September 13, 2008
Question from Eugene, Oregon, USA:
My daughter was recently sick for one week and is just now starting to feel better. After 48 hours of violent vomiting and diarrhea, I took her to the hospital where she was given an I.V. and Zofran. She then started to feel better. Since my daughter has been having elevated postprandial spikes (see my previous question), while she was sick, I continued checking her blood sugar and ketones as well. For six days straight, she had large ketones, and now only a trace on the seventh day. During the first four days of her illness, her blood sugar was between 45 mg/dl [2.5 mmol/L] and 55 mg/dl [3.1 mmol/L] on an Accu-Chek Aviva meter, which I calibrated based on a laboratory test and believe is accurate. My daughter was waking up low and staying low all day. She had not been eating, was drinking little and was dehydrated. I was concerned about the low blood glucose levels, but the doctor told me they were fine because she was sick. I was also told the ketones were normal. I was told, by four different doctors, that my daughter just had a stomach bug. I insisted on more testing and tests showed she had a water-born illness/parasite. So, what I’d really like to know is where low blood sugar levels were normal for being sick? Were the ketones normal?
It seems to me that you need a real good review on the mechanics and physiology of glucose control. This forum can only give you some help. There are many, many things that affect one’s blood glucose reading, but there are three very basic factors that are essential: 1) the insulin available; 2) the food intake; and 3) the activity or exercise that is done. The body has several ways to try to maintain glucose for energy when one of the three factors above is skewed. So, for instance, if one is unable to eat (example: illness or non-availability of food), then stored glucose in the muscles and liver are then taken out of reserve and placed into the blood circulation. These stored sugar reserves can hold out several hours, typically. Another energy-shifting mechanism when food is unavailable is the utilization of stored energy that is in the form of fat. Fat carries more calories per unit than do carbohydrates and protein. One of the substances produced during the utilization (or “burning”) of fat for energy is the family of substances called “ketones.” Ketones have several of their own effects on the body, among them is that the brain can use ketones for energy, too! Isn’t that wonderful? True, high concentrations of ketones often don’t make us feel so good and can blunt the appetite center (which allows us to not feel hungry and then not eat and then burn more fat for energy. This cycle is the mechanism for the promotion of “ketosis-prone, low-carbohydrate diets” such as Atkins, etc.) So, during an illness, it is NATURAL and NORMAL for the body to produce detectable ketones. It is not the usual way the body wants energy, however. SUGAR is the way the body prefers energy, but nonetheless, ketones are a natural “back-up plan.”
With your child’s gastrointestinal illness, another normal system probably went awry: with the vomiting and diarrhea, the intestines probably were not working efficiently at digesting and absorbing whatever nutrients that were being provided (as food), thus potentially accelerating the shift to fat metabolism.
In the patient who actually has type 1 diabetes, the unchecked ketone production leads to the accumulation of a variety of acids. The normal chemical balance of the body gets all messed up and can lead to potentially deadly diabetic ketoacidosis. What prevents this in a non-diabetic? Insulin. How do we get ourselves to make insulin? We eat things that have glucose (or easily converted to glucose). It sounds to me that your child’s metabolism seems pretty normal, although the post-prandial spikes may be exaggerated.
I’m curious to know why you check your daughter’s blood sugar so often. It just seems a bit excessive to do so when your daughter does not have diabetes. How does your daughter, her father, and your doctor feel about this?