Diabetes and Ketones

The presence of ketones in the bloodstream is a common complication of diabetes, which if left untreated can lead to ketoacidosis. This section of diabetes.co.uk is intended as an information resource for diabetes sufferers who want to know more about ketones and diabetes. If you are looking for medical advice, think you may have ketones, or would like ketone testing please contact your GP or diabetes healthcare team as soon as possible.

What exactly are ketones, and what do they have to do with diabetes?

Ketones are an acid remaining when the body burns its own fat. When the body cannot get enough glucose from the blood to use as energy (in the case of type 2 diabetics it may receive very little glucose, in type 1 cases it will receive none), it will begin to burn fat. When the body is burning too much fat, it may cause ketones to become present in the bloodstream.

So, my body can’t get enough sugar. Why is this a problem?

Sugar is the primary fuel that the body uses for energy. Insulin, a hormone produced in the pancreas that metabolises blood sugar, is either deficient or non-existent in the blood of diabetes patients. If the body cannot burn sugar, it will burn stored fat, and ketone build up will begin. When ketone levels become too high, the risk of ketoacidosis is raised, and this emergency condition can lead to coma and even death in serious cases.

I am type 2 diabetic, should I be tested for ketones?

All people with type 1 diabetes should be tested for ketones, and although type 2 diabetics are less likely to suffer the complications caused by ketones, it is essential to know what the symptoms are, and when you should test. Finding ketones present in your urine is a sign that the management of your disease needs adjusting. Ketone testing should also be a matter of course for pregnant diabetics and women who develop gestational diabetes.

More Information

• Diabetes and pregnancy
• Gestational diabetes

When should I test for ketones, and how will this affect the management of my diabetes?

Your GP or healthcare team will be able to inform you of the best possible time for you personally to test for ketones. However, it is generally understood that testing should take place when fasting (i.e: when food has not been consumed for eight hours or more) and any of the following occurs:

• Blood sugar is on or above 250 mg/dl for two consecutive tests
• When any illness occurs (as even the most minor can cause ketones)
• If you vomit or suffer from diarrhoea
• You suffer from depression or stress
• You fall pregnant

The test will not interfere with the management of you diabetes.

How does ketone testing work?

The ketone test is simple and involves a dip and read urine test strip. If the colour changes, there are ketones in your urine. Ketone test strips are available over the counter in some chemists.

I am diabetic and my ketone test is positive, what should I do?

Contact your healthcare team, and explain the situation to them. Should the tests show very small amounts of ketones take the following actions: Drink water every hour, and continue testing every three hours. Do not exercise. If your ketone levels do not fall after two tests contact your healthcare team. If the test shows moderate or high ketone numbers then telephone your doctor at once, and drink water.

I think I might have ketoacidosis, how would I know?

If you are suffering from DKA (diabetic ketoacidosis) then early signs would be likely to include: stomach pains, nausea and/or vomiting, breathlessness, breath that smells of fruit. In this instance, call your doctor as soon as possible. Ketoacidosis is an extremely severe condition.