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RE:[IP] Ketones with pump
High BG and ketones are independent of each other and inversely related to
Here is my understanding. Some may disagree. Please speak up. (As if I
have to ask.)
One shows ketones when one is breaking down protein and fat to get energy.
A low calorie diet or an insufficient insulin supply will put you into the
need for tapping into you protein/fat reserves. One only shows ketones in
the urine after they are of some sufficient level in the blood. Then they
"spill over" into the urine.
So, as long as you have glucose in your blood and or liver and you have
ENOUGH insulin to run things right, there should be no ketones showing in
When pumping, you have a shorter time to ketones showing than if you have a
NPH thing going. If you disconnect, fail a site, get bad insulin or
somehow loose that supply of insulin, you have a few hours until you will
be starting to produce ketones in your blood at higher level than is
normal. No big problem if you test often and are diligent about trouble
shooting high numbers. The high numbers are an early signal that there may
be a problem with the insulin delivery. High numbers are more often a sign
of poor basal rates or carb ratio, but the numbers should go up before
ketones spill unless you are actually starving.
One nice thing about pumping is that you can calculate how much insulin is
in you and add more in precise amounts. The pumps record the times and
amounts of boluses. Ever get to lunch and have a high number and wonder if
you forgot your morning shot?
To your questions:
>>how would a bg of 200-250 produce moderate-heavy ketones if you weren't sick or something?
High BG does not produce ketones, lack of insulin does.
>>Would the total lack of insulin produce such a phenomenon in someone regardless of the bg?
Yes, BG and ketones are independent of each other and inversely related to insulin supply.
>>are ketones really easy to get if your bgs aren't very high but your not get enough insulin(likeif you fast for 12+ hours)?
As long as your basals are OK. You will have enough insulin for you
metabolic activity and no ketones will show in a 12 hr fast. And your BG
level will be good too. But there are a lot of factors that effect BG
level and it would be hard to have a perfect 12 hr run of bgs. Typically,
a 3-6 hr run is all we hope for. Theoretically a 24 cycle could be
>>And do most peopleon pumps have problems with insulin site
absorption-with developing ketones?
If you test often you should see an increase in BGs and add insulin. We
have only seen ketones from being disconnected for 6 hrs and not knowing
it. Forgetting to reconnect after a bath and going to sleep. Waking with
moderate ketones and Bg 400. A 2 unit bolus and water knocked them down in
a couple of hours.
My daughter is home now with a fever and aches and pains. She has no
ketones and an increase in her basals has kept the BG near 200 all day.
That is a little high but OK for the situation. Several boluses during the
night kept her in the 200s.
Think of the pump as programmable NPH or Ultra lente.
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