Ketones, Bad Insulin, and Sprite-That just happened


(Chad) #1

We were having some issues with Lici on Friday afternoon that looked like maybe we needed to dose her a bit heavier than normal. I called the nurses office around 4:30 pm but they had already gone home. We had discussed this with the doctor at our last visit but my wife wasn’t comfortable with it at first so we tabled the discussion. The EDNO was in favor of lowering our carb ration from 40 to 30:1. Not really an emergency, so we didn’t call the emergency line. So Saturday started out as a normal day. We started with a BG around 80 at breakfast and that’s about when it started going wrong. We corrected for a relatively low carb breakfast but for some reason we saw a spike reserved for pancakes and waffles with pizza for breakfast. After triple checking we counted 30 carbs, no cereal, no milk, it just went crazy. We got her back down to 160 three hours later. Once again we had a light lunch, once again the spike from hell. What is up? we decided to go to the previously discussed 30:1 ratio and would email the nurse on Monday. We ran some errands and surprised the girls with dinner and a movie. We have one of those movie theatres that double as a restaurant. Since it was about a 30 minute drive and we technically didn’t have to correct a high during lunch we went ahead and treated her current high of 310 despite having only eaten lunch 2 hours ago. The Dexcom had given no indication of dips or flattening out in those 2 hours so we figured it would be ok. Plus we had manually checked her BG to dose for the high and it was only 10 off from the Dexcom. If anything went wrong on that 30 minute drive my wife had 2 juice boxes waiting. We arrived at the theatre and had already discussed what to order. Lici wanted corn dog nuggets and fries and we researched it beforehand and was going to be about 65 carbs. Easy day, we would pre-bolus for the carbs before we ordered and even give an extra half unit. Her Dexcom had shown flattening out and even showed a diagonal down arrow form the car bolus… She was about 226 when we got the food. Then things got really bad. She was 400 by the end of the movie and 488 by the time we got into the car. We couldn’t really check for ketones on the drive home but we called the on call Doctor. He was more concerned at the fact that we had given her so much insulin than the fact that she was so high. By the time we got home the CGM and the Glucose meter wouldn’t show how high she was. The glucose meter just had two up arrows. Let me preface this statement by saying her normal daily insulin intake including Lantus is about 5 units. We were at 12 units by 930. Now we have ketones. I call the Doc back and he immediately tells me to throw out her old insulin and give her 3 units. Here’s the kicker he wants her to drink Sprite as well. Holy crap, you gotta be kidding me. You want me to give her more sugar? After hanging up and on the way to the store to buy Sprite I thought about it. He’s giving us a correction for the high while simultaneously covering the Carbs. This does multiple things. 1. brings her down slowly so as not to crash her. 2. gives her liquids to help flush ketones. 3. flushes insulin through her body and get rid of all the old stuff that wasn’t working well. By midnight the Ketones had disappeared. At 330am we finally saw a dip below 400. At 600 am she finally got under 200. by breakfast she was at 120. That was a long night. I was pleasantly surprised when the doctor called us back on Sunday morning to see how she was doing and even more surprised when the school nurse checked in on us (thanks Dexcom Follow). Total units for a 24 hour period 16, total ounces of sprite 24, total hours of sleep 0. I don’t remember much about Sunday besides we all slept. Anybody else experience something similar?


(joe) #2

@Restless_Daddy hi Chad,

I wouldn’t have gone sprite… crazy amount of sugar. I would have corrected and watched the CGM, but that’s me. Flushing ketones can be done with straight water.

a word on “restaurants”.

I ate a restaurant burger. a plain straight burger, no bun, no ketchup (ketsup, catchupp, whatever they call it by you) … zero carbs, right? wrong! total bolus ended up being for 30 (THIRTY) carbs. Where did they come from - only heaven knows (actually I am a pretty creative cook and know you can stretch hamburger by adding breadcrumbs - a possible source of carbs). I have the same reaction to restaurant food all over the world. that corn dog? I would have estimated 90+ grams of carbs had I dared eaten one at your movie/restaurant. it’s the way restaurants work. it’s been my observation that restaurants start out at 2X to 3X the carbs minimum… your mileage may vary. Nice work in the aftermath though. glad nothing really bad happened.


#3

Good catch on the ketones
Joe is right, restaurant food often has tons of hidden carbs yet id like to add another perspective.

I have noticed lately there seems to be a virus or something going around. No symptoms other than high blood sugar for 24)36 hours.
I mentioned a week or two ago how my sugar went off for one day or so. I had to more than triple my daily insulin dose, and on another support forum, I noticed other people going through the same thing.
It’s just a thought that she could have got the same bug as some of us did.

In light of everything I think you handled it quite well.
All the best


(ksannie) #4

Fats actually raise blood sugar for long periods of time. So maybe it was the fats in the burger. If I eat cheese, my BG is very high for the next 4-6 hours. So I cannot say why it happens, but it is pretty common.