Ketones are chemicals produced by the body when it is not able to use glucose as a source of energy due to a lack of insulin. When there is too little insulin and the body cells cannot take in enough sugar from the blood, the body starts to break down fat for energy instead.
This process of ketones formation, known as ketosis, is normal for otherwise healthy people as it can be a part of weight loss. Ketones can also appear in people without diabetes if they haven’t eaten for a while or after a prolonged exercise. However, diabetic patients who use insulin should know that ketones formed in the blood and spilled into the urine can indicate that they have insufficient insulin.
Diabetics are at risk of ketone buildup in the blood, causing it to become acidic. And if the levels of ketones become too high, there can develop ketoacidosis – a serious short term complication of diabetes that can result in coma or death if not addressed in time.
- Dry mouth
- Strong thirst
- Frequent urination
- Blood sugar higher than 240 mg/dL.
If left untreated, the symptoms can progress to:
- Flushed skin
- Extreme fatigue
- Fruity odor on breath
- Stomach pain
- Trouble breathing.
These symptoms are life-threatening and require immediate medical attention. In order to prevent emergency, people on insulin should perform a ketone test any time when:
- The blood sugar is higher than 300 mg/dL (17mmol)
- The blood sugar has been repeatedly higher than 230 mg/dL (13 mmol)
If you feel unwell or experience any of the ketoacidosis symptoms listed above, regardless of the blood sugar readings, you can measure the ketones either in blood or urine. Both types of tests can be performed at home.
The blood ketone test is done similar to a blood glucose test, but requires blood test strips and a meter that can test for ketones:
- Insert a blood ketone strip into the meter
- Prick a finger with a lancet
- Allow a small drop of blood onto the testing area on the ketone strip
- Wait for the result.
Urine test for ketones is more common and less expensive. It requires urine strips, which change the color when reacting with ketones, and sometimes a clean container. Proceed as follows:
- Take a strip out of the tub
- Pass urine over the test area on the strip or, if you urinate into a clean container, dip the test area into the urine
- After a set amount of time, as specified in the instruction to the strips, the strip will start changing the color
- Compare the color of the test area to the color chart on the package and interpret the results
- Disregard any changes in color that may occur after the set amount of time has passed.
The results of ketone testing can be interpreted the following way:
- Less than 0.6 mmol/L – negative or normal
- 0.6 – 1.5 mmol/L – moderate (test again later to see whether it has lowered; otherwise it may indicate the development of a problem)
- 1.6 – 3.0 mmol/L – high (contact your doctor for advice as it could indicate the risk of diabetic ketoacidosis)
- More than 3.0 mmol/L – very high (seek emergency as this is dangerous).
People who are newly diagnosed with diabetes are recommended to test for ketones twice daily. Pregnant women should check ketones every morning before breakfast and any time the blood glucose is higher than 250 mg/dL.