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PEP Talk

Do you test for ketones?  

What are ketones?
Ketones are a marker of fat metabolism where the body is using fat for energy instead of it’s ideal fuel source - glucose. Ketones are an indicator that there is insufficient insulin levels and therefore usually associated with elevated glucose levels. Ketones are usually only monitored in type 1 diabetes, as in type 2 diabetes, the pancreas produces enough insulin to reduce the risk for ketone production, especially in high amounts. 

Why are we concerned about ketones?
High levels of ketones can lead to an acidotic state in the body, which can be incredibly dangerous and life threatening if not treated promptly. This acidotic state – called Diabetic Keto Acidosis or DKA – is a combination of high blood glucose levels, high ketone levels and associated acid state of the body.

The most common causes of DKA are:
1. Undiagnosed or new diagnosis of type 1 diabetes
2. Illness (especially gastro-intestinal illness)
3. Too little 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 (as ketones can be produced rapidly)
• Blood glucose level above 250 mg/dl and you are about to exercise**
(**You should never exercise with ketones present as exercise may lead to blood glucose and ketone elevation.)

How do you test for ketones?   
• Urine (most traditional way) – Ketone strips come in a container. You pass urine on the strip and look for it to change color. The color may vary from beige (no ketones) through shades of pink (mild to moderate) to purple (immediate medical attention). 
• Blood - using a special test strip and meter designed for measuring blood ketones

What do you do if ketones are present?  
• Do not exercise.
• Contact your health care team if ketones are present to establish your management plan.
• Drink plenty of water – at least 8 ounces per hour.
• Monitor your blood glucose at least every 4 hours.
• 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 high unexplained blood glucose levels means you need to change your site, tubing and insulin.  Always check your blood glucose at bed time.
• 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 before you get sick.


Just Ask Kellie!  DRI's Director of Patient Education Kellie Rodriguez explains ketones.

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