Having a trace amount of ketones in your urine is normal. You can test at home or at a clinic to determine your ketone levels. If your levels are high, you may want to talk with a healthcare professional.

Having small amounts of ketones in your urine may not be a cause for concern, especially if you’re following certain types of diets.

In fact, a higher-than-average ketone level can be good if that’s your goal. This is especially true for people who may have started eating a ketogenic diet to lose body fat.

However, it could signal other issues that might need a closer look, particularly in people who don’t eat a low carbohydrate diet. And if you live with diabetes, high ketone levels might require medical attention.

This article will provide more information about ketone levels, what it means if you have trace amounts of ketones in your urine, and lifestyle or treatment options to discuss with your healthcare team if necessary.

Your body makes ketones when it breaks down fat for energy. It’s normal to have a tiny amount of ketones in your urine because your body usually uses glucose instead of fat for fuel.

Having larger amounts of ketones in your urine means your body is using a large amount of fat for fuel. This may happen if you’re following a low carb or ketogenic diet, or it may indicate that an undiagnosed condition is interfering with your body’s ability to absorb glucose.

You can check your ketone level with a lab or home urine test. The home tests are not as accurate as other methods, such as blood tests in a lab or doctor’s office. But they can be a helpful gauge, especially if you monitor a condition that affects your glucose levels, such as diabetes.

If you take an at-home test, your results will fall into one of the following categories:

  • negative or trace amounts
  • small amounts
  • moderate amounts
  • large amounts

Often, you can determine your particular ketone level by comparing the urine dipstick to a color-coded chart indicating the various levels.

You can consult your healthcare team about which level is normal based on your overall health, eating style, and activity level.

Elevated ketone levels in your urine have several possible causes, including some health conditions.

Some possible causes include:

Dehydration can also cause your urine to become more concentrated, leading to a higher ketone measurement.

If you’ve been following a low carb or keto diet for a while, your body should adjust to using ketones for fuel and your ketone levels should go back to normal.

Ketosis versus ketoacidosis

When you restrict the number of carbohydrates you eat to fewer than 50 grams per day, you produce less glucose and less insulin. Usually, your body makes carbohydrates into glucose, a type of sugar that fuels the cells of your body. Insulin is a hormone that allows your cells to absorb glucose.

When you take in fewer carbohydrates, your metabolism switches gears. It breaks down fat into ketone bodies, and your cells use these for fuel. This state is called nutritional ketosis.

Going into ketosis isn’t necessarily a bad thing. A 2021 research review found that switching from burning glucose to burning ketone bodies could be adaptive and protect your body from oxidative stress in the long run.

Ketosis is considered safe because the concentration of ketones in your blood is low. It’s different from ketoacidosis, which is a serious condition. In ketoacidosis, the concentration is high enough to cause your blood to become acidic. That could have negative health effects.

There are different types of ketoacidosis:

  • DKA: This can occur when someone with diabetes (usually type 1) has too many ketones in their blood. It can be a medical emergency. In unmanaged diabetes, a combination of high blood sugar and low insulin can cause DKA.
  • Alcoholic ketoacidosis: If you drink very heavily for a long period, you may become malnourished. Your pancreas may also stop producing insulin. Without glucose from food or insulin to absorb the glucose, your body has to switch to burning fat for fuel, producing too many ketones.
  • Starvation ketoacidosis: This is rare but can be caused by long periods of eating too little or not at all.
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High levels of ketones in your urine don’t necessarily indicate undiagnosed diabetes.

There are several other possible reasons for high ketone levels in your urine.

If you’ve received a diabetes diagnosis, talk with your healthcare team about what your ketone levels may mean for your diabetes management.

Many pregnant people have higher-than-usual ketone levels in their urine. However, studies conflict on the specific level of ketones they may have.

A 2020 study of 187 pregnant women with overweight or obesity found that 22% had ketones in their urine at 16 or 28 weeks gestation. That number shrank to 8% at 36 weeks.

If participants had been prescribed urinary testing for another reason, they were more likely to have abnormally high levels of ketones in their urine — this is called ketonuria. It usually indicates a more serious underlying condition such as diabetes or ketoacidosis.

Even trace amounts of ketones have been associated with risks to a developing fetus. More research is needed to clarify the level of risk and how ketones affect it.

If you are in ketosis or ketoacidosis, you may have symptoms such as:

  • fatigue or tiredness
  • fruity-smelling breath
  • loss of appetite
  • confusion
  • trouble breathing
  • abdominal pain
  • nausea or vomiting
  • insomnia
  • difficulty sustaining exercise

If you’re experiencing symptoms, talk with your healthcare team right away. Your symptoms may be part of the “keto flu” if you’re following a low carb diet.

Having trace amounts of ketones in your urine isn’t unusual. It’s also not usually something to worry about. Following a low carb diet can cause moderately elevated ketones until your body adjusts. Pregnancy and dehydration can also elevate ketone levels.

While it’s fairly normal to have tiny amounts in your urine, higher levels may indicate an underlying health condition. If you have diabetes, high ketone levels may mean you need help to better manage your blood sugar levels. Talk with your healthcare team about what conditions you may have and whether you need further testing.