Ketones.
We know that ketones are bad, and usually a sign that something has gone wrong with your insulin delivery.
However, there are times where the normal metabolism processes will also cause ketones, even when your insulin delivery is just fine.
When your cells can’t get the energy they need through available glucose in your bloodstream, your body will start to break down fatty acids. A by-product of this process is ketones. I’m not a doctor, or even a medical professional, so there are many more accurate descriptions of the process available. My basic understanding for the purpose of this post is that when the body has to turn to fat stores for it’s energy, you will have some ketones.
Yesterday was a basketball day for me (where I play ball for about 2 hours over lunchtime). I had eaten a bagel with cream cheese and a glazed doughnut for breakfast. I also had two bottles of juice during basketball to keep my bloodsugar up. My bloodsugar hovered between 74 at it’s lowest, and 107 at it’s highest (pretty damn good!). When I left the gym after showering and dressing, I tested 105. I felt good. I worked really hard during basketball and had an excellent workout. I was however very dehydrated – even before basketball. This is thanks in part to my official addiction to Diet Coke (caffeinated – a diuretic), and also the fact that I had not taken in much water in the past few days. I did drink 32oz of water during basketball, but I’m sure it did not “equal out”. I sweat like a stuffed pig in a sauna, and probably lost 64oz of water through that alone.
I got back to work and felt really really worn out. I naturally just thought that it was because I worked really hard. I really pushed it today, much more than usual. So, of course I should feel a bit spent. It made sense. I was also immediately completely bombarded by work stuff – more so than usual after being away from my luxurious cube for a couple hours.
About 30 minutes later my muscles felt “funny”, and my blood sugar had spiked up to 247 (with no food!!)! I had suspicions at that point that I was spilling ketones like a two year old using a “grown up cup”.
I was again distracted by work stuff, and would you believe I totally forgot to correct for that 247?! It was another hour before it hit me that I had forgotten to take a correction bolus – I did another test to get an accurate reading, and by this time was up to 268. I corrected for that, found a ketostix and proceeded to the bathroom.
Remember the dehydration thing? Yeah.
I managed to produce a sample and the ketostix immediately turned a dark purple. Large ketones.
It’s now 4:00pm. My breakfast was at around 9:00am, and the two juices I had were between 11:30am & 12:30pm. With basketball usually burning an insane amount of calories (2000+, I have worn my heart rate monitor a time or two), and me not having eaten very many calories, it’s no wonder that my body was burning fat stores to survive. That’s actually the point of all the exercise isn’t it (well, that & to get the heart pumping)?
The issue with the presence of ketones is it makes you a bit more resistant to insulin. That’s why my blood sugar was rising. If I would have known about the ketones I could have increased my insulin to balance the resistance. I now also need to flush the ketones out (lots of drinking water & peeing), and get my body to stop producing them by feeding it (so it stops burning fat for energy).
It’s manageable, and information is the key. By (my) suppertime later that evening (7 or 8 o’clock) I was back down to 84 and managing just fine. Still working to flush the ketones, but blood sugar control was doing fine.
But I was totally & completely wiped out. In part because I really exerted myself at basketball, and in part from running high that afternoon, but I’m also convinced that all those ketones in my system also contributed to my exhaustion. I know that they can upset the acid balance of your chemistry, which can’t be good. But what else do they do? How do ketones interact with your body? What trouble do they cause? Why do they make my muscles feel funny? What would happen if you spent an extended period of time with ketones in your system – managing blood sugars with more insulin?
I believe that a non-diabetic person can deal with them a little better because their pancreas will automatically match their higher insulin needs (ketones make them resistant too – but their pancreas just creates more insulin). But, don’t they still deal with needing to flush them out of their system, and their acid balance should be thrown out of balance too right? How about when the Atkins diet was all the rage, and people were using ketostix to see if their diet was working or not – didn’t they feel crappy with high ketones? Or is it different for a non-diabetic? Does their body do something besides the increased insulin to deal with them?
What else do ketones do? That is the question of the day.
Great post and explanation from heidi – thanks from an extremely grateful UK medical student cramming for an endocrinology exam!
Refer to Diabetes for
useful information
Heidi,
Could I ask you if yopu lnow why I have such a hard time with hypos once the ketones are gone. It is NOTt dure to an overdose of insulin to get rid of the ketones. I have ended up in the hospital twice due to hypos after having ketones and I am scared to death of ketones now. Last time I started haveing trouble with ketones at 10PM due to an insertion site problem. I was up all night testing and fixing the problem and finally by the early morning the ketones were gone and I was really proud of myself for managing…… (I had eneded up in the hospital 6months earlier due to passing out from a hypo after ketones.) But then after my jusband went to work and I figured all was normal, I took my normal mealbolus and ate breakfast – that is when the terrible hypos ocurred. My head DOES NOT function, I am freezing, my body shakes uncontrollably and I feel nauseous. My head feels just terrible trying to figure out what to do. Everything just becomes so very difficult. I feel so HORRIBLE. No doctor has any advice to give me…… I am quite freaked out by the whole thing!
Heidi! Thank you! That information is SUPER!
Like you say – it’s fascinating that the body has back up plans for this type of thing. Amazing.
Your ability to understand this process, AND explain it to us, is also pretty amazing! Thank you for taking the time to share that information with us.
Great post Scott!
Though it may be a little late, I would like to take part in the ketone debate and maybe enlighten you about some facts (I’ve got a Master in biomedicine and is thus familiar with biochemistry).
As you said ketones are produced by non-diabetics too, as an alternative source of energy when glucose is not available in sufficient amounts. This will be the case during starvation as an example. Most organs prefer to use glucose, and glucose can be generated from break-down of glycogen in the liver, or through a process called gluconeogenesis in which the starting materials are lactate or amino acids. During starvation the only source of amino acids for gluconeogenesis is muscle, so this will result in break down of muscle protein, weakening the muscles. To preserve muscle, the body may turn to fatty acids. Fatty acids cannot be turned into glucose, but they are very rich in energy. The brain, of course, need energy for us to be aware and to keep our body going as a whole. The brain does not have any significant glucose stores. In fact, with a BG of 4.7 mM (84.7 mg/dl), the glucose concentration in the brain is only about 1 mM! To convert glucose into energy, the brain, as any other organ, uses a process called glycolysis. This process slows down when the glucose level drops, thus leaving the brain in need of energy (I think all of us can relate to the feeling of our brain not functioning properly when our BG is too low). The brain cannot use fatty acids as fuels directly as they cannot traverse the blood-brain barrier. Ketone bodies however, can, and thus they are transportable equivalents of fatty acids. Ketone bodies allow the brain to function properly during starvation. Because ketones in this situation are used as fuel, most of them are converted to energy and in the end CO2. Most of the acid produced in the normal metabolism is in the form of CO2 that is readily excreted by the lungs to balance our acid-base level. Ketone body acids on the other hand, especially when present in high concentrations, overwhelm the kidneys’ capacity to maintain acid-base balance. In diabetes, when insulin in insufficient, the BG is high because the body is not able to get the glucose into the cells. This makes the body think that the general level of energy is low, making the liver busy with gluconeogenesis. Fatty acids are also broken down to generate acetyl CoA, a compound that can be used in the citric acid cycle to generate energy. However, to enter the citric acid cycle, acetyl CoA must condensate with another compound, oxaloacetate. Because of the high level of gluconeogenesis, oxaloacetate is depleted, and acetyl CoA is instead diverted to formation of ketone bodies. The lack of insulin causes this process to accelerate. The kidneys have a hard time getting rid of both excess glucose and ketone bodies. In normal metabolism both glucose and ketone bodies are considered as sources of energy and thus should not be excreted, but when they are present in high concentrations, the kidneys are unable to withhold them. On their way out glucose and ketone bodies draws a lot of fluid with them, leading to dehydration.
This was quite a long story, even though I tried to keep it short. For us T1s ketones are a nuisance, but apart from that I actually find if fascinating that the body has back-up plans for something as important as energy sources!
Thanks for the comments everyone! I hadn’t even thought to look it up in wikipedia! Excellent information there.
I still want more detail though – maybe I’m obsessing?
Chrissie – wow, very interesting and scary scenario you’ve got going there. Ketones & how the body reacts are one of those things that there just doesn’t seem to be enough information on. Especially when your particular situation doesn’t fit the “norm”.
This is just another example of how complicated the bodies natural processes are. It’s really fascinating. The more we know about it, the better equipped we are to handle our situations.
This was an excellent post, Scott!
Terrific use of your personal experience as a way to educate and open up a discussion about ketones.
While I don’t have answers to the questions you pose, must say you’ve answered a few of mine. Thanks!
Kevin,
I looked at you wikipedia site and found what it said under “ketones in bilogy” interesting – that “the heart and brain operate 25% more efficiently using ketones as a source of energy”! I wonder it that explains my weird hypos after ketones disappear. By the way the problems only happens to me when I have a pump problem, ie not when I exercise too much. Maybe my brain is still geared to reacting efficiently? BUT, after the ketones disappear, and the bg plummets, by head is totally VERY stupid. It functions but I cannot remeber anything. When the doctor was telling me what to do over the telephone, I wrote everything down because I could remeber nothing. My husband also noted that my thinking was “peculiar”. HORRIBLE experiences and I do not have a rule to go by if this happens again. I like rules. Rules that work that is….. I have rules of dosage and all that with ketones, but they do not work for me.
What an informative post! And such timing, too, since I just tested mine for the first time in….um, a really long time, and really didn’t know what it meant if I had them. Nothing like the blogosphere.
And Kudos to those exercise numbers!
Ooops, I mean I admire Scott for handling this so well. Goofed up the names…….
May I join you two in saying – yeah, really good questions. I want to know all I can about ketones. They REALLY mess me up when I get them due to an insertion site problem , or a bubble in the infusion line. I go pale and sweaty just at the thought. I have ended up twice in the hospital’s ER due to ketones! WHY – because when the ketones disappear my body really over-reacts to insulin. I have HUGE problems balancing the situation – first I cannot get rid of the high bg values and the ketones, then I have TERRIBLE hypos. Once I passed out while talking to the meds on the phone. AND you feel like SHIT. I have yet to hear of another who has this problem of oversensitvity to insulin AFTER removing the ketones……. Could someone please tell me I am not alone! My doc doesn’t understand it either and just said I must avoid getting them. This means I test for them in the blood and even with 0.3mmol/liter I treat immediately with a syringe .
Kevin I really admire how you could handle this. I followed all the rules given by my doctors, so I do NOT rhink it was my fault….
Maybe because non-diabetics always have some insulin, they do not feel so terrible. I hope someone has some really good input here. I will go now and read the link!
Lots of good questions, Scott. I sure hope someone knows the answers (’cause I don’t, and I always like learning new things).
I never thought about it in the way you phrased it: “What else do ketones do?” Like you said, I’ve just always thought of them as a by-product of burning fat for fuel and too much of them can make your chemistry acidic (i.e., toxic). But the details on the other stuff would be good to know too.
Here’s some good info I just found, though (I LOVE wikipedia).
http://en.wikipedia.org/wiki/Ketosis
And two things: 1) I too am a diet coke addict (I sincerely think it’s the best drink on the planet). I also think that it helps keep my sweet-tooth in check. 2) Those BGs while exercising are awesome. I don’t think I’ve ever had such tight numbers while exercising.