Living with Diabetes

Ketones: What you Need to Know

Do you test for Ketones?What are ketones?
Ketones (acid) are a result of fat breakdown. The body breaks down fat when it cannot access sugar (glucose). Ketones are usually an indicator that there is little to no insulin. Ketones are usually associated with elevated glucose levels but can occur with in-range target glucose. Ketones are typically only monitored in type 1 diabetes because usually in type 2 diabetes, the pancreas produces enough insulin to reduce the risk for ketone production. However, if you are ever in doubt, check for ketones.

Why are we concerned about ketones?
High levels of ketones – called Diabetic Ketoacidosis or DKA – can be incredibly dangerous and life-threatening if not treated promptly.

The most common causes of DKA are:
1. Undiagnosed type 1 diabetes
2. Omission of insulin
3. Illness (Not enough insulin to meet the body’s needs)

Signs or symptoms associated with DKA are:
• Ketones in the urine or blood
• Dehydration (dry mouth or lips, sunken eyes or skin that remains pinched up when you pinch it)
• Nausea and vomiting
• Fruity breath
• Rapid breathing (Kussmaul breathing)
• Abdominal pain
• Drowsiness or confusion

When should you test for ketones?
• When you experience unexplained blood glucose levels above 300 mg/dl
• Illness (insulin requirements are usually greater)
• You should never exercise with ketones present – as exercise may increase blood glucose and ketone levels.

How do you test for ketones?
• Urine (most traditional way) – Ketone strips come in a container. Place urine on the strip and look for it to change color. A color chart is usually right on the bottle and can be compared to the color on the strip. The color may vary from beige (no ketones) through shades of pink (mild to moderate) to purple (moderate to large).
• Blood (more accurate) – Using a special test strip and meter designed for measuring blood ketones

What do you do if ketones are present?
• CONTACT YOUR HEALTH CARE TEAM TO ESTABLISH YOUR MANAGEMENT PLAN (If it is after hours, let the answering service know to inform the on-call responder that ketones are present and an immediate call-back is requested.)
• Do not exercise
• Drink plenty of water – at least 8 ounces per hour
• Monitor your blood glucose at least every 2 hours (easier with a continuous glucose monitor)
• Insulin as ordered – you may require larger doses than usual
• If you experience any signs or symptoms of DKA, go to your closest emergency center.

Key considerations:
• Check that you have a supply of ketone strips and that they haven’t expired
• For pumpers, two unexplained elevated blood glucose levels may mean that you need to change your site, tubing and insulin
     1. Disconnect from pump
     2. Administer insulin manually (pen or syringe)
     3. Change infusion set
     4. Monitor blood sugar closely for the next 2 hours to ensure blood sugar is decreasing
• If you vomit more than once and can’t maintain fluids, go to your closest emergency center.
• Be prepared – have a sick day management plan established with your health care team

SOURCE: Diabetes Research Institute's Education and Nutrition Service (2019)

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