My 16 year old daughter has had diabetes for 11 years and celiac disease, which she has had for three years. She also has been diagnosed with lupus-like symptoms which have left her feeling tired. She also has thyroid disease. Her celiac is under good control and her diabetes is under control with her A1c being in the high 6s to low 7s. For the past six months, she has been struggling with spilling ketones even though her diabetes is under control. Do you have any explanation on why she would have moderate to high ketones even with her autoimmune diseases being under control?

Ketone spillage is not related to celiac disease or thyroid disease. Ketones just indicate that body fat is being broken down. This could occur with lack of food (starvation). It could also occur if there is insufficient insulin available and high sugars (illness blocking how insulin works, for instance, omitted insulin, not keeping up with growth needs, etc.). It may occur if there is hypoglycemia and the body switches from sugar to fat metabolism for energy. So, you may want to do some detailed blood glucose monitoring, especially overnight, to be sure that there is not asymptomatic hypoglycemia. You should be in close contact with your diabetes team to help figure this out since positive ketones indicates that there is something unbalanced occurring.

I usually define “good control” of celiac disease as negative transglutaminase and also negative anti-gliadin antibodies. Then, there is no gluten exposure occurring.

SB