking the drug. (SGLT-2 inhibitors are still under patent, so they are supposed to be prescribed in place of statins–which are now all out of patent, so their profit margin is less).

(Cathy) #10

I find that the breath ketone monitor is pretty inaccurate. Mine is one of the first generation so maybe they have improved.

As I understand it, those meters are designed for use for T1 diabetics and is an alternative method of detecting ketones.

If you actually had a ‘bug’ and were probably dehydrated (vomiting and not able to eat), your breath ketones might appear higher than normal and your actual unit might not be very accurate. Blood testing is the best for accuracy.

Adults can ‘develop’ type 1 diabetes and it can be sudden and unpredictable. So please don’t rule that possibility out.

(Edith) #11

Is it possible you were just sick?

(Malin Hallett) #12

Well yes of course, I was just wondering if my high ketones were the driver or the result, but I guess I’ll never know. Probably from what people are saying the result though - dehydration etc.

(Malin Hallett) #13

Thanks, I think is probably the most plausible answer too :slightly_smiling_face: