The worst type of tone

What is the worst type of tone?

Negativity. Sarcasm. Keytones. Ketones, of course.

Yesterday I had another frustrating morning dealing with unexplained ketones. The last time was a few weeks ago on Memorial Day. Not the way I wanted to spend a day off work. Almost the same circumstances happened this morning.

I went to bed last night with a totally “normal” blood sugar – 126 on the meter, 141 on the CGM with a steady line. My habit when I wake up in the morning is to check my CGM before I get out of bed. I often don’t wake up to the alarms, so it is my routine to see how the night was and likely how the morning is going to go. The trend line had headed down to the 90s and lower 100s. Nothing unusual.

I tried to start my morning routine but I was thwarted by the same stomach pain and nausea as the last time. The worst of it lasted a little over an hour (again). When I got to a place I could check my blood sugar, it was completely normal (a perfect 100 even!) but just like last time I had moderate ketones.

Although it was the last thing I wanted to do, I ate a little something, grabbed a large glass of water, and took a little insulin. I answered a few emails, texted my boss, and apparently fell asleep on the couch.

When I woke up a few hours (!) later, I knew immediately that I was low. I got a juice box, a snack, more water, and sat down to test. I checked my phone once I had finished the juice box and a friend had texted to ask about the ketones. I almost replied that they were gone because I was low. How could I be low AND have ketones?

Apparently I can.
The ketones are obviously not at a dangerous (or even a head-to-the-hospital) level. I feel absolutely awful and contemplate the doctor for a few hours. The ketones eventually clear out without any medical treatment other than a little insulin and a lot of water. My stomach feels iffy for the rest of the day but is basically back to normal by the next morning. I had not been over 200 for at least 24 hours before this started, and have not been over 200 at 9 hours later. I am thoroughly confused.

I’ve searched the interwebs and the twitterverse.

The options seems to be:

  • The ketones are a result of “fasting” during the night. I ate last night around 9:30 so it was about 12 hours without food. I’d be okay with fasting ketones if they weren’t accompanied by the stomach pain.
  • Dehydration. See above. Water bottle next to the bed?
  • A short-lived stomach bug with unfortunate timing and minimal extra symptoms. Last time, I was the only one I knew who was sick but this time my boss was out sick yesterday and another person in our office was out sick today.
  • It’s just life with diabetes. I had a lot of stomach issues around the time I was diagnosed. I saw a GI doctor several times, went through a whole bunch of testing including a four quadrant CT scan, and the best he could come up with is a “diabetes stomach” (not referring to gastroparesis). As far as I know, that is not a recognized diagnosis.

Has anyone else experienced anything similar?
Does anyone have any ideas what could be going on?

Bedtime update:


  • Wow. That’s crazy! How on earth are you low and have ketones? Cause what they’ve always told us was insulin & water to get rid of them. And that’s what you don’t need to do when you’re low. So wild.

  • Insulin and Gatorade! Water doesn’t always hydrate you – which seems weird- but you need electrolytes for the water to get into your cells. Also, are you sure the ketone meter is accurate? what meter is that – I’ve never even heard of it. Also, ever thought of quitting diabetes? 🙂 feel better!

  • I’m sorry things aren’t going so well. A nurse in my pump group gave us this warning- KETONES MEANS YOU NEED INSULIN regardless of the bs number. If you have to feed it to stay above lo, then that’s what you have to do. If you can’t eat, then you need to goto the ER so they can feed you intraveniously.

    Stay hydrated and I pray that you can turn things around.

  • I’m just wondering if you eat low carb. I do, and I go in and out of ketosis (which is not the same as DKA) all the time. I have never tested my blood or urine for ketones, but I know that I go there. Any chance you are getting this when you are consuming less carbs? It would make sense with the low BG and ketones at the same time?

  • When I was first diagnosed in 1981 and all we used at home were urine tests, ketones were the only way to diagnose a low. Ketones means the glucose in the bloodstream isn’t getting to the cells (so it needs another way, ketosis).

    Sugar in the urine + ketones in the urine = need insulin. No sugar in urine + ketones in urine = need sugar. Does that mean that whenever I’m trying to treat a low BG of 38 that I have ketones? Honestly, I’ve never checked, but back in the early 80s I have had ketones with no sugar in the urine, and I’m pretty sure my BG wasn’t at zero.

    So, I don’t have the answer, but I think that if you already have insulin, I doubt it means you need more. Abby’s answer seems to make sense to me about the electrolytes (especially if you’ve got some mild sickness going on), but what do I really know?

  • Pretty much the same as what everyone else says. It sounds majorly weird, but try to eat just so you can have insulin. For some reason, your body is relying on your stored fat for energy and in doing so, it’s throwing your body out of whack (no durr, right?) and producing ketones, and ketones need to be balanced out with insulin ( why, I have YET to understand ). Try regular Gatorade for both carbs -so you can bolus- and electrolytes. It has helped me when this happened before.

  • This, unfortunately, has happened to Joe a few times. It usually accompanies a stomach virus. He has been low with high ketones. I have had to do Glucagon Mini-dosing … to keep his blood sugar up…while continuing to keep his insulin basal rate going. It usually subsides within 1/2 a day or so…However, some of the viruses have left us not bolusing for carbs for up to a week or two after the initial insult. His system will get so messed up that he does not absorb the carbs. I have found that out the hard way…and had to “Mini-gluc” him up.

  • It’s actually not weird at all. You have ketones because your body needs fuel. It’s more common with high blood sugar, but if you can have ketones at any time. Try having a snack that combines carbs & protein before bed. It doesn’t really have anything to do with needing insulin…it has to do with your body needing fuel.

    • I had a snack at 9 pm. I don’t know that I can eat any closer to bedtime. And the ketones increased as I ate throughout the day. Very weird stomach bug.

  • My doctor told me to increase the protein & fiber to make the carbs burn slower. Any chance that could work? I’ve also had years and years of mystery stomach pain. I just finished another round of testing and have another appointment schedule in August to some more scans. BTW, the ketones and on target/low blood sugar is really common in type 1 pregnancies (but can happen any time)…googling about ketones in type 1 pregnancy might give you more info about the mechanics of it all.

  • Wow, I am currently experiencing the samething. My ketones were large. With a B/g of 485. I went to Urgent Care were I recieved x2 bags of fluids. And insulin vía IV. An hour later my sugar was down within normal orange. Now my Ketones are still at moderate. With a B/g of 80. Cant I know it is not my meter(it was exaclty The same reading as urgent care) and Iknow its not The Ketone Strips(it was The same reading as urgent care). I Really couldnt find any info on Google at all. If you ever found out how to treat this or what it was.Please let me know.

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