Dear Diabetes: What are the basics of ketones?
When the body is unable to burn glucose for energy, it burns fat instead, a process that creates an acid waste product called ketones (pronounced “KEY-tones”). The body may switch to burning fat when losing weight or if there is not enough insulin to help burn glucose. As more fat is metabolized, more ketones are produced. In people living with diabetes, this may lead over time to diabetic ketoacidosis (DKA), a serious medical emergency. DKA may be avoided by managing diabetes and checking for ketones at times when a person is most at risk.
People living with type 1 diabetes have the highest risk of developing unhealthy levels of ketones, typically during extended periods of untreated high blood sugar, known as hyperglycemia. People living with type 2 diabetes may also be at risk. Ketones levels may rise, leading to DKA over time, if an infection or steroid treatment significantly increases insulin resistance, or if the pancreas reduces the amount of insulin it releases. Injecting too little therapeutic insulin, a clogged insulin pump or a missed insulin injection may also cause ketone levels to rise. Alcohol abuse may contribute significantly to unhealthy levels of ketones.
Talk to your healthcare team if you have concerns about your ketone levels. Ketones can be detected by over-the-counter urine tests available in most pharmacies. The American Diabetes Association (“the Association”) recommends taking a urine test every 4 to six hours when your blood glucose is more than 240mg/dl. Testing is also recommended when:
- Pregnant (every morning before breakfast, or as directed by a doctor)
- Fighting an infection, such as a flu or cold, or are running a fever (every 4 to 6 hours)
- Nauseated, have vomited more than once or have abdominal pain
- Feeling very fatigued or confused and “foggy”
- Feeling constantly thirsty and/or have dry mouth
- Skin is flushed or feels “clammy”
- Short of breath or your breath smells “fruity”
Testing is easy to do, but needs to be done correctly for greatest accuracy. Your healthcare team can help advise you on how and when to test and how to read the results. One can also test blood ketones with a blood glucose meter that, in addition to testing blood glucose, has the ability to test blood ketones. You need specific strips for this and these strips can only be used to test blood ketones.
Typically, a person dips the urine test strip into a clean cup containing their urine or passes the strip through their urine stream. The strip pad will change color. Comparing the strip to a color chart that comes with the test will indicate whether there are no ketones, a small or moderate amount, or large quantities.
At the sign of any ketones, contact your doctor to discuss further action. If there is a small amount, a person may be advised to test a few more times every couple of hours. A doctor may also recommend adjusting the therapeutic insulin dose, drinking plenty of water and avoiding exercise. If there are moderate to high levels of ketones in urine, the healthcare team should be contacted immediately. The Mayo Clinic advises calling 911 if a person is unable to keep food or fluids down while glucose levels are above 240 mg/dl and ketones detected in urine.
As part of a strategy to live healthier and avoid hyperglycemia and DKA, the Association recommends partnering with your healthcare team to set blood glucose targets and checking levels frequently. More healthful eating, regular physical activity and medication adjustments may help keep levels on track.
© 2015 The DX: The Diabetes Experience