When your body cannot get energy from glucose, it takes it from fat.
Ketones are produced when fat is metabolized.  Do not confuse ketones with
ketoacidosis.  Not the same.  Metformin decreases insulin resistance so the
body can better use available glucose - among other things.  So Metformin
helps the base problem.  I'm not a doctor, just a recently diagnosed T2.  I
am on metformin myself.  I have had several urine tests lately and some have
been positive for ketones.  It's nothing I worry about as I understand it -
I am testing once a day for protein in the urine.  My endo is far more
concerned with my kidney health.

Paul

Well first off, what type of meter did you buy? Because iirc theres only
only meter that checks blood ketones, and you need a special strip to
test for that.

Secondly, if you were having ketones all this time, at that high of glucose
you'd pretty much be dropping weight like crazy, which you don't mention
at all.

You also don't mention your age or weight.

Also, no eating foods low in "acid" will not remove ketones from the blood
the only way to do that is to inject insulin, rehydrate the body and reduce
the
glucose, often other things are needed but can only be given by IV...
ketones
in the blood like that also is a medical emergency known as DKA, which
you've
not mentioned any of those symptoms either.

I think you're doctor was right, you need the metformin, you also need to
learn
a new way of eating, start to exercise as well.

Best of luck to you, hang around ask questions theres some good advice as
long
as you ignore the trolls.

RK, T1 Pumper

Dear Jim
My meter says "Ketones" when my blood sugar is over 250 (American
measure, sorry, I don't know the conversion to your measure).  It DOES
NOT mean there are ketones in my blood, it means that the meter is
reminding me to check my urine for ketones.  Please check the owner's
manual of your meter to see if this is also true for your meter.

Jim Jaworski wrote in message ...

   Your meter said "ketones" because that is an important (and  standard
warning) for Type 1 diabetics who have blood sugars that high.

Your meter did not measure ketones.    Nobody knows if you had ketones or
not.    You measure ketones with a urine sample.  The meter manufacturer
merely programmed the meter to warn about ketones as a courtesy for Type 1
diabetics.

Your doctor seems to think that you are a Type 2 diabetic.    Type 2
diabetics rarely have problems with ketones.   Those who do have had the
disease for a very long time.     You do not qualify.

I seriously doubt that you have ketones.    If you are still worried,  buy
some ketones-in-urine test strips from your local pharmacy and test.

Metformin is not a research drug.  It has been used to treat diabetics for
over 40 years and has one of the best safety records of all the
anti-diabetes drugs.

The recommended clinical maintenance dose of metformin is 1500 mg/day.
However,  the doctors are supposed to walk the dose up from 500 mg/day in
order to minimize diarrhea and gas problems.   Therefore,  do not be alarmed
if it doesn't seem to help at first.

Your doctor is being very conservative.   Actually,  I think he is being too
conservative.     Here is an example of another doctor's approach to a
person in your situation.   Note that Gary's reading of 270 mg/dL in U.S.
units corresponds to 15 mmol/L  in the units used by your meter

"From: Gary Pewitt <gpewitt@execpc.com>
Newsgroups: alt.support.diabetes
Date: Tuesday, February 25, 2003 11:46 PM

Gary's doc was aggressive.   He attacked Gary's high sugars really hard with
most of the anti-diabetic drugs around,  then backed off after he got Gary's
sugars out of the danger range.

Note that your sugars are well into the danger range.    If I see a 10.6 I
immediately take emergency action.  I inject insulin, then exercise.

Keep coming back.   Diabetes is one of those odd diseases in which the
patient does all the work and most of the management.  The docs mostly sit
on the sidelines cheering us on and writing the occasional prescription.
Reading the diabetes newsgroups every night has produced substantial
improvements in my health,  my standard of living,  and,  I'm sure,  my life
expectancy.

If you are interested in reading up on Metformin,  try reading these
discussions:

a. Metformin reduces blood sugars

http://www.diabetesnet.com/diabetes_treatments/metformin.php

b. Metformin improves cholesterol and triglycerides

http://tinyurl.com/5errv

c. Metformin cuts heart attack risk in T2

http://www.diabetesincontrol.com/issue132/item2.shtml

(   http://tinyurl.com/akgrl   )

d. Actually, Metformin just plain reduces overall mortality rates among T2
diabetics

http://tinyurl.com/69yjd

Regards
 Old Al

Jim...

Meters cannot tell you IF there are ketones present.

When your meter sees that you have very high glucose levels, it  puts
"Ketones" on the screen.  It's telling you, you should check your urine
(with a ketone dip stick) for ketones.   You may or may not have them.

The complication of ketoacidosis and Metformin, is very serious... but
it is also very rare.

You need the metformin.  I looked at the chart you made...  Your numbers
are way too high.  They are continuing to cause the damage that is
creating the pains in your feet.  And they are doing the same things to
your eyes and kidneys.  I'm sorry to be so blunt.  But they are.  If
those are your fasting and bedtime numbers (and many were over 20, some
close to 30!)... then your post meal numbers will likely be even higher.
  That must become unacceptable to you.   I do see you're making
progress...  You need to take strong action.  Today.

What, besides taking your blood glucose levels twice a day, are you
doing to get control of this disease?  What food plan?  What exercise plan?

Here's the advice I give all those who want to get control of their
diabetes.  Stick around here and tell us how you're doing!

Sounds like you're planning a move to take control of your diabetes... good
for you.

There is so much to absorb... you don't have to rush into anything.  Begin
by using your best weapon in this war, your meter.   You won't keel over
today, you have time to experiment, test, learn, test and figure out just
how your body and this disease are getting along.  The most important
thing you can do to learn about yourself and diabetes is test test  test.

More than most anything, what you eat will affect your diabetes and
your blood glucose numbers.

And more than anything you eat, carbs will affect your diabetes and
your blood glucose numbers.

So, the most important information you can begin to compile about
yourself, is how your body handles carbs.

This sounds like you would need a low carb food plan right?

You don't... what you need to uncover is YOUR   Personalized Carb Number.

Which actually works better for most everyone.  Because low to one
person is wildly high to another, but waaaaay too low for someone
else.

Is low carb less than 30g a day?   Is it anything less than the
Pyramid reccomendations?

Finding your Personalized Carb Number is easy.

Here's how you can figure out your own Personalized Carb Number.

The single biggest question a diabetic has to answer is:

What do I eat?

Unfortunately, the answer is pretty confusing.

What confounds us all is the fact that different diabetics can get great
results on wildly different food plans.  Some of us here achieve
great blood glucose control eating a high complex carbohydrate diet.
Others find that anything over 75 - 100g of carbs a day is too
much.  Still others are somewhere in between.

At the beginning all of us felt frustrated.  We wanted to be handed
THE way to eat, to ensure our continued health.  But we all
learned that there is no one way.  Each of us had to find our own path,
using the experience of those that went before, but still having
to discover for ourselves how OUR bodies and this disease were coexisting.

Ask questions, but remember each of us discovered on our own what works best
for us.  You can use our experiences as jumping off points, but eventually
you'll work up a successful plan that is yours alone.

What you are looking to discover is how different foods affect you.  As I'm
sure you've read, carbohydrates (sugars, wheat, rice... the things our
Grandmas called "starches") raise blood sugars the most rapidly.  Protein
and fat do raise them, but not as high and much more slowly... so if you're
a T2, generally the insulin your body still makes may take care of the rise.

You might want to try some  experiments.

First:  Eat whatever you've been
currently eating... but write it all down.
Test yourself at the following times:

Upon waking (fasting)
1 hour after each meal
2 hours after each meal
At bedtime

That means 8 x each day.  What you will discover by this is how long
after a meal your highest reading comes... and how fast you return to
"normal".  Also, you may see that a meal that included bread, fruit or
other carbs gives you a higher reading.

Then for the next few days, try to curb your carbs.  Eliminate breads,
cereals, rices, beans, any wheat products, potato, corn, fruit... get all
your carbs from veggies.  Test at the same schedule above.

If you try this for a few days, you may find some pretty damn good
readings.  It's worth a few days to discover.

Eventually you can slowly add back carbs until you see them affecting your
meter.

The thing about this disease... though we share much in common and we
need to
follow certain guidelines... in the end, each of our bodies dictate our
treatment and our success.

The closer we get to non-diabetic numbers, the greater chance we have of
avoiding horrible complications.  The key here is AIM... I know that
everyone is at a different point in their disease... and it is progressive.
But, if we aim for the best numbers and do our best, we give ourselves the
best shot at heath we've got.
That's all we can do.

Here's my opinion on what numbers to aim for, they are non-diabetic numbers.

FBG                          under 100
One hour after meals       under 140
Two hours after meals     under 120

or for those in the mmol parts of the world:

Fasting                              Under 6
One hour after meals         Under 8
Two hours after meals       Under 6.5

Recent studies have indicated that the most important numbers are your
"after meal" numbers. They may be the most indicative of future
complications, especially heart problems.

Listen to your doctor, but you are the leader of your diabetic
care team.  While his /her advice is learned, it is not absolute.   You
will end up knowing much more about your body and how it's handling
diabetes than your doctor will.   Your meter is your best weapon.

Just remember, we're not in a race or a competition with anyone but
ourselves... Play around with your food plan... TEST TEST TEST.  Learn what
foods cause spikes, what foods cause cravings... Use your body as a science
experiment.

You'll read about a lot of different ways people use to control their
diabetes... Many are diametrically opposed. After awhile you'll learn that
there is no one size fits all around here.  Take some time to experiment
and you'll soon discover the plan that works for you.

Best of luck!

Jennifer

Ketones are not always a big deal for a T2.... Although you should be
mindful of them.

The big thing to watch out for is ketoacidosis, which is more of a risk for
T1's.... A T2 has to be pretty far gone to be in ketoacidosis, from what I
gather. On the other hand, if you have ever done Atkins, his diet plan and
books do discuss deliberately induced "ketosis"which is different from
"ketoacidosis"..Ketosis may be OK in a T2, or in anyone on a diet and
exercise plan following a particular approach. Simply put, ketosis results
from a low carb regimen, with the result of the body burning more proteins,
rather than so much glucose. In the end, it is a question of balance.

One word of caution, however, would be that for a T2 with impaired kidney
function/kidney damage, it is not a good idea to induce ketosis.... If that
is the situation, be careful.... That, presumably, is why you have a
competent doctor who has ordered lots of tests to monitor you.

Just some thoughts.

Will, T2

Jim - print Jennifer's reply off and put it on your fridge door. Read it
often - it's a lifesaver. It'll help you to help your meter to stop
complaining about ketones : )  I remember feeling a bit miffed when mine
stopped saying Hi...

You're a Type 2. The ketones panic is for Type 1s. Take the metformin, and
try and walk it up to at least the 1000mg mark, maybe more - until your
numbers are between 4-7 at most times, and never more than 8.

The other leg of diabetes control is exercise - what are you doing about
that? And have you been told when not to exercise, whilst you're running
high numbers? A gentle walk after lunch and dinner would be really
beneficial, but don't try anything more energetic if your BG is over 12.

Nicky.

JIm, I dont believe that type II diabetes have ketones.  It will be fine
for you to take the metformin,  I wonder if he will increase in time
because 500 is a very low dose.

Others more knowledgeable will tell you the real story behind the
ketones but from my recollection, I think I am right.  I have never
spilled a ketone in over 6 years of being a type II.

Loretta

--
In tribute to the United States of America and the State
of Israel, two bastions of strength in a world filled with strife and
terrorism.

Hi Jim

First - welcome to the club.  I know you didn't really want
to qualify for membership, but at least you've come to the
right place.

You've had some excellent replies. I won't repeat them all
but I strongly recommend that you go back and re-read two in
particular, from Jennifer and OldAl.

I had a look at your *.pdf and a few things stand out.

That list of foods is probably the worst menu I've seen for
a diabetic in quite a while. In the whole list the only food
I can eat without spiking (getting a high blood glucose) is
the garden salad. The rest are like a guide for "what not to
eat".

Read Jennifer's advice again, print it out, and then put it
into practice and you'll start to see why I said that. And
please - don't buy any more bananas, apple pies, muffins,
lentil soup, Cheerios...the list goes on. Buy lots of green
veges, fish, meat (or alternative protein if you're
vegetarian - I noticed there were no meats in your menu).

I'm rarely this definite - but find a new doctor as a matter
of urgency, preferably one who specialises in diabetes. If
your doctor was fully aware of those numbers and simply
dispensed a daily 500mg metformin - belatedly - with no
further advice or referrals then you need to get good advice
rapidly. I would guess that your A1c is well into double
digits, and I'd be worrying more about glucose toxicity than
possible metformin side-effects. You may need to be on
insulin, at least until those numbers become more
manageable. You are already experiencing the consequences of
those high numbers.

I also think you may need further testing as to your type.
As others noted, you didn't mention your age or weight.

Make an appointment to see a competent doctor ASAP.

And put Jennifer's advice on testing into practice while you
wait for the appointment.

Cheers Alan, T2, Australia.

First up, what have you been told and what are you doing now
since diagnosis. Has your diet and exercise levels changed?
If so, in what way? What are eating these days? Testing
twice a day will not give you a clue on what foods are doing
to your numbers by the way. You need to test before each
meal and snack and test 1 and 2 hours after for the time
being. You adjust your carb levels according to the results
of the tests. But first up, I for one would like to see what
you are eating right now, a daily food plan with food types
and amounts. See what you are up to at the point ;)