Ketosis or Ketoacidosis?

[tilt]

Hi,

I have been diagnosed as diabetic two weeks ago (my doctor said my sugar and cholesterol were "completely out of control". He said I could either start medication right then or could try and lose weight for a month and see if that makes any difference.

I started on Atkins two weeks ago but only tested my urine with Ketostix today. They turned a dark pink (last but one shade on the bottle). My question is: How would I know if the colour change were due to ketosis or ketoacidosis? The instructions on the ketostix mentioned that any colour change meant that I had better call my doctor immediately and maybe even check myself into Emergency!

By the way, the doctor never told me whether I was type 1 or type 2. All I know is that ketosis is desirable on Atkins but ketoacidosis is not and is in fact danegrous.

Thanks and cheers :)

[Lisa N]

Hi Tilt!

The answer to your question lies in how your blood sugars look (you are testing your blood sugars regularly, right?). If they are in a normal range, then the dark color on the test strips is due to dietary ketosis. If your blood sugars are high (over 250), then a call to your doctor as soon as possible would probably be prudent. You need a high blood sugar to develop ketoacidosis.
BTW...darker is not necessarily better on the ketone testing strips with weight loss and can be an indication of dehydration. Try to get at least eight 8 oz. glasses of water daily.
HTH!

[eevee]

Here are definitions from MedicineNet Medical dictionary....

Ketoacidosis: A feature of uncontrolled diabetes mellitus (http://www.medterms.com/script/main/art.asp?ArticleKey=343) characterized by a combination of ketosis and acidosis (http://www.medterms.com/script/main/art.asp?ArticleKey=6846). Ketosis is the accumulation of substances called ketone bodies (http://www.medterms.com/script/main/art.asp?ArticleKey=11541) in the blood. Acidosis is increased acidity of the blood.


Symptoms of ketoacidosis include slow, deep breathing with a fruity odor to the breath; confusion; frequent urination (polyuria (http://www.medterms.com/script/main/art.asp?ArticleKey=16279)); poor appetite; and eventually loss of consciousness. The treatment of ketoacidosis is a matter of urgency and is usually done in a hospital. It may require the administration of intravenous (http://www.medterms.com/script/main/art.asp?ArticleKey=4021) fluids, insulin (http://www.medterms.com/script/main/art.asp?ArticleKey=3989), and glucose (http://www.medterms.com/script/main/art.asp?ArticleKey=3608), and the institution of changes in the person's diet



Ketone bodies: Chemicals that the body makes when there is not enough insulin (http://www.medterms.com/script/main/art.asp?ArticleKey=3989) in the blood and it must break down fat (http://www.medterms.com/script/main/art.asp?ArticleKey=3394) instead of the sugar glucose (http://www.medterms.com/script/main/art.asp?ArticleKey=3608) for energy. The ketone bodies -- acetone (http://www.medterms.com/script/main/art.asp?ArticleKey=6845), acetoacetate, and beta-hydroxybutyrate -- are toxic acidic chemicals. They build up in the blood and then spill over into the urine. The body can also rid itself of acetone through the lungs. This gives the breath a fruity odor. The presence of ketone bodies in the blood is termed "ketosis" and in urine is called "ketonuria (http://www.medterms.com/script/main/art.asp?ArticleKey=12478)."
Eve

[Luscious]

I'm pretty sure if you were Type 1, your doc would have had you in hospital and getting onto insulin injections pretty much right away. If he has suggested medication and diet, then it is likely Type 2.

[tilt]

Thanks Lisa, Eve and Luscious.

No Lisa, I am not checking my blood sugars at all. Did not know I was supposed to. The doctor said I have to try and lose weight for a month and repeat my tests, so I thought that is all I have to do. Do I have to keep going to the lab every day or can I do it myself (long as it does not involve poking a needle into myself)?

Eve, I do urinate frequently, but I thought that was because I drink lots of water, plus the Winter (because I don;t sweat as much in Winter, the water has to get out some other way, right?). Also my appetite has gone down a lot but I thought that was because I am on Atkins Induction where the appetite is SUPPOSED to go down due to the high fat.

Luscious, I hope it is Type 2 rather than Type 1, I hate needles!

But the fact of the matter is that in the last two weeks since I started Atkins, I have not lost any weight or inches and I have been following the instructions religiously.

Cheers

[Lisa N]

No Lisa, I am not checking my blood sugars at all. Did not know I was supposed to. The doctor said I have to try and lose weight for a month and repeat my tests, so I thought that is all I have to do. Do I have to keep going to the lab every day or can I do it myself (long as it does not involve poking a needle into myself)?

Yikes, Tilt! You've been diagnosed as a diabetic and nobody has said anything to you about testing your blood sugars at home?? That's frightening, especially since your doctor has said that your blood sugars are "out of control"! Did your doctor happen to tell you how high your blood sugar was?
Yes, you should be doing that...several times a day at this point and I hate to tell you, but yes it will involve poking yourself somewhere. Some of the "poking" devices (called lancets) now allow you to test at sites that don't hurt as much (and really it doesn't hurt that much even on your fingers) as your fingertips like your forearm, but a drop of blood will be required each time you test. Really, it's not all as bad as it sounds and it's vitally important that you know what your blood sugars are doing and how different foods affect them. You simply can't rely on a blood test at a lab every several weeks to control your blood sugars.
You can get a glucometer (home blood glucose testing device) at most any pharmacy and a lot of large grocery store chains that have pharmacies as well as the testing strips that go with them. You do not need a prescription to purchase one. All of them come with manuals that instruct you how to use them. Check how much the test strips that go with the meeter you're considering cost before you buy the meeter; often the strips cost more than the meeter does. You might also want to check with your insurance carrier if they will cover the cost of the meeter and test strips.
Typical times to test, at least until your blood sugars are within normal range and stable, are: fasting (first thing in the morning before you eat, smoke or drink anything), before meals, 2 hours after meals and bedtime. Before meals isn't absolutely vital unless you are a type 1 and need to base your insulin dose on your pre-meal blood sugar, but you should be testing at the rest of the times for now.
I would encourage you to get a glucometer and start testing as soon as possible so that you know how you're doing. Without one, it's impossible to tell if you are spilling ketones in your urine because of high blood sugars or because of being on a low carb eating plan.
One other question...are you using strips that only test the urine for ketones or does it also test for glucose in the urine?

[wsgts]

I had the same problem. Doctor said your blood sugar is 599, here go get this prescription filled, I'll call it into the drug store.

So, I sat and wonder what the hell my sugar is doing, and if I should have called 911 or what.

You need to know what you sugars are doing, even if it was calling the doctor's office to find out how bad off you were. Need the cholesterol information as well (might as well have it).

Don't take it for granted that there was anything much wrong with your numbers unless you know what they are, but if they were actually "out of control" you probably need self monitoring. If it was me, I would purchase the monitor is it was over 150. Just go to a pharmacy, and ask the pharmacist to walk you through the procedure. It's a little intimidating to do by yourself, so let them help you.

Either way, let us know what happens.

Later,
wsgts

[Lisa N]

http://www.lowcarbretreat.com/ketosis.html

The above link also does a much better job explaining the difference between benign dietary ketosis and diabetic ketoacidosis than I ever could. :)

http://listserv.lehigh.edu/lists/diabetic/html/ketones.html

And one more link that explains very matter-of-factly exactly how ketones become a problem for diabetics (note...the process is not the same for dietary ketosis).

[tilt]

Thank you all.

LisaN, my FBG was 16.5 (I guess that is 297 in US meaasurements?), haemoglobin was 0.115 (2.07 US?)

Cholesterol - Total - 295, Triglycerides - 504, HDL - 44.

And no Lisa, my doctor did not tell me to monitor my sugar levels at home on a regular basis. He just told me that he would have to start me on medication right away but that if I promise to try and control my diet and lose weight, he would give me a month to try before he made a decision to start me on medication. Plus the diet he recommended was to cut out fat, cut out red meat, cut out sugars and to start exercising. Funniest part is, before I met with the doctor, I never ate fat, red meat or sugars *LOL*. Now I have started on Atkins and eat exactly that, totally against my doctor's advice and without his knowledge.

Lisa, the Ketostix only tests ketones in the urine, not sugars. Are there strips for that too? And thanks for the info on the glucometers and how to self-test. I wonder why my doctor did not mention this to me. Maybe I should sue him for dereliction of duty *LOL*

WSGTS, thank you too for the info.

Cheers

[Lisa N]

the diet he recommended was to cut out fat, cut out red meat, cut out sugars and to start exercising. Funniest part is, before I met with the doctor, I never ate fat, red meat or sugars *LOL*. Now I have started on Atkins and eat exactly that, totally against my doctor's advice and without his knowledge.

Well...the diet your doctor recommended has two purposes. Cutting red meat and fat was (in your doctor's mind) the way to go to reduce your high cholesterol. Unfortunately, that method is ineffective with most people at best since your own body makes more than 80% of the cholesterol in your bloodstream and does nothing to address your very high triglycerides. Fats and proteins have very little, if any, effect on your blood sugars.
The part about cutting sugars is standard advice to diabetics. Again, unfortunately, largely ineffective because they forget or ignore that high glycemic carbohydrates such as those found in white bread, flour, rice, potatoes and pasta are pretty much the same thing as sugar as far as your body is concerned. Cutting sugar is only the tip of the iceburg.
By going low carb, you are addressing the root of the problem which is most likely insulin resistance and has a big impact on your total cholesterol, triglycerides and your blood sugars; all of them should come down with low carbing.

Lisa, the Ketostix only tests ketones in the urine, not sugars. Are there strips for that too?

Yes. They're called KetoDiastix and test for both ketones and sugar in the urine. They are more expensive than the regular ketostix and largely unnecessary if you are testing your blood sugars with a glucometer on a regular basis. The only time I would use one is if I tested my blood sugar and found that it was over 250.

And no Lisa, my doctor did not tell me to monitor my sugar levels at home on a regular basis.

*sigh* I know that some doctors feel that diabetics testing their own blood sugar can stress and obsess over them, but study after study has shown that diabetics who monitor their own blood sugars are far more successful at controlling them than those that do not. You cannot make adjustments to your daily menus based on what your blood sugars are if you don't know what your blood sugars are! Personally, I would far rather know what my blood sugar is than sit around wondering how I'm doing...that would be way more stressful for me than knowing exactly what the numbers are and being able to do something about it.
Whether or not you decide to get a meeter and start testing is up to you, but I'd highly encourage it.

[eevee]

Just a note....the body prefers to make cholesterol from carbs if they are available. Limiting carbs therefore generally lowers chol, as the body's mechanism for producing it (with very few carbs) in all likelihood does not overproduce. Quite often l-c produces initial higher figures, but for most, they then reduce..........Eve

[Kristine]

Hi Tilt. :wave: I'm down the highway from you in St Catharines. Enough snow for you yesterday? ;)

There's a Canadian Diabetes Association office in Hamilton, and satellite pharmacies that can help you. :thup: Check out this page. (http://www.diabetes.ca/Section_Regional/ontario_hamilton.asp) They can teach you how to use the glucose monitors.

PS: Trust me, the new lancets are gentle! You'll barely feel it! :)

[tilt]

Thank you everyone for the info and support :)

Kristine, thanks for the link, and well, whatever you say about the lancets, I am still a pussy when it comes to anything poking into me :)

And yes, (I never thought I would say this), I have had enough of the snow, I want to take my motorcycle out :)

And by the way everyone, I know this is not the forum for this, but today I weighed 230 lbs, an 8 lb drop from March 1, day 1 of induction! So at last Atkins has started to work for me :) All I hope now is that my bloodwork reflects this to my doctor!

Cheers

[JimP]

Tilt,

Like you... I have always hated needles (you could probably call it a phobia)... but I have learned to accept poking my finger just fine... and it really is not a problem. I do not even hesitate anymore.

I decided that poking myself was much better than the other alternatives... like amputated feet, failed kidneys, and going blind. The thought of sitting in a wheelchair, attached to a dialysis machine with a seeing eye dog makes it pretty easy to take my BG levels six or more times daily.

/Jim

[black57]

Tilt, the fat, the red meat and other protein will actually help to stabilize your glucose/insulin levels. You should also find yourself producing more glucagon which helps to clean your arteries of fatty deposits. Glucagon is the partner hormone to insulin which is produced by the pancreas when insulin is stable.

So if you reduce your carbohydrate/sugar consumption this will lower your glucose which in turn will lower your body's need for insulin, which, in turn, will increase the production of glucagon and so on and so on. So it is also easy to see the usefulness of a glucometer.

[tilt]

JimP, thanks for the pep talk :) I realise I have to learn to accept that poking myself 5 to 6 times a day is inevitable. I am just whining for the sake of whining *grin*

Black57, thanks. I know what you say is true, I have done a lot of (really a lot of) reading into Diabetes, Insulin Resistance etc, and also the benefits of low-carbing. This is why I decided to go ahead with Atkins even though I know my doctor would probably have a heart attack if he found out. I hope to prove to my doctor that what you say is true and that my Diabetes can be brought under control (not to mention my cholesterol levels) without depending extensively on medication to do so.

Anyway, to change the subject, it is a wonderful day today, nice and sunny, I am off for a nice long ride on my motorcycle :) See you folks!

Cheers

[simplydawn]

HI there!

: sits back stunned ::

I am honestly sitting here w/my mouth open...that a Dr would say 'out of control' then not give you the keys to help get it 'in control'.. .but I am not sitting here w/ my mouth open in disbelief, but in frustration for lack of a better word to use at the moment.

I am SO glad you found this forum, and the advice and encouragement you are finding here is key,crucial and will certainly help you understand your situation.

As you can see, I am a diabetic, and it has been with l/c that I have seen a drastic change in my blood sugar levels, for the last 2 months, the insulin injections I was on, were slowly decreased until finally last week, I was taken off completely.

It helped me a great deal to monitor my own levels, to keep track of what elevated them, what kept them where they needed to be, and to be diligent. Finding food intolerances along the way, such as cottage cheese for me, is a big food intolerance...it majorly jacks my sugars, but if I waited to go to the Dr to find out, what my levels were, then I wouldnt know that it was that particular food item that was doing it, or even that it was, because he is looking at averages, not dailys.

When I go to my Dr, I bring: My log book with my BG readings, a print out of 2 weeks of my food diary and any notes and questions I have, so I don't get sidetracked and forget by the time I leave his office.

Keep in touch, looking forward to getting to know you..