Why ketones with low blood sugars?

Hi,

I was recently diagnosed with type 1 and taken off insulin straight away as my bloods were so low. However, while they remained low off the insulin, I was still developing ketones. My team have no idea why and no tips on what to do, other than keep checking and retaking my insulin but if anyone could give me more advice that would be great!

The body will produce ketones when it can't use blood glucose as an energy source. There are a number of reasons why the body will produce them including severe dehydration, lack of insulin, fasting, or a ketogenic diet (low-carb diet).

Ketone build up becomes dangerous if there is a lack of insulin present as it can quickly lead to Diabetic Ketoacidosis which will make you ill very quickly.

I was on a conference on exercising with diabetes recently, and one of the speakers there is one of the world's leading researchers into exercising with diabetes. His view is that as long as insulin is present, ketones should not usually cause an issue, but if insulin is not present, then it becomes a big issue.

From talking with others who have experienced DKA, it seems much more common amongst T1Ds who pump than use MDI. Pumpers who experience a blocked cannula, can be without any insulin after about 4 hours, whereas as those who inject usually have basal insulin in their body which lasts 12-24 hours and therefore doesn't cause so much of an issue. That isn't to say that MDI can't lead to DKA - it definitely can, but it appears to be more rare.

I honestly don't know why you would have low blood sugars and high ketones. Do your medical team believe that you are still in the honeymoon period where your pancreas is still producing some insulin? I imagine that it could be possible for the pancreas in this case to produce some insulin which lowers BGLs, but then stop, and for ketones to then build up. I am not medically trained though and the one thing I have learned from T1D is that there are so many factors, some of which are completely unknown that can have an influence on my diabetes management.

Did having high ketones lead to an issue such as DKA, or are you otherwise fine?