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October 23, 2000


Question from New York, USA:

My 17 year old daughter has had type�1 since age nine. She is considered to have "brittle" diabetes. Unfortunately, she has been hospitalized too many times to list. She has an anxiety disorder and was bulemic. She spent the past three months in a clinic and did very well. She is currently taking medication for the anxiety and also seeing a therapist. At the clinic, she was changed to carbohydrate counting with insulin shots after meals. She went from a weight of 110 pounds to 130 pounds, but has lost five to seven during the month she has been home. She is currently having a problem with ketones with normal blood sugar ranges and even a few low ones. I have read many other questions regarding sufficient food/insulin intakes as well as stress/anxiety difficulties in controlling diabetes. What is a sufficient carb intake for a 17 year old girl? Can food and insulin deficiencies cause up to large amounts of ketones? Can stress without producing high blood sugars?


Ketones are produced whenever the body breaks down fat. This can happen if you don’t eat enough carbohydrate and have to break down fat for energy. If you don’t have diabetes, blood sugar can be normal or even low. In people with diabetes, the most common cause of ketones is too little insulin with high blood sugar, though ketones with normal or low blood sugar can also occur if you don’t eat enough carbohydrate (starvation ketosis).

In any case, it sounds like your daughter is in immediate need of evaluation by her physician and/or psychiatrist to sort this out. Your daughter may need intensive ongoing psychiatric/nutritional support.