Interrelationships of blood sugar and ketones in insulin-treated diabetics

Watkins, P J; Fitzgerald, M. G.; Malins, J. M.

doi:10.1136/bmj.4.5684.648

Cited by 6 publications

(4 citation statements)

References 20 publications

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“…The same interval was also noted in the third patient. e" TIME IN HOURS DISCUSSION The fact that not only the blood glucose concentration, but also the degree of ketonaemia, may vary during the day in diabetics was observed by Poulsen (11) as early as 1941 and has later been confirmed by Watkins et al (15). Besides this observation the present results show the time relationship between 3-HB and AcAc and their precursor FFA.…”

Section: Resultssupporting

confidence: 82%

Diurnal Variations in Blood Glucose, 3‐hydroxybutyrate, Acetoacetate, Plasma Free Fatty Acids and Glycerol in Diabetics

Rooth

Carlström

1972

Journal of Internal Medicine

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Abstract24‐hour studies of the changes of blood glucose, 3‐HB, AcAc, plasma FFA and glycerol have been made in five diabetics on long‐acting insulin and 10‐hour studies in two patients receiving short‐acting insulin. The reduction in the concentration of 3‐HB, FFA and glycerol preceded that of glucose. AcAc initially increased after the administration of insulin. The reappearance of ketonaemia is preceded by an increase in plasma FFA and glycerol by 3 to 4 hours. One patient who was ketoresistant showed no significant increase in plasma FFA or glycerol concentration either during hyper‐ or hypoglycaemia.

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Section: Resultssupporting

confidence: 82%

Diurnal Variations in Blood Glucose, 3‐hydroxybutyrate, Acetoacetate, Plasma Free Fatty Acids and Glycerol in Diabetics

Rooth

Carlström

1972

Journal of Internal Medicine

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“…The present study of ketosis in diabetes has not been directed to instances of manifest keto acidosis in the traditional clinical sense, but to the value of ketone measurements in the control of the patients and to the diurnal variations in the level of ketosis in diabetics. Earlier studies (17,22), also covering in some instances 24 hours of the day, showed that the level of ketonaemia may vary considerably as in the present study.…”

Section: Discussionsupporting

confidence: 70%

“…As a guide to optimal control of the diabetic patient the integrated analysis of blood glucose and blood 3-HB and/or AcAc is preferable to that of blood glucose alone (7,22,26,27). The ketosis may be monitored in several ways, as the present study has shown.…”

Section: Discussionmentioning

confidence: 83%

Clinical Value of Ketone Body Determinations in Brittle Diabetes

Rooth

1972

Journal of Internal Medicine

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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.

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“…11 Small changes in blood ketones may be associated with massive ketonuria and strongly positive urine Ketostix tests, the blood levels being well below those associated with ketoacidosis. 12 Yet, in true diabetic ketoacidosis, with blood AA levels 100 fold above normal (i.e., 5 mmol/L), the Ketostix test on urine gives the same positive result.…”

Section: Discussionmentioning

confidence: 99%

Ketonuria in Pregnancy—With Special Reference to Calorie-restricted Food Intake in Obese Diabetics

1980

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Early morning ketonuria, as judged by Ketostix testing, occurred in 19% of urine samples from insulin-independent diabetic pregnant women eating 1000 calorie diets, in 14% from diabetics on higher calorie diets, and in 7% of urines from nondiabetic pregnant women. Ketostix test was never found to be positive in blood, even when it was 2+ in urine samples, and acetoacetate levels were always below 1 mmol/L. Enzymatic estimations of acetoacetate (AA) and beta-hydroxybutyrate (BB) in urine and plasma samples revealed (1) no significant differences in range or mean between the groups receiving different restricted diets or full diets, the highest value observed for plasma AA being 0.34 mmol/L; (2) that Ketostix became positive at a concentration of AA above 1 mmol/L and that such a value in urine corresponded to plasma levels of between 0.06 and 0.1 mmol/L, i.e., double the normal; and (3) a 50-100-fold increase in urine AA when blood levels exceeded 0.08 mmol/L. Neonates born to diabetic mothers with ketonuria had no fetal distress or asphyxia neonatorum. The lowest Apgar score at 5 min was 8; 80% of neonates had a score of 10. Hence, positive Ketostix tests in urine samples do not indicate toxic levels in the blood, and a 1000 calorie diet for obese pregnant diabetics appears to be safe as regards neonatal outcome.

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Interrelationships of blood sugar and ketones in insulin-treated diabetics

Cited by 6 publications

References 20 publications

Diurnal Variations in Blood Glucose, 3‐hydroxybutyrate, Acetoacetate, Plasma Free Fatty Acids and Glycerol in Diabetics

Diurnal Variations in Blood Glucose, 3‐hydroxybutyrate, Acetoacetate, Plasma Free Fatty Acids and Glycerol in Diabetics

Clinical Value of Ketone Body Determinations in Brittle Diabetes

Ketonuria in Pregnancy—With Special Reference to Calorie-restricted Food Intake in Obese Diabetics

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