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May 28, 2002


Question from Lincoln Park, Michigan, USA:

I know that running ketones leads to DKA [diabetic ketoacidosis] and that DKA leads to weight loss. I also know when people "do" some of (if not all) of the popular weight loss programs, they are checked for ketones when they're weighed each week. How long does one have to run ketones in order for the weight loss to happen? Do people gain that weight back (kind of like water weight) once the body is again stabilized? I ask because, when I announced I was starting the pump, someone mentioned a concern about my misusing it since I have an eating disorder.


Except in the case of a few rare inherited biochemical disorders, excess ketones in the blood and urine occur when insufficient glucose reaches the inside of the cells to be converted into energy. This can occur when the diet is restricted for any reason or where there is either not enough insulin or insulin resistance. In your case both these factors apply.

Assuming that your eating disorder has been one of overeating, you need to balance the ‘carbs’ you do actually eat with the amount of insulin you take. In theory, the blood glucose control problem should be made easier with an insulin pump, but you still will have to face the very difficult issue of appetite control and perhaps also the common temptation to restrict insulin in order to reduce weight. Having ketones is certainly not a requirement for weight loss. Insulin and carbohydrate intake need to be balanced at a point where you slowly bring your BMI (Body Mass Index) back into the normal range. It sounds straightforward, but it requires great determination to make it successful.