Surprise Ketones

Andrew had very large ketones tonight!!!  We completely didn't see it coming.  At lunch, his BG was 72 (great number), and he ate a slice of meat and some pears.  He rose steadily through the afternoon, so Gene had him do a correction about 30 minutes before dinner.  He was in the low 300's then, but he was coming down before we sat down to eat.  Andrew ate and got seconds, but then said that he didn't feel good.  He was a little nauseous.  So, I asked him to check his ketones.  He looked at it and said, "Time for a site change!!!"  It was black.  The site was two days old and looked fine, but we changed it anyway.  I was afraid to give an injection because he had a large dinner bolus on board.  Or did he?  We checked blood ketones, and they were the highest I've ever seen - 2.2.  I called the doctor just to be sure since I've never seen ketones that high.  She said we were doing everything right and that the ketones should clear.  Push 4 ounces of fluid per hour and give any corrections >300 with a syringe.  Andrew was happy that his last check was 298, so he could do the correction by pump. His last ketone check was also down to small.  Crisis averted.  I'm so glad he wasn't playing ball or exercising tonight.  Once we found the ketones, we put in his favorite movie, The Blind Side, and sat on the couch.  I'm also thankful for Dexcom, because I turned his basal rate of insulin way up until I could see his BG coming down.  His basal rate right now is still insanely high (+120%!), and Dex says 240 and steady.  I don't want to cancel the basal yet, but I can't sleep with that going either!