What do you do when your blood sugars are low, and you have high ketones?

There are several ways in which this situation can arise, but in someone with diabetes the most common is that an insufficiency of insulin has arisen because of a missed injection or perhaps an intercurrent infection. This leads to treatment of the DKA [diabetic ketoacidosis] with extra insulin. Normally in this process both carbohydrate and fat metabolism are restored synchronously, but sometimes the insulin reduces blood glucose levels to normal before the ketones are cleared. This is always a situation that requires liaison with your son’s diabetes care team over the details.

In principal though, the need is to give small doses of Humalog or NovoLog every two hours or Regular every three hours until the urine ketones are small or less or the blood ketones are less than 0.6 mmol/L, and at the same time orange juice should be given plentifully to replace water and potassium, wash out ketones and bring blood sugars up to over 120mg/dl [6.7 mmol/L]. Very occasionally it may be necessary to give glucose intravenously.

DOB