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[IPk] Re: Ketones with non-high bg

In a message dated 4/17/2002 1:13:07 AM GMT Daylight Time, email @ redacted 

> I'm a woman in need of advice. I'm trying to sort out my overnight basals 
> (yes, yes, 3am test). I have been doing overnight testing (one night I did 
> 12am, 1am, 2am, slept through the 3am alarm, and 5am). I've been doing this 
> for over a week at this stage, and I've never caught anything hugely out of 
> range - the readings are anywhere between 4 and 10, but not higher.
> However, I also have ketones every night. For example, last night at 9pm I 
> was at 10.2, I had an adjustment bolus and insulin for an eggs-and-cheese 
> dish. At 1.25am I was at 7.7 and I had a trace of ketones. At 6.57am I was 
> at 9.4 and I had small ketones. These numbers are a bit high compared to 
> other days, but the ketone pattern is the same.
> None of my overnight testing has demonstrated particularly high or low BGs 
> over a period of hours.
> My head (often a good indicator of what has happened overnight) feels 
> fairly 
> fine in the morning. Not particularly muzzy or achy. I'm also not thirsty 
> when I wake up in the morning, which I would expect to be if I'm producing 
> ketones.
> Question: What would cause me to produce ketones at BGs between 3-12? This 
> is the range I've seen over the past week, on different days.
> To add to my frustration, I got A1c results back today: 7, up from 6.8 four 
> months ago, which was up from 6.2. Last time the nurse has told me the very 
> poor BGs I had over christmas week probably caused that large increase, but 
> clearly that is not the case because I have been doing well in terms of 
> recorded numbers for the past 6 weeks or so. I had an A1c of 6 for a year 
> after starting the pump, so as you can imagine I am very concerned about 
> all 
> this. Clearly, I have a problem overnight.
> So, I'm doing overnight tests, tracking results, and changing basal rates 
> when appropriate. Any other suggestions? Oh yes - I will be making an 
> appointment with my diabetes day centre, but I'd like an expert opinion as 
> well.
> elizabeth
Hi Elizabeth,

Sorry to hear that things haven't been going as well as you'd like.

I agree with other comments made today - do check the meter and strips first, 
as your HbA1c has been rising (though personally I'd kill for results like 
that, I appreciate that for you it's not so good).  If they're OK, then there 
are other causes of ketone production - hyperglycaemia isn't the only one, 
some are not necessarily abnormal/harmful.  You've sent in previous 
correspondence that makes me think these others may be relevant if your 
equipment's accurate.  Factors such as eating a higher fat/protein diet, 
veg-based but with low/lowish carb content; lots of exercise without carb 
backup; not eating for long periods; being underweight with the previous 
factors - can cause ketone production to occur.  I agree that it's really 
only worth testing if your bg is raised, 14 and above is the figure normally 

By the way, I do apologise for problems in my transmissions, half of what I 
wrote to Donald yesterday was missed out.  Still can't get the hang of 
editing with the new system.  (Help!!!)

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