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June 7, 2002

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Question from Kentucky, USA:

We have seen moderate to large amounts of ketones in our son while sick and no high blood sugars (mostly below 60 mg/dl [3.3 mmol/L]). Can ketones appear with low blood sugars ? Do they have the same significance as ketones from high blood sugar? How do you get rid of them? Can ketones build up in the body even with controlled blood sugars?

Answer:

Yes! Ketones are produced primarily when the body uses fat for fuel rather than sugar. Therefore, folks with diabetes can become ketotic because of the lack of insulin which no longer allows them to use glucose sugar efficiently for fuel. In this condition, the degree of ketones can progress to a clinical situation called DKA [diabetic ketoacidosis] which can be deadly.

Diminished body stores of sugar (called glycogen), which are used up quickly in such situations such as illnesses or starvation, can also lead to fat-for-fuel metabolism which can lead to ketone production. In this situation, glucose levels are not elevated and may in fact be low. This is generally not thought of as life-threatening when this type of short-term ketosis appears.

DS