Clinical Value of Ketone Body Determinations in Brittle Diabetes

Abstract

The first part of this study is a clinical investigation on the value of concomitant measurements of blood glucose and the ketone bodies for the improvement of control in 35 patients with brittle diabetes. Three groups are identified: 1) The keto resistant patient in whom only the blood glucose measurements are of value. 2) A group in whom about equally valuable information is obtained from blood glucose and the ketosis. 3) The Poulsen‐Somogyi reactors in whom both blood glucose and ketonaemia should be analysed. The level of ketosis may be judged from blood 3‐hydroxybutyrate (3‐HB) and acetoacetate (AcAc) or from breath acetone, although the latter does not change as fast as the metabolized 3‐HB and AcAc. The changes in the urinary concentrations of 3‐HB and AcAc are almost as rapid as those in the blood, and after insulin a decrease in these urinary concentrations is often seen before the blood glucose begins to decrease. The second part of the study shows the positive correlations between the increase in blood glucose above 200 mg/100 ml of blood and blood 3‐HB and AcAc and the decrease in the ratio blood 3‐HB/AcAc with decreasing blood glucose. Preliminary data are also given on the decrement of blood 3‐HB and AcAc with time, indicating an initial slower phase and a second faster one. The daily blood lactate changes were greater than expected. Initially they were parallel to the blood 3‐HB and AcAc variations. Once blood glucose concentration also fell the lactate increased a mean of 1.9 mEq/1.