High Ketones

Last Thursday was a very hard day for Amanda.  Wednesday night her blood sugar was in the 400's.  So we changed her infusion set. Not sure why it was so high that night.  She hadn't checked her blood sugar all day.  Not Good.  And I think it had been too long since she had changed her set (which should be changed every 3-4 days).  Not Good.  Well all we could do at that point is change the set.  Thinking all is good now.  She goes to bed.  She checks it a little later and it is in the 300's.  Okay, all is good. It is coming down.  Later in the night she gets up thirsty.  We check again- back in the 400's.  I give her  a bolus and go back to bed.

Next morning, she is in the 500's.  I ask her to check her ketones.  It reads HIGH.  NOT GOOD.  She hasn't had high ketones since she was diagnosed 8 years ago.  Here is the definition of ketones according to the Joslin Diabetes Center:

Ketones are produced when the body burns fat for energy or fuel. They are also produced when you lose weight or if there is not enough insulin to help your body use sugar for energy. Without enough insulin, glucose builds up in the blood. Since the body is unable to use glucose for energy, it breaks down fat instead. When this occurs, ketones form in the blood and spill into the urine. These ketones can make you very sick.



These ketones can make you very sick is an understatement.  She was throwing up and very weak. We called her doctor and talked to her regularly all day.  We disconnected her pump and started shots. We had to give her phenergan and slowly introduce sprite mixed with sprite zero.  Once she was able to keep it down, she needed fluids to bring the ketones down.  The ketones and blood sugar had to come down similarly.  So it was a balancing act to bring the sugars down but not too fast.

By bedtime, she was in the 300's and had trace ketones. We were able to put her pump back on.  After pulling off the last infusion set we noticed that the tubing that is inserted right under her skin had crimped. So she wasn't getting any of her insulin on Wednesday night.

Friday morning all was back to normal (Not that any of this is normal).

This could have been a hospital visit.  I am so thankful for our doctors and nurses at the Endocrine Clinic.