Ketone Testing

Ketone testing can be done at home
Ketone testing can be done at home

Ketone testing is a key part of type 1 diabetes management as it helps to prevent a dangerous short term complication, ketoacidosis, from occurring.

If you have type 1 diabetes, it is recommended that you have ketone testing supplies on your prescription.

Ketone testing may also be useful in people with other types of diabetes that are dependent upon insulin.

Why test for ketones?

Ketones are produced by the body as an alternative source of energy to sugar. The body produces ketones by breaking down fats, this process is known as ketosis.

Ketones may be produced as part of weight loss, however, it’s important for people with diabetes on insulin to note that ketones can be produced when the body has insufficient insulin.

When the body has too little insulin, it means that cells of the body cannot take in enough sugar from the blood. To compensate for this, the body will start to break down fat to provide ketones.

However, if a high level of ketones is produced, this can cause the blood to become acidic which can lead to illness and even potential danger to organs if not treated in time.

This state is referred to as diabetic ketoacidosis.

Where can I get ketone testing kits and sensors?

The most accurate way of testing for ketones is to use a meter that measures blood ketone levels.

The following blood glucose meters are able to test blood ketone levels in addition to blood glucose levels:

If you take insulin, you should be able to get these prescribed by your GP.

Ketone Test Strips
Menarini
GlucoMen LX Plus Ketone Strips
Comes in packs of 10 ketone strips only for the GlucoMen LX Plus.
Urine Ketone Strips
Menarini
Bayer Keto-Diastix
The Keto-Diastix from Bayer contain 50 strips to test for glucose and ketones in the urine.
GlucoRx Ketone Test Strips
GlucoRx Ketone Test Strips
GlucoRx ketone test strips contain 50 strips to test for ketones in the urine.

You can also test urine for ketone levels, however, urine ketone testing is not as accurate as blood ketone testing as the levels of ketones in the urine will usually only reflect a level of up to a few hours previously.

When to test for ketones?

People with insulin dependent diabetes should take a ketone test:

  • Any time your blood sugar is over 17 mmol/l (300 mg/dl)
  • If sugar levels have repeatedly been over 13 mmol/l (230 mg/dl)
  • If you are unwell and have any of the symptoms of ketoacidosis

How to do a blood ketone test

A blood ketone test is carried out in a similar way to a blood glucose test.

  • Put a blood ketone strip into the meter
  • Prick your finger using the lancing device
  • Allow blood to the ketone strip
  • Wait for the result
  • Safely discard the test strip
  • Discard the lancet into a sharps bin

Note that only a select number of blood glucose meters provide ketone testing functionality.

How to do a urine ketone test

Before testing, check the expiry date on the tub to ensure the strips are good for use. Also check the instructions which will tell you how long you need to wait, after urine is applied to the strip, before checking the colour chart.

The process for ketone testing will then usually follow steps similar to these:

  1. Remove a strip from the tub, taking care not to touch the spongy end of the strip
  2. Pass urine over the test area of the strip or, alternatively, collect urine in a container and then dip the test area of the strip into the urine
  3. Begin timing immediately after applying urine - the strip will begin to change colour
  4. After a set number of seconds (check the instructions), compare the colour of the test area to the colour chart on the side of the tub of strips
  5. Disregard any colour changes that might happen after the set number of seconds has passed
Transcript

Testing for ketones is relevant for people with type 1 diabetes.

In type 1 diabetes, a lack of insulin can lead to higher levels of ketones which in turn could lead to a dangerous state called ketoacidosis.

Diabetes UK recommends people with type 1 diabetes test for ketones if blood glucose levels become high - usually above 15 mmol/L.

Testing for ketones in this way can help you to get advice and treatment before the level of ketones becomes dangerous.

There are two different ways to test for ketones. The traditional way has been to use urine ketone testing strips. More recently though, some blood glucose meters have also been developed that can test the blood for ketones.

A blood test for ketones is similar to how you would do a blood glucose test.

The following ketone testing advice is based on the recommended process for using Bayer Ketostix.

  1. Before testing, check the expiry date on the tub to ensure the strips are good for use
  2. Remove a strip from the tub, taking care not to touch the spongy end of the strip
  3. Pass urine over the test area of the strip or, alternatively, collect urine in a container and then dip the test area of the strip into the urine
  4. Begin timing immediately after applying urine - the strip will begin to change colour
  5. After 15 seconds, compare the colour of the test area to the colour chart on the side of the tub of strips
  6. Disregard any colour changes that might happen after 15 seconds has passed

If blood glucose and ketone levels do not decrease after two tests contact your health team for advice. Bayer provides the following advice for management of ketone levels:

  • A level below 0.5 mmol/L
    This is a trace level of ketones - no action is needed
  • Around 1.5 mmol/L
    This indicates that ketone levels are slightly higher than normal.
  • It’s recommended to drink a glass of water each hour and perform a follow up test 3 to 4 hours later to see if the ketone level has decreased or not.
  • Around or above 3.0 mmol/L
    This is a higher reading. Contact your health team immediately for advice.

What should the ketone test results be?

  • Under 0.6 mmol/L - a normal blood ketone value
  • 0.6 to 1.5 mmol/L - indicates that more ketones are being produced than normal, test again later to see if the value has lowered
  • 1.6 to 3.0 mmol/L - a high level of ketones and could present a risk of ketoacidosis. It is advisable to contact your healthcare team for advice.
  • Above 3.0 mmol/L - a dangerous level of ketones which will require immediate medical care.

Ketone testing for weight loss

Some people use ketone testing as a way to test whether their body is breaking down fat. Higher ketone levels indicates a greater likelihood of weight loss.

Note, however, that this use of ketone testing is not recommended by the NHS and ketone test strips provided by your GP are not to be used for this purpose.

For people with diabetes on insulin, having high ketone levels should be regarded as potentially dangerous.