Are ketones always present normal?

This has always been a puzzle to me; how do you tell if ketones around 2 to 2.5 are a problem?

As someone not on insulin but eating LCHF and usually in ketosis those ketone levels would be normal; probably 1.5 to 2 most days, higher if I'm fasting. I think between 4 and 5 are classes as "fasting ketones" for non-diabetics.

However I know that the ketones are there because i'm not eating carbohydrates and using ketones for fuel as a normal everyday thing.
I also almost certainly don't have high insulin levels because there isn't really much there to require a big shot of insulin from my pancreas.

The problem with insulin dependent people is that ketones are generated when there is plenty of glucose in the blood, and plenty of insulin, but the glucose isn't going into the tissues so the body panics and starts emergency measures by generating ketones. This can become serious very quickly.

So I don't know how a keto T1/T2 can tell the difference between normal day to day ketones and emergency ketones as the system crashes.

High BG levels is one indication but I get spikes above 12 mmol/L at times so I think I would probably match most of the emergency indicators if tested at the wrong time.

As a non-combatant I would tentatively suggest that you aim to get your BG down during the day and then any ketones will probably be nutritional. With high BG you just can't tell so you are always at risk of Diabetic Ketoacidosis.

Hi Fenn, you are not stupid in the slightest, you are INTERESTED in your health and that is a good thing! Please don't get the thread deleted, lots of people have the same questions and similar concerns across all of these threads and you can rest assured, people will be reading it and gaining valuable knowledge. x

According to the NHS, if your ketones are above 0.6-4mmol/l, you'll need to go to A&E. You're just as much risk as us going into DKA.
If you do a blood ketone test:

• lower than 0.6mmol/L is a normal reading
• 0.6 to 1.5mmol/L means you're at a slightly increased risk of DKA and should test again in a couple of hours
• 1.6 to 2.9mmol/L means you're at an increased risk of DKA and should contact your diabetes team or GP as soon as possible
• 3mmol/L or over means you have a very high risk of DKA and should get medical help immediately

If you do a urine ketone test, a result of more than 2+ means there's a high chance you have DKA.

Fenn said:

I get it, ok thank you, sorry, I feel stupid, can this be deleted?

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Hi Fenn.

It is within your power to delete your first post - and by doing so, you will delete the entire thread.

However, I would urge you not to.
You have asked a very valid question, and anyone in your situation (insulin user, running high, seeing ketones) could be asking themselves exactly the same question - so your post and that answers you have received may be helping other people too.

I think part of the problem is that many low carbers seek 'ketosis' (characterised by low blood glucose, sufficient of insulin, and the presence of ketones), while insulin users are taught to be VERY WARY of ketoacidosis (characterised by high blood glucose, insufficient insulin to get the glucose down, and the presence of ketones).

It is very easy not to realise the fundamental difference between nutritional ketosis and ketoacidosis (a lot of health care professionals don't realise the difference either!). But one is a sign of great blood glucose control and a happy low carber in ketosis, while the other (ketoacidosis) can kill you.

Like everyone above, I would urge you to contact your healthcare team and use insulin to get those numbers down.

Best wishes,