Ketonuria can be detected by performing a urine test
Ketonuria can be detected by performing a urine test

Ketonuria occurs when high levels of ketone bodies which occur when cells are broken down for energy are present in the urine.

Ketonuria can be dangerous if ketones levels become high and may need to be monitored amongst people with diabetes who are prone to high blood glucose levels.

Ketones tend to be produced as a result of insufficient insulin in the body and therefore people with type 1 diabetes, in particular, are at a greater risk of ketonuria.

Why does ketonuria occur?

Ketonuria occurs when diabetes mellitus becomes out of control and blood sugar levels rise too high.

When this happens, the body, not having sufficient insulin to get energy into the body’s cells, breaks down body tissue (fat and muscle) into ketones, which can be used as fuel without the need for insulin.

However, high levels of ketones can make you feel ill and can lead to a dangerous state called ketoacidosis.

If you have high blood sugar levels, over 14 mmol/L it is worth testing for ketones to prevent ketoacidosis developing.

In some instances, although less commonly, ketonuria may develop due to fasting, certain diets or eating disorders.

How do ketones enter the urine?

When ketones are released they start to enter the bloodstream, which causes it to acidify.

To control this the kidneys will filter ketones out of the blood to be excreted in the urine.

How does ketone build up affect the body?

Particularly in people with type 1 diabetes, if a build up of ketones is not treated, it can rise to a dangerous level. The following conditions can be caused when glucose and ketone levels become too high:

  • Hyperglycemia (too much sugar in the blood)
  • Ketoacidosis (too many ketone bodies in the blood)
  • Ketonuria (accumulated ketone bodies in the urine)

Ketonuria and illness

If you have an illness or infection, blood glucose levels can quickly climb higher than they normally would and therefore the risk of rising ketone levels also increases.

What are the symptoms of ketonuria?

Symptoms of ketone build up include:

  • Thirst
  • Regular urination
  • Nausea
  • Dehydration
  • Heavy breathing
  • Dilated pupils
  • Mental confusion (rare)
  • Breath may also smell of fruit

How is ketonuria treated?

As ketonuria tends to develop as a result of insufficient insulin, you may need to take extra insulin depending on the level of ketones. If you have a ketone level over 1.6 mmol/L, it is worth contacting your health team for advice.

Urine Testing Strips
Accu-Chek Ketur
Comes with 50 strips to test for ketones in the urine. Also known as Ketur Test Reagent Strips for Urinalysis
Bayer Keto-Diastix
Reagent Strips for Urinalysis. The Keto-Diastix from Bayer contain 50 strips to test for glucose and ketones in the urine.
Bayer Ketostix
Bayer's Ketostix contains 50 strips to test for ketones in the urine.

How do I avoid ketonuria?

High levels of ketones can be avoided by maintaining good control of blood glucose levels. For those who are insulin dependent, remembering to inject at the appropriate times can help to avoid ketone build up.

People at a higher risk of ketonuria, such as those with type 1 diabetes, are advised to monitor their blood glucose levels, and ketone testing may also be recommended.

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