What's bad about ketones?

[thediabeticswife]

Why is it such bad news to find ketones in your urine?

Silly question perhaps, but this is all new information to me!

 

[borofergie]

Ketones in your blood (at high enough levels in your urine) are an indication that your body is burning fat instead of glucose from your blood (perhaps because you have been fasting, or engaging in a low carbohydrate diet). People engaged in the Atkins diet sometimes look for ketones in their urine, to show that they have entered "ketosis" (fat burning mode).

There is no problem with this if your BG is under control, but if you have high blood sugars plus high ketones it is a sign of ketoacidosis - a kind of out of control ketosis that poisons your blood with bi-product acids.

If you have high BG readings and high ketones you should take yourself to your diabetes clinic or A&E immediately.

I was in a similar position, when my GP tested my urine, at my diagnosis meeting and discovered ketones at a concentration of 15mg/dl ("small" on the Ketostix label). I thought nothing of it until I got a call from the Diabetic clinic, asking me to come immediately, and be prepared to be admitted into hospital that afternoon...

Luckily, in my case, the ketones were a result of me "low carbing", and their concern eased as soon as they saw that my BG levels were under control (<7 mmol/l). However, they warned me that if my blood sugar went above 15 mmol/l AND I recorded ketones of 80mg/dl or larger then I should go straight to A&E.

If you don't know what your BG scores are, and you are showing ketones, I think that you should be very careful.

 

[thediabeticswife]

Aaaah so it's not the ketones by themselves that are the problem - but when high and combined with high BG, it's a different story.

Thank you!

 

[phoenix]

Aaaah so it's not the ketones by themselves that are the problem - but when high and combined with high BG, it's a different story

Almost but not quite. Small amounts of ketones are produced when fat is broken down . This happens everyday, its part of normal metabolism . Insulin is required to regulate this process, if sufficient insulin is present, the breakdown of fats will be controlled and ketones will never get too high.
In the case of a T1 diabetic with no , or far too little insulin in circulation, there is no regulation of this process There is in effect no brake so fat and muscle, are broken down and ketones can rise very quickly ,' poisoning' the blood, causing diabetic ketoacidosis.
Most frequently this happens concurrently with high glucose, because the liver releases more glucose in an attempt to fuel the 'starving' cells. There are times (less commonly) that it can occur with relatively low glucose levels. This could happen for example if the person has had several bouts of vomiting or has previously been fasting, or has been drinking excessive alcohol.
In the case of people with T2 there is normally sufficient insulin to avoid DKA at any glucose level. T2s develop DKA only occasionally it is usualy triggered when a severe infection or some other problem causes a demand for more insulin than is available.

 

[thediabeticswife]

Thank you - it sounds awful.