Ketones and Diabetic Ketoacidosis

In addition to testing your blood sugar, there may be times when you'll need to test your urine for ketones. Ketones are waste products produced when your body breaks down fats, instead of blood sugar, for fuel. When ketones are present, your body tries to get rid of them through urine. If it can't get rid of these poisonous bodies fast enough, they can build up and cause diabetic ketoacidosis (DKA).¹

Ketoacidosis is a very serious condition that can lead to diabetic coma. Sometimes, it can be deadly.² That's why testing for ketones can be a critical part of your diabetes self-care.

Detecting Ketones

You should test for ketones every 4 to 6 hours under the following circumstances, or as directed by your healthcare team.²

Type 1 diabetes:³

• if your blood sugar is high-generally above 240 mg/dL

All types of diabetes, including type 1, type 2, and gestational:³

• if you are ill
• if you are under stress
• if your blood sugar is above 300 mg/dL
• if you suspect you may have ketoacidosis

A simple urine test strip will tell you your ketones level. Depending upon the test you use, it may use words like negative, trace, moderate, or large/high, or it may match up with a color or number range to give you your level.³

Symptoms of Ketoacidosis

The warning signs of ketoacidosis can come on fairly slowly, unless you have been vomiting or have diarrhea. In those cases, ketoacidosis can develop in just a few hours.² That's why it's important to test frequently when you're ill.

The first symptoms are:²

• thirst or very dry mouth
• frequent urination
• high blood sugar
• high levels of ketones in the urine

The next symptoms to appear include:²

• constantly feeling tired
• dry or flushed skin
• nausea, vomiting, or abdominal pain
• a hard time breathing
• fruity-smelling breath
• difficulty paying attention or confusion

If Your Ketones Are Moderate or High

• Do not exercise. Large amounts of ketones upset the chemical balance of your blood, so wait until things are back to normal to get active.²
• Talk to your doctor. Your doctor will advise you on the next step, whether that's taking extra insulin or going to the hospital.²

¹ American Diabetes Association. "Hyperglycemia." Available at: http://www.diabetes.org/type-1-diabetes/hyperglycemia.jsp. (accessed May 8, 2006)
² American Diabetes Association. "Ketoacidosis." http://www.diabetes.org/type-1-diabetes/ketoacidosis.jsp (accessed May 8, 2006)
³ American Diabetes Association. Diabetes Forecast 2006 Resource Guide, pp. RG63-RG66. "Urine Testing." Available at: http://www.diabetes.org/uedocuments/rg06_urine.pdf. (accessed May 8, 2006)