How to manage hypoglycemia and ketosis with BSL 4.7 mmol/L and ketones 1.8?

From the Guidelines

For a blood sugar level of 4.7 mmol/L and ketones of 1.8 mmol/L, you should consume 15 grams of fast-acting carbohydrates immediately to treat the mild hypoglycemia while also addressing the moderate ketosis. Good options include 4 ounces (120 mL) of fruit juice, 1 tablespoon of honey, or 3-4 glucose tablets. After consuming carbohydrates, recheck your blood sugar in 15 minutes; if it remains below 5.0 mmol/L, repeat the carbohydrate intake. Once your blood sugar exceeds 5.0 mmol/L, consume a small protein-containing meal or snack to maintain stable glucose levels. To address the ketosis, increase your fluid intake to at least 8-10 glasses of water over the next several hours to help flush out ketones. If you use insulin, you may need a small correction dose once your blood sugar rises above 10 mmol/L, but do not administer insulin while hypoglycemic. The elevated ketones with low blood sugar suggest your body is using fat for energy due to insufficient glucose availability. This combination often occurs during prolonged fasting, intense exercise without adequate carbohydrate intake, or if insulin doses are mismatched with food intake. If symptoms worsen, ketones remain elevated after treatment, or you experience vomiting, seek medical attention immediately, as suggested by the most recent guidelines 1.

Some key points to consider:

• The treatment of hypoglycemia requires ingestion of glucose- or carbohydrate-containing foods, with pure glucose being the preferred treatment, but any form of carbohydrate that contains glucose will raise blood glucose 1.
• Added fat may retard and then prolong the acute glycemic response, and ingested protein may increase insulin response without increasing plasma glucose concentrations 1.
• Ongoing insulin activity or insulin secretagogues may lead to recurrent hypoglycemia unless more food is ingested after recovery, and once the glucose returns to normal, the individual should be counseled to eat a meal or snack to prevent recurrent hypoglycemia 1.
• It is essential to increase fluid intake to prevent dehydration and to help flush out ketones, and to consume a small protein-containing meal or snack to maintain stable glucose levels after the initial treatment of hypoglycemia.
• If you experience severe hypoglycemia, seek medical attention immediately, as it can lead to serious complications, as highlighted in the guidelines 1.

Remember, the management of hypoglycemia and ketosis requires careful attention to blood sugar levels, ketone levels, and overall health status, and it is crucial to follow the most recent guidelines and consult with a healthcare professional for personalized advice 1.

From the FDA Drug Label

Hypoglycemia (too little glucose in the blood) is one of the most frequent adverse events experienced by insulin users. Mild to moderate hypoglycemia may be treated by eating foods or drinks that contain sugar. Patients should always carry a quick source of sugar, such as hard candy or glucose tablets. Hyperglycemia (too much glucose in the blood) may develop if your body has too little insulin. Hyperglycemia can be brought about by any of the following: Omitting your insulin or taking less than your doctor has prescribed.

To manage hypoglycemia and ketosis with a blood sugar level (BSL) of 4.7 mmol/L and ketones of 1.8, consider the following steps:

• Treat hypoglycemia: Consume sugar-containing foods or drinks to raise blood glucose levels.
• Monitor blood glucose: Frequently check blood glucose levels to ensure they are within a safe range.
• Adjust insulin regimen: Consult a doctor to adjust the insulin dosage and regimen to prevent hyperglycemia and ketosis.
• Stay hydrated: Drink plenty of water to help the body recover from ketosis.
• Seek medical attention: If symptoms worsen or if there are signs of severe hypoglycemia or diabetic ketoacidosis (DKA), such as disorientation, seizures, or unconsciousness, seek immediate medical attention 2.

From the Research

Managing Hypoglycemia and Ketosis

To manage hypoglycemia and ketosis with a blood sugar level (BSL) of 4.7 mmol/L and ketones of 1.8, consider the following steps:

• Monitor blood glucose and ketone levels regularly, as recommended by 3, to quickly identify any changes in glucose or ketone levels.
• Be aware of the risk of euglycemic diabetic ketoacidosis, especially if taking sodium-glucose cotransporter 2 inhibitors, as noted in 3.
• Follow the guidelines for determining ketonemia, as outlined in 4, which suggests retesting glucose and ketones when beta-OHB levels exceed 0.4 mmol/L.

Ketone Measurement and Interpretation

When measuring ketones, consider the following:

• A beta-OHB level of > 0.4 mmol/L may indicate abnormal ketone levels, as suggested by 4.
• A beta-OHB level of > 3.0 mmol/L had a sensitivity of 100% and specificity of 88% for diabetic ketoacidosis, according to 5.
• Even non-pathologic ketone levels should be taken into account for proper diabetes control, as noted in 6.

Recommendations for Patients

Based on the studies, patients with type 1 or type 2 diabetes should:

• Perform regular blood ketone tests, especially when taking sodium-glucose cotransporter 2 inhibitors, as recommended by 3.
• Monitor beta-OHB levels when symptoms like nausea or vomiting occur, during infections, or when blood glucose levels exceed 15 mmol/L, as suggested by 4.
• Use a point-of-care device to measure blood ketones and glucose, as recommended by 7 and 6.