Five Things to Know about Ketones

If you live with diabetes, you have probably heard that ketones are something to watch out for. That they have something to do with the dreaded diabetic ketoacidosis (DKA). But do you really understand what ketones are and why they happen?

It’s scary to think about, sure. But it’s also very important to be in the know about ketones and to be prepared.

1) What are ketones?

If there isn’t enough insulin in your system, you can’t turn glucose into energy. So your body starts breaking down body fat. Ketones are a chemical by-product of this process.

This can occur when people with type 1 diabetes don’t take insulin for long periods of time, when insulin pumps fail to deliver insulin and the wearer does not monitor blood glucose, or during serious illness (in type 1 or type 2) when insulin doses are missed or not increased appropriately for the stress of illness.

Ketones can happen to anyone with diabetes, but the condition is more common in people with type 1.

2) Why are ketones dangerous?

Ketones upset the chemical balance of your blood and, if left untreated, can poison the body. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Eventually they build up in the blood.

The presence of ketones could be a sign that you are experiencing, or will soon develop, diabetic ketoacidosis (DKA)—a life-threatening medical emergency.

3) When should I test for ketones, and how?

There are several situations in which it is a good idea to check for ketones, usually every four to six hours. Talk to your doctor to know what makes the most sense for you and your diabetes management plan.

  • Your blood glucose is more than 300 mg/dl (or a level recommended by your doctor)
  • You feel nauseated, are vomiting or have abdominal pain
  • You are sick (for example, with a cold or flu)
  • You feel tired all the time
  • You are thirsty or have a very dry mouth
  • Your skin is flushed
  • You have a hard time breathing
  • Your breath smells “fruity”
  • You feel confused or “in a fog”

Ketone test strips are available at your pharmacy. They kits are quick and simple to use—though it is important to follow the instructions closely. Always have test strips on hand and check their expiration date.

Make sure you understand the directions in advance, and ask your doctor or nurse if you would like a demonstration. Generally, the test will involve dipping a strip in a urine sample, waiting for it to change color, then comparing your results to a chart on the packaging. The color will estimate the concentration of ketones in your urine. Remember to record your results!

4) When should I call my doctor for this?

Talk to your doctor immediately if your urine results show moderate or large amounts of ketones. This is a sign that your diabetes is out of control, or that you are getting sick. If you are unable to reach your diabetes care team, head for the emergency room or an urgent care facility.

Share the notes from your log, as this important data will provide clues as to how to treat you and adjust your diabetes management plan.

Small or trace amounts of ketones may mean that ketone buildup is starting. You should increase your intake of fluids (water is best) and take other steps to get your blood glucose levels in check. You should test again in a few hours. Call your doctor if the levels increase.

5) Will exercise help?

Exercise is often a good way to bring down high blood glucose—but not when ketones are present. Never exercise when your urine checks show moderate or large amounts of ketones and your blood glucose is high. It may make your blood glucose level go even higher.



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23 Responses to Five Things to Know about Ketones

  1. Rana mohammad Ali says:

    I want to know about insulin pump

  2. Terry says:

    Insulin pump-

    In addition to the above link^

    Talk to your diabetic doctor and find out which pumps they are familiar with and recommend. If they don’t know about pumps, find another doctor who is.
    You will work very closely with your doctor to “tune” the pump so that you live a more normal (sugar level wise) life.

    I’ve been on a pump (I’ve tried 2 different manufactures so far) for the past 13 years and it’s helped me tremendously.

    Hope that helps

    • Jaweriah shahbaz says:

      Doesnt it effect your normal daily life?

      • Ashley Smit says:

        Depends on the levels, i was tested an his a 5.8 and that ruing over a week of my life, Mainly vomiting 24/7 and severe abnominal cramps, On the other hand i bet alot of people have really small amounts that will go un noticed.

  3. Barbara says:

    Learn more

  4. Marie-France says:

    What is the difference between diabetic ketoacidosis (DKA) and nutritional ketosis?

    • American Diabetes Association says:

      This is a good question! Nutritional ketosis happens whenever we don’t eat any carbohydrates for a certain period of time, and the body starts to break down fat, and eventually protein, to produce energy. There is still insulin in the body that helps regulate the whole process, and ketosis never progresses far enough to make the blood too acidic. Some level of ketosis is common in many weight-loss diets. The same process happens in diabetic ketoacidosis, but it proceeds unchecked, until the ketones make the blood so acidic that it becomes toxic.

  5. katie blanton says:

    I’m considered a borderline diabetic and I constantly have keytones in my urine should I be worried

    • American Diabetes Association says:

      Be sure to follow up with your doctor. This could be a sign your blood glucose levels have risen.

  6. Ian says:

    What about blood ketones?? Is it not far more appropriate to check for blood ketones, given they tell you immediately what is happening with your body, rather than urine ketones – something that may have been sitting in the bladder for up to 3hrs – therefore representing something that may have occurred 3 hrs ago???

    • Ashley Smit says:

      I think it starts in the urine then goes on to blood, doctors will always test your pee before blood for ketones

  7. vikram says:

    My three year baby ve sugar.we give her mrng 4units and eve 2 units every day and her her sugar level normally in between150 to 300 and she hasn’t got ketones in urine.and it starts from a month ago.we also starts heomopathy as well,so pls tell me da right solution….. thanxx

  8. John says:

    Does anyone ever survive to old age with all these problems awaiting. If you don’t catch DKA, you catch neuropathy etc. Sometimes feeling depressed for being who I am.

    • Rick U. says:

      I’ve had type 1 for 50 years this month and am still going strong. I’ve had laser surgery on both eyes and a vitrectomy on one, but my overall vision is fine, kidneys great, and I feel good. I am blessed I admit, but life is a blessing in my opinion!

      • Robin Owen says:

        Likewise, mine for 43yrs. Has never really stopped me doing anything from sports to global exploring to my career. It is more that you should have an awareness of the risks and manage your diabetes (along with your diabetologist) as effectively as possible. Overall the more effectively you manage your diabetes, the lower your risks will be. Keep in mind also that non-diabetics face complications in life as they get older – so not everything is due to being diabetic. Also things have and continue to improve with the Abbot continuous glucose monitoring patch coming out soon as the latest improvement. “When I we a lad” I had to clear my bladder, then pee in cup, take 5 drops of urine d 10 of water and add a reagent tablet and look at the color – “and yer tell the young kids of today and they won’t believe yer”. Your concerns are genuine, but we have the tools to effectively manage diabetes. Good luck to you.

    • Ashley Smit says:

      You dont “catch” DKA you develop it though bad diabetic car? i developed it pretty bad and took 3-4 days to be back to level 0

  9. Janiafoster says:

    Plz tell me some more how to rib of ketones in my body plz

  10. Janiafoster says:

    Plz help me get rid of this stuff put my body

  11. Ashley Smit says:

    i Just spent 4 days in hospital hooked up to a drip as well as other things, Trust me its not fun. even after getting my levels to 0 I still get abdominal pain from the amount of vomiting.The only real cure if to hydrate and i was also given vitamins. I found it hard to eat anything and drinking anything other than milk felt like acid going down, i guess water is the better option but that was burning still for me

    P.s they make test strips you can but or in my case my dietitian gave me some.

    Again all the hospital did was flush my body with water.

  12. Julie Newman says:

    I’m type 2 diabetic and six days ago started a ketogenic diet. The goal of Keto diet is ketosis. It has brought my blood sugar numbers greatly already. I’m checking for ketones in the the urine and I have trace amounts. This is a good thing with this way of eating. Now I’m worried though after reading this article. Is this safe for a type 2?
    Thank you

    • Adele Cooper says:

      Love your self for who you are chick, DO NOT DO THE KETOSIS THING, this is simply your body trying to survive of what it needs because it is starved of carbs or insulin or maybe both!! your body goes into survival mode and breaks down your body fat to do so, BUT of course there will be long term complication ITS NOT A SIMPLY A DIET – keep safe, keep healthy, eat the right thing, the right amount and exerciser a little, this will fulfill your goal even if you dont do the exercise babe – by doing what was introduced as the Atkins diet you will cause complications in the long run – its just not worth it, eat little n offen plus eat fruit veg, fish etc if you get me.

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