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"Glucose derived from carbohydrate is the body's first choice as an energy
source. Without insulin, cells cannot utilize glucose and the body shifts
from metabolizing carbohydrates to fat for energy. This shift is
accompanied by elevated blood glucose levels (hyperglycemia) and the
appearance of normal, acidic by-products of fat metabolism known as
ketones. When fats are the main source of energy, ketones accumulate and
are detectable in the blood and urine. The accumulation of ketones moves
the body's electrolyte balance to the acidic range, contributing to
diuresis (excessive urination) and dehydration as the body tries to
reestablish its acid-base balance by excreting the ketones. This
life-threatening condition is known as diabetic ketoacidosis (DKA)."

There is a further notation in this chapter that the researchers "observed
that the most common triggering event for DKA in all treatment protocols is
failure to respond to elevated blood glucose readings immediately and

"Pumping Insulin" and the MiniMed book indicate that it may be necessary to
increase insulin by as much as 50% to 100% to bring the BGs back into
target range when ketones are present in the urine.

Most recommendations re: prevention of DKA are centered around *prompt
action* when BGs get above 240, remain there and ketones are present.
Injection by syringe of fast acting regular, changing the infusion set,
tubing, reservoir / cartridge are also recommended. "Copious amounts of
fluid" are recommended, but can be a challenge, since "impending DKA" may
make the pumper nauseous.

I've never suffered from DKA. I do remember vividly the tales my CDE told
me when I started pumping, so I tend to be a bit cautious with high BGs.

Bob Burnett

mailto:email @ redacted
Insulin-Pumpers website   http://www.bizsystems.com/Diabetes/