New Graduate Ketonuria

Hi there.Just graduated yesterday.BG's rising throughout week with some changes to QA/CP ratio and BI taken.Last night at 3am Bg 4.3.I know not technically hypo but took 1 Cp to cover myself til I woke.Woke at 10am with Bg of 15.3.Took covering insulin and increased my ratio to 3:1.At 1230pm felt sicky took urine to find +1 Ketonuria and BG of 18.5.Looking for any advice as have only had ketones once in 28 years of Diabtes.I know weekend is a difficult time to get advice and will contact my own DSN on monday,but as I say any advice would help as I am panicking a bit.Cheers folks!

Hi

My first advice is don't panic you seem to be doing everything asked of the dafne regime, it's just the results are outside targets at the point of testing. I cannot give you any professional advice and it will soon be Monday when you can see someone, the course I went on aimed at getting the Lantus dose spot on and the rest follows

Then watch out for the liver dumps of glucose and over correcting hypos with CP's also try to aim for a good test result before breakfast as the little dafne diary states "as a general guidline breakfast = 2-3 UNITS/CP and other meals 1-2 UNITS/CP".

Your ratios are constant mid-week and mid-day your readings are higher than other times.

In Summary
Do not panic
Follow Dafne regime
Ensure Lantus correct
Watch out for over correcting hypos and liver dumps
Re-visit morning ratio as outlined in diary.

If all else fails get in front of your blood sugars test as necessary for 1 day to have full anlaysis so you know the full picture and with that you will have the answers you need.


Good Luck

Thanks Nomis for your reply.Amazingly my ketones are now away after 2 doses of 11units of insulin as per sick day rules regime.I can't believe how quick that works.Glucose is normal at present so back to the usual regimes from now on.I just suppose I need to get my BI sorted to stop the rise in BG's.I did certainl calm down though after reading your reply which helped me a lot so thanks!

why did you take corrective and raise ratio and raise BI at the same time?

Beacuse different result througout day were affected.It would seem that my BG's are poor throughout the whole day.My BG is especially poor at lunchtime which would suggest a 3;1 ratio at breakfast.From now just changing my BI if i need to until Monday when i can get more advice.

hey there...............

I would comment on your PM BI, it sees to be holding you overnight give or take which is good, you should investigate how much 1 unit of insulin drops you at different levels of BG, the higher you are the more you will need, this is briefly mentioned in the handbook, but is not widely known for some reason...

Before upping your QA, try a BI test during the day, a carb free breakfast, lunch or dinner can let you know what your dose of 20 is doing, best to do this before the QA adjustment...

you seem to be doing ok though, dont panic, all these results your writing down are helping you to understand whats going on, it doesnt change over night.....chin up.....

Cheers for all the advice.Stil had ketonuria today.Went carb free last night with quite a big rise this morning.Not keen to tocu my QA as of yet.Am waiting on my DSN getting back to me.All the advice has really helped though as it doen't make me feel like such a diddy.Still feel a bit shitty with the high BG's though which I know I will have to put up with until it's sorted.I know it's early days though so shouldn't expect perfection yet.

Hi, don't panic about ketones. They are not going to do you any real harm short term unless they were pretty high which yours are not. As others have said the key is to get your BI correct and then fix the rest. If you
change more than one thing at once you have no way of knowing what has resolved the issue. One thing that has sort of been mentioned, most people find they need a higher ratio in the morning becasue of the waking up.
Sort of like the Dawn Phenomeon to a degree, most people to wake up in the morning fire off a load of hormones etc to get their body up and running. This tends to mean you need more insulin but as ever everyone is different.
Another thing to bear in mind, when you give yourself 11 QA at 12:30 and another 11+4 at 14:30 you will get an overlap in insulin since the normal time frame for QA is 'about' 5 hours. This can mean you get an effect you don't intend, its worth just bearing in mind.

Cheers Marke.Once again thanks for calming me down as it were.I now believe I do suffer from the Dawn Phenomenon,and am on a 3:1 ratio in the morning.Will increase my BI insulin again tonight as I am sure that will help.Am nearly their though as sugars have been roughly 10 all day so far so fingers crossed.Once again thanks.