education

Ketones - An alarm sign

The discovery of ketones in urine should be taken seriously, it will indicate a bad treatment evolution and we should not wait to treat it.

Finding the causes will be useful in order to avoid the appearance of this incident and we will try to understand the reason of this toxic waste in the organism.

Our organism is constituted by thousand of cells that need energy in order to live. For that reason, thanks to the oxygen contributed by the blood, they "burn" the foods which are used as fuel. When there is a lack of "a fuel", the organism uses others, and the waste could be then different. It would be a little like black smoke of a factory that doesn't use any good fuels at all.

In order to burn, foods are firstly transformed inside the "digestive apparatus" in glucose, fatty acids, amino acids, etc that goes to blood, getting the necessary amount of some of those elements, in particular of glucose which is an essential fuel.

The rates of glucose in blood stay more or less constant for a complex action of numerous mechanisms, being the insulin the one that greater takes party.
The insulin will decrease glucose and others such as glucagon, adrenaline and cortisol will increase it.

Insulin is the key that permits cells use glucose. Properly they burn it thanks to the blood oxygen and then produce waste: H2O and CO2 that will be eliminated by kidneys and lungs.


Ketones = Lack of Insulin
If insulin is absentee, our cells could not consume glucose within blood, it is because insulin could not enter the cell, then it would stalemated in circulatory torrent.
Usually normal rates are approximately of 1 gr/ l, this can increase in a significative way, so they might be hoped rates of 3 or 4 gr/l or even more.

Cells try to nurture acting on fat reserves. So, when there is a lack of glucosa, they burn fats. Later if reserves have been drained, they could use proteins then. In those conditions, there's weight loss, that is observed many times when someone with diabetes type 1 is going through a malfunction.

When these products burn our cells produce waste: "cetonic bodies" are toxic to the organism functioning, because they acidify blood, even when lungs and kidneys make everything in order to eliminate them.

Glucose concentration increases in blood. That excess of sugar stimulates thirst and increases the volume of urine. Ketones and glucose pass to urine, this is an important sign of an insulin failure.

When there's missing insulin liver builts great amounts of glucose. Millions of organism cells "scream from hunger" when glucose, being in excess in blood, go by their doors and "the key" which is insulin is not there to open that door. If nothing is done coma happens, the brain works bad and the surveillance decreases.

Fatigue, vomits, slow and deep breathing precedes coma. This coma doesn't have anything to do with lack of glucose coma or hypoglycemic coma .This coma is denominated cetoacidotic coma, because the acid is due to in part, to cetonic bodies. Something must be done quite quick since organism is in total mishap because of the lack of insulin. Treatment will be quick insulin and to hydrate.

Ketones with sugar or with a little sugar
When organism lacks insulin, glucose could not be used for cells. But when lacking glucose, like in a period of fast, for example, glucose reserves are very poor.
Organism cells will use a similar mechanism that sends fat reserves.

If you find a little of ketones in urine, but nothing of glucose, you suspect that there will be a hypoglycemia in the precedent hours and will be necessary to verify the feeding and glucemic balance.
In these two situations, the presence of ketones is much less dangerous. It is in minor amount and when hypoglycemia corrects ketones disappear.

Children who refuse to eat or who vomit could present same effects and then produce ketones.

The Surveillance
If your glucemia is high and it is superior to 250 [mg]% it is essential to make a control of ketones. You should take this caution because excess of glucose points out, a priori, a lack of insulin. In presence of ketones, encouragement has a special scent similar to that of the "sour apples" because they contain cetonics bodies . Also notice the presence of fatigue, of intense thirst, of ketones.
If your urinals test show an important amount of glucose: verify the presence of ketones.

Ketones is very easy to detect in urine, many ribbons exist to measure glucose and ketones in excess like Ketodiastix (but in these ribbons excess of ketones could alter of coloration of glucose reaction), like the Ketodiabur and products that measure ketones just like Ketostix.

A drop deposited on the tablet, the wet ribbon in urine or on the spout of urine, allows to compare the presence of ketones in a scale of colors.

Treating Immediately
If you have many glucose and ketones it is important to apply an injection of approximately 1/ 10 or 1/ 5 of quick insulin of the global dose of all day (5 or 6 units, for example), after three hours glucemia and ketones in urine will be verified.

If it doesn't move or continuous still high and the ketones is still present, we could continue with a complement of quick insulin.

People must eat normally, quit eating will complicate the situation. If nothing happens and just don't come to absorb hydrates of carbon, for example the sugary drinks, is better to call a doctor or hospitalize the patient. In this case in the hospital they will put the patient glucose and intravenous insulin in serums and the several parameters will be watched over in order to permit a progressive recovery.

Take very serious the appearance of ketones this is the sign of alarm of a wrong treatment of diabetes. Depending on if you have received a good information in order to watch over your illness it will be easy to solve this incident, unless other problems intervene to put treatment out of balance: before a minor doubt, call a doctor.

Dr. Antuña de Alaiz
Clínica Diabetológica
Translated by a courtesy from:
J. Alfredo Huelgas García (Mexico)
an Clínica Diabetologica volunteer
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