5 Facts about Ketones
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Blood Glucose Management: Checking for Ketones

What are ketones?

The human body normally runs on glucose that’s produced when the body breaks down carbohydrates. But when your body doesn’t have enough glucose or insulin to use the glucose, your body starts breaking down fats for energy. Ketones are byproducts of this breakdown. Those with type 1 diabetes are especially at risk for making ketones.

Ketones can make your blood acidic. Acidic blood can cause a serious condition known as diabetic ketoacidosis (DKA). Because the presence of ketones is often one of the signs that a person needs medical help, those with diabetes are often encouraged to check ketones in urine or blood regularly.

Ketone levels can range from negative or none at all to very high levels. While individual testing may vary, some general results for ketone levels can be:

  • negative: less than 0.6 millimoles per liter (mmol/L)
  • low to moderate: between 0.6 to 1.5 mmol/L
  • high: 1.6 to 3.0 mmol/L
  • very high: greater than 3.0 mmol/L

Call your doctor if your ketones are low to moderate, and seek emergency medical attention if your ketone levels are high to very high.

What are the symptoms of ketone buildup?

Symptoms

If you have diabetes, you need to be especially aware of the symptoms that having too many ketones in your body can cause. Examples of early symptoms of ketone buildup include:

  • a dry mouth
  • blood sugar levels greater than 240 milligrams per deciliter
  • strong thirst
  • frequent urination

If you don’t get treatment, the symptoms can progress. The symptoms that occur later can include:

  • confusion
  • extreme fatigue
  • flushed skin
  • a fruity breath odor
  • nausea
  • vomiting
  • stomach pain
  • trouble breathing

You should always seek immediate medical attention if your ketone levels are high.

What causes ketones to build up?

Causes

Ketones are the body’s alternate way of fueling. They build up when you:

  • don’t have enough insulin
  • can’t use the insulin you have
  • aren’t eating enough

This may occur if you aren’t feeling well or you’re trying to diet and you aren’t eating enough.

Your body receives signals to release energy from fats when it:

  • doesn’t have enough insulin, which occurs in type 1 diabetes
  • can’t use insulin properly, which occurs in type 2 diabetes
  • can’t use glucose properly, which occurs in starvation

When these fats reach your liver, it breaks them down into ketones.

The release of ketones can become a cycle. Your body will continue to release energy from fats, and the liver will continue to release ketones. This can cause your blood levels to become too acidic, which can be deadly.

Some diets, such as a low-carbohydrate diet, are intended to release fats and create ketones. Those who don’t have diabetes can usually compensate for these changes. However, the excess ketones can be dangerous for someone with diabetes. This is why doctors recommend that people with diabetes proceed carefully when restricting their diets.

How are ketones tested?

process

You can use blood or urine tests to test your ketone levels. At-home testing kits are available for both types of tests. Urine tests are available without a prescription at most drugstores, or you can buy them online.

Your should test your urine or blood for ketones when any of the following occurs:

  • your fasting blood sugar is higher than 240 mg/dL
  • your blood sugar exceeds 300 mg/dL
  • you feel sick or nauseated, regardless of your blood sugar reading

Urine testing strips contain a special chemical. If the strip interacts with urine that has ketones, it will turn a specific color. Several manufacturers make testing kits for ketone levels. Many of them provide results that indicate no ketones up to a high level of ketones in the body. If a child isn’t potty-trained, a parent can usually press the stick to their child’s wet diaper to test for ketones.

An at-home meter is available to test for blood ketones. This is tested in a similar way to a finger-stick glucose test. You’ll prick your finger with a needle and place a small drop of blood onto the testing area.

Doctors often recommend that people who’ve just been diagnosed with diabetes test their ketones twice daily.

If you have a large amount of blood ketones, usually greater than 3.0 mmol/L, or you have a large amount of ketones in your urine, you should seek emergency medical treatment.

What happens if your ketone levels get too high?

Complications Icon

If you don’t get treatment for high ketone levels, DKA can occur. The most serious effects of DKA include:

  • swelling in the brain
  • a loss of consciousness
  • diabetic coma
  • death

This is why it’s important to have a plan for if your ketone levels are moderate and if they become high.

Treatment for high ketone levels

Treatment

High ketone levels usually take time to start getting higher. Accordingly, it can take several days to correct DKA. Treatments can include:

Intravenous (IV) fluid replacement

One DKA symptom is increased urination, which can result in fluid loss. Rehydrating with IV fluids can help to dilute the extra glucose in your blood.

Electrolyte replacement

When a person has DKA, the electrolyte levels tend to be low. Examples of electrolytes include potassium, sodium, and chloride. If a person loses too much of these electrolytes, their heart and muscles can’t function as well.

Insulin

People usually receive insulin through an IV to improve their ability to use excess glucose in the blood for energy. This usually involves testing glucose levels on an hourly basis. When your ketones and blood acid level return to normal, IV insulin may no longer be necessary.

Since an underlying illness can also lead to DKA, such as a severe stomach bug that causes vomiting, your doctor may prescribe treatments for that illness as well.

What is the outlook?

Outlook

Seeking immediate medical treatment when ketone levels are high can ensure a person gets the help they need. You may need hospitalization for several days if you have DKA, but it’s treatable. However, you should evaluate your diet and blood glucose management plan after a DKA episode to help prevent your ketone levels from getting too high again.

Are there ways to prevent high ketone levels?

Prevention

Careful management of diabetes is the key to preventing high ketone levels. Do the following to keep your blood sugar levels healthy and ketone production to a minimum:

Check blood sugar levels regularly

Your doctor will recommend how frequently you should check your blood sugar levels, but this is typically three to four times per day. You should check your blood sugar more often if:

  • your blood sugar levels are getting higher
  • you’re having symptoms of high or low blood sugar
  • you’re sick

Follow a healthy diet plan

Eating enough food and taking enough insulin for the foods you eat that contain carbohydrates is vital for managing diabetes.

Create a plan for moderate ketone levels

Sometimes, moderate ketone levels can be treated before they worsen. A doctor can help you create a plan when your ketone levels get too high, such as administering additional insulin and drinking more water.

Always keep ketone testing kits available

Keep ketone testing kits with you at home and when you travel so that you have a fast way to check your ketone levels.

Work closely with a diabetes educator and your doctor

Diabetes management takes constant vigilance to ensure your insulin administration and eating plan is working effectively. The medication and insulin combination that works best varies depending on the person. You should talk to your doctor if you’re concerned about your ketone levels being frequently high.

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