Normal ketone values?

[SimonP]

I feel fine, in fact really good.

I was wondering about rounding it up to a 200km ride, but would have needed to stop to eat something vaguely substantial as I was sitting around 4mmol/l for the last 45min and didn't really fancy eating more Skittles - I should have stopped and bought something salty which is what I was craving a little bit earlier.

I'm not really tired at all (legs feel about the same as they did yesterday after a 55km ride with some uni friends, today's ride seems to have made little difference, my only complaint is that I lost an hour in bed due to the clocks changing and had to get up reasonably early to arrive for lunch today 🙂).

If I needed to would be happy to roll out the door and do the whole thing again now (though I am feeling quite full and have bolus on board, which may not help, plus I'd need to charge lights/computer/etc! )).

P.S. I should add that while I would ride again, I don't think I'd be very fast despite my legs feeling fine. Feeling fine and working optimally are not the same things!

P.P.S. The wonders of post-exercise endorphins; I did, however, feel rather tired the day after, not helped by not sleeping well (which I often find after a long ride - low HRV/slightly elevated resting HR/etc.) Nothing to do with ketones I don't think tho.

 

[everydayupsanddowns]

Gosh! Slightly surprised at that high-ish level of ketones. I wonder if that was you burning fat?

Would be interested to hear what a sports-specialist Endo made of your data (someone like Rob Andrew from Extod maybe?)

I wonder if people like Henry Rugby Bloke get high-ish ketones too (too late on a Sunday for my brain to be working!)

 

[SimonP]

It would indeed be interesting to know what ketone levels people have post-exercise, though it's hard enough to get information on BG values and insulin dosing approaches for professional athletes so I'm not holding my breath.

If I burned ~4600 calories (which should be fairly accurate as I have a power meter on the bike), carbs are 4 cal per g, which is 4x155 = 620 cal. I wasn't eating pure carbs, so perhaps round it up to 1000cal consumed (I can sit down and work it out exactly as I know what I ate). So I definitely had a deficit so must have been burning quite a bit of fat.

 

[SimonP]

To set your minds at rest, I just did another test and they are now 1.4mmol/l (Ketones) and 8.2mmol/l (BG).

So apparently they drop off quite quickly, I'll try to remember to do a test as soon as I walk in the door after the next big ride.

I presume I'm in ketosis due to fat burning. I can see there is perhaps a potential danger of DKA with basal reduction (which I do) and no bolus for food during the day if the basal reduction is too severe (which I have done in the past by accident and didn't need to eat for 5h+ - though I didn't feel too terrible, just really really hungry and tired). Though I don't know whether this a real risk, or whether having some basal on board is sufficient to avoid DKA even if it isn't enough to cause a drop in BG coupled with exercise.

As you say @everydayupsanddowns a question for a sports-specialist endo. I could reach out to my consultant, who knows him, to see what he thinks.

 

[SimonP]

Another data point, short ride (but quite high power, hilly and unexpectedly my fastest 40km). Ride was 63km, 1000m, 2h39min

~30min since I got back: ketones = 0.5mmol/l; BG=8.0mmol/l. I ate a sandwich uncovered before the ride (~35g CHO), and a Nature Valley bar about half way around (~26g CHO). I have been running high all morning (and therefore not eaten anything, just lots of white coffees), not sure whether I have a lurgie brewing or just that I was sat around not doing much (school Easter hols).

I'm surprised my ketones are so low, I was expecting something a bit higher as I must be running a calorie deficit. We live and we learn 🙂

 

[gail2]

you feel bloody ill thats what As a type 2 on insulin i once went to Gps with BG of over 20 saying i didt feel well due to hi levels He tested my BG then said i want to test for your keytones which he did As soon as he did that he called 999 and said i want an abulance on blue lights please. THey were there in 10 mins I was so ill i collaspled in A/E i cant remember a lot of it but according to my parner, he thought he was going to lose me
I didt think a t2 could get DKA but according to The Prof they can

 

[saffron15]

I was prescribed ketostix when I started forixgia a SGLT2 in September. I was going to test to see what it was like but it said use within 6 months of opening. I felt a bit unwell last month and tested but it was normal. I have discovered they are quite cheap to buy so will probably buy some when the 6 months are up.

 

[Captainmartin]

Ok here we go, I was admitted to hospital with DKA and sepsis. My keytone score was 7!
I didn’t have a keytone meter at the time, I do now. I was blue lighted into A&E and spent four nights in hospital. I was out of breath and being sick amongst other things. Now I’ve got a meter I check regularly and the highest it has been is 0.3, trust me you don’t want to go through that. If they ever get to 3 I’m off to A&E ASAP

 

[Lucyr]

Ok here we go, I was admitted to hospital with DKA and sepsis. My keytone score was 7!
I didn’t have a keytone meter at the time, I do now. I was blue lighted into A&E and spent four nights in hospital. I was out of breath and being sick amongst other things. Now I’ve got a meter I check regularly and the highest it has been is 0.3, trust me you don’t want to go through that. If they ever get to 3 I’m off to A&E ASAP

Was that caused by empagliflozin? If you were on it at the time and have since stopped it then luckily your risk of DKA happening again would be far lower

 

[Captainmartin]

I was on empagliflozin but now have stopped all the tablets and I am on insulin injections instead which seem to be working better than the cocktail of drugs I was on before.

 

[Lucyr]

I was on empagliflozin but now have stopped all the tablets and I am on insulin injections instead which seem to be working better than the cocktail of drugs I was on before.

Empagliflozin will have been what caused the DKA then, unlikely to happen again now you’re off it

 

[Standup]

As with many things diabetes related the research and knowledge seems inconsistent or patchy. After my surgery which made me type 3c I use to test whenever I was above 15 BG as this was the hospital advice and it was never above 0.5 for ketones. One day months later at a different hospital for a review which ran late and hadn't take my insulin with me I was at 18 for several hours but the medical staff said its fine. Test at 20+ or if you've been at 18 for the last day or so. I was quite surprised at how relaxed they seemed but I guess they have the experience.

 

[SimonP]

Another long-ish ride, another data point.

140km, 1600m, ~7h total duration. I didn't eat enough, I didn't really have enough food that I wanted to eat so was bumping along at ~4.5mmol/l for the last hour or so trying to force down Skittles. Note to self, for rides >5h take something savoury to eat half way.

1h after getting home: BG 8.0mmol/l and ketones 2.7mmol/l

 

[Captainmartin]

Another long-ish ride, another data point.

140km, 1600m, ~7h total duration. I didn't eat enough, I didn't really have enough food that I wanted to eat so was bumping along at ~4.5mmol/l for the last hour or so trying to force down Skittles. Note to self, for rides >5h take something savoury to eat half way.

1h after getting home: BG 8.0mmol/l and ketones 2.7mmol/l

Have your keytones come down yet? At that level I was advised to go to hospital

 

[SimonP]

Have your keytones come down yet? At that level I was advised to go to hospital

I only got back an hour or so ago, so just tested when I posted. I really don't think this level is anything to worry about. If it were >5 then perhaps I'd wonder. I refer back to my first post, I think the guidance nowadays is overly cautious, though I guess the thought process is that it's better to be safe than sorry.

Don't worry, I'm having a beer to rehydrate and will eat supper soon (so have just taken a small pre-bolus)

I'll report back later in the evening with another ketone reading.

 

[SimonP]

I've just done another test (2h40 after arriving home), BG = 13.2mmol/l (obviously I overestimated the effects of post-exercise insulin sensitivity, more insulin on the way!) and ketones = 1.5mmol/l.

I must try to remember to test as soon as I walk in the door, it might be scary! 🙂

 

[SimonP]

Another data point, ketones=3.0mmol/l (4h after finishing ride once I made it home to the meter), BG=13mmol/l (at the same time as the ketone test, having come down from ~16mmol/l which it crept up to on the train back - I took insulin.) 155km, 1764m, 7.5h

I felt rotten for the last 1h30 and for almost all of the train journey, though I don't think this was anything to do with ketones (though presumably they would have been higher when I was riding and when I stopped.)

I managed to run high initially (FotF and not enough bolus to sort this, reduced basal to 4 vs usual 9), I then didn't need/couldn't eat much over the first 4h (when BG started heading down and I did eat it stayed up for much longer then usual afterwards - this is ideal, but unusual), which made me wonder about ketones.

I'm definitely underfuelled as usual: 141g CHO consumed x4 = 564cals, Garmin reports 4362cals over the ride), but then I dropped like a stone over the last 3h or so and so had to continually eat - sweet things provide better packing density than non-sweet so that's what I had with me, but I really needed something that wasn't sweet and even the dark chocolate nature valley bars which aren't overly sweet were not something I could face.

Interestingly while I felt really rubbish (nauseous, hot and cold) for about 4h in total (last 1h30 of ride, an hour at a friends house for a BBQ I didn't eat, then half of the train journey), I did eventually eat the very smallest corner of a Nice biscuit and 5min later felt perfectly ok - as in I could go and ride again quite happily, while just before I'd already arranged to picked up from the train station as I felt so terrible.

I had taken some insulin, firstly while waiting then some more once on the train, but my BG hadn't started to come down, so I don't really think this is a ketone issue, also my BG never came right down until I got home and took more insulin, so I do think this is more a case of just feeling sick with all the sweet stuff and needing a palate reset, though if this is the case why didn't eating a few tomatoes from the BBQ salad serve the same purpose. I'm willing to consider all possibilities, it's not pleasant and I'd like to avoid it if possible, not least because it meant I truncated my ride!

I'm going to go even more OT, my previous long rides have always had a decent duration stop and eat, which means I don't need to force down so many carbs until very close to the end of the ride. I need to do this habitually for anything longer than 6h I think, I also need to take something savoury just in case (while beans on toast sound wonderful right now, they probably don't pack very well and I can't even eat them now as I'd need to take loads of insulin just before bed), Ritz crackers perhaps, salted chickpeas, something along those lines. I'll get my thinking hat on 🙂