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Patient’s Renewed Commitment to Low BG’s Leads to “Keytones” Clarity

Dec 22, 2020


The importance of checking for ketones in people with type 1 diabetes….

I recently received a text message from a type 1 patient who has been wearing a pump for over ten years. 


I need your guidance. My blood sugars have been in the high 200s and 300s since Thursday. I woke up with a 398 blood sugar. Ive been eating out a lot and drinking too much. I need to follow a rigorous low carb diet and less alcohol. I called the patient and let her know I was sorry to hear she was feeling overwhelmed. I asked if her pump was working, When you correct, does your blood sugar come down? She said, Yes.” “Did you check your ketones? She didnt know what I was talking about. 

I explained and asked her to go to the pharmacy and get strips. I called the pharmacy. Sure enough, there had been a prescription sent in before by her endo, but she never picked them up. She checked. She had small ketones. This was after she corrected and drank a lot of water as I recommended she do. Her glucose levels were then in the low 200 range. Sure, better than 398, but taking no chances, I suggested she change her site, tubing, insulin, etc.…, and check in an hour. She wears a CGM, so she let me know it showed she was coming down. Her keytones, as she called them, were small. I encouraged her to keep drinking water, keep a close watch on her glucose and ketones, correct and cover as shes been taught. 

She then told me she was going out to eat and didnt know what to eat. We looked up the menu for the restaurant. She agreed to eat salad, bronzini fish, and broccoli for dinner. She had a plan. 

Since she lives alone, I recommended she set her alarm and check her glucose, including her ketones, hourly during the night. She contacted me in the morning with her glucose reading of 142mg/dl. Keytones were still small. Today, she plans to closely monitor her glucosecorrect and cover as needed, check ketones four times a day, eat low carb, and drink a lot of water. Well be in touch. 

Lessons learned: 

  • High glucose levels can cause people with type 1 diabetes to go into diabetic ketoacidosis (DKA), for the most part, due to not getting enough insulin. Checking for ketones is recommended when the diabetes patient’s levels are 240 or above. People who have type 1 and wear pumps are very prone to DKA. For several reasons, including a pump breakdown, the person is not getting the insulin they need. They have no back up insulin, so that they can go into ketoacidosis. 
  • Dont take anything for granted. Just because people have been taught doesnt mean they understand and can practice what they have learned, especially when things are not going well. 
  • Just because people have had diabetes a long time doesnt mean they always get it. 
  • Just because people have worn a pump for a long time doesnt mean they remember everything they were taught. 
  • Sometimes the longer people have diabetes, the laxer they become in their care. Managing diabetes 24/7 can be a lot of work. 
  • Be a non-judgmental health care provider so patients can feel comfortable reaching out for help. 



If you have a “Diabetes Disaster Averted” story like this one about the role of checking ketones in type 1 diabetes, please let us know! If we feature your Disaster Averted in our Diabetes Clinical Mastery Series e-newsletter, you will receive a $25 gift card. Please click here to submit a short summary of the incident, what you feel you learned from handling the incident, and your name and title. If you prefer to remain anonymous, please let us know, but still give us your name and address (so we can send you the gift card).







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See more about diabetic ketoacidosis.