blood ketones vs urine ketones vs ketosis vs ketoacidosis ?

[twinkle1980]

ok

I'm not sure I understand this yet, so can someone please define or correct me?

Blood ketones is a sign of too high bg and a warning you may be heading (or already in) DKA?

Urine ketones is a sign that your body is burning fat to use as an energy source and therefore your in ketosis - this is not necessarily a reflection of where your bg are at, but that you are not eating "enough" carbohydrates to cover your bodies energy needs - common in low carb diets.

Is that right or have I got completely the wrong end of the stick?

 

[AMBrennan]

Re: blood ketones vs urine ketones vs ketosis vs ketoacidosi

Well, You are wrong. Blood ketones and urine ketones is basically the same thing, except that urine tests lag behind blood values and are accurate. My opinion that blood ketone testing offers little benefit over Ketostix unless you're treating acute DKA.

Presence of ketones indicates ketosis I.e.body using non-carbohydrate sources for fuel. Combined with high BG, it's indicative of DKA where the body is unable to use glucose due to lack of insulin; note that it's the lack of insulin that drives up blood sugar (cells report not getting any glucose => liver dumps some more) regardless of diet.
Common advice is to check for ketones if blood sugar is high (>15 mmol/l) to distinguish between overdoing the carbs (e.g. Drinking a liter of Lucozade will give you sky-high blood sugar but won't trigger DKA) and a serious emergency.

Ketosis as such is not dangerous, but whether it's desirable is another question entirely.

 

[twinkle1980]

Re: blood ketones vs urine ketones vs ketosis vs ketoacidosi

thank you so much for clearing that up for me.

 

[Riri]

Re: blood ketones vs urine ketones vs ketosis vs ketoacidosi

I struggle with understanding ketones as well. I read what you say about high sugars after overdoing lucozade for instance. But my question is, if you forgot to bolus after lunch and remembered 2 hours later when your BSs were say 16/17 would you definitely not show ketones on your meter then? I.e. are ketones only present when there is an underlying problem like ill-health combined with high sugars? I worry about ketones and have, over the past 12 months, often seen my ketone meter read over 1 but my sugars may be at ay 12 (not sky high) and I'm feeling fine. My DSN is also surprised that ketones show up at this level and as often as they do with me.

When I had the noro virus bug before Christmas and I was vomiting terribly for 6-7 hours the amazing thing was that my blood sugars stayed below 7 but my DSN on the phone said I had to test for ketones - and yes there they were at 1.5!

I am very confused and wonder if I am getting myself into too much of a panic when I see ketones of between 0.6 and 1.6 when I feel perfectly well. I do all the normal things to get them down - inject more insulin and drink loads of water.

 

[elainechi]

Re: blood ketones vs urine ketones vs ketosis vs ketoacidosi

well i got told to phone a hcp if ketones above 2 ....now they say well depends on vomiting loss of consciousness......daughter 3.9 a bit dry and stomach cramps.....classic signs of possible dka.....also i knew by she had eaten loads but insulin pen new and untouched!!!!!!!!
now i ve been in ketosis on a low carb diet ...not diabetic myself...just to lose a few pounds but this can be dangerous too if no carbs is for an extensive period and ....healthy....people have died xxx

 

[Indy51]

Re: blood ketones vs urine ketones vs ketosis vs ketoacidosi

It may help those interested to read Jimmy Moore's posts about nutritional ketosis and taking blood ketone readings to stay in ketosis for weight loss on a LCHF diet. As part of the first post, he shows a graph by Drs Volek & Phinney regarding the differences between blood ketone levels for ketosis and ketoacidosis.

My understanding is that is the combination of high BG levels along with ketones that present the danger for insulin dependant diabetics, though I don't claim any kind of expertise in this area.

http://livinlavidalowcarb.com/blog/jimm ... 1-30/14409

 

[phoenix]

Re: blood ketones vs urine ketones vs ketosis vs ketoacidosi

Indy,
I have a suspicion that Phinney and Volek have used venous blood glucose values rather than fingerprick ones for their DKA figures . Very dangerous to give a level in the9- 10mml/l+ area for DKA.

On JMs personal graph he sometimes records levels that are as high and higher than those that have occurred at diagnosis of DKA in someone who is a T1 and indeed T2 diabetic
He most probably doesn't have a deficiency of insulin His insulin will act as a brake to stop the breakup of fat and build up of ketones. All T1s have almost no insulin and some T2s may be extremely insulin deficient, particularly when sick..
DKA is when the blood becomes acidic from a build up of ketones in the blood ie there is not enough insulin to restrain the breakup of fats.

In one study done in an Emergency department, they tested 111 people with diabetes as they arrived. They were all complaining of illness but they wouldn't all have the symptoms of DKA. They received all the usual blood tests, testing the blood from the vein ( glucose, ketones and acidity .) They also tested them using an Optimum blood ketone meter.
Seven had DKA.
From the results:

A blood ketone result of 3.5 mmol/L (using an Optimum meter) yielded 100 percent specificity and sensitivity for the diagnosis of DKA

In that study (mostly older people) Those that that DKA had average ketone levels of 5.7mmol/l ,all those who had a level above 3.5mmol/l on the meter had DKA. Those below it in this small study didn't ( as you can see doesn't equate at all with P and Vs graph)
Six of those seven people with DKA had T2 diabetes!

Here is the advice from the manufacturers of the meter(BAYER) as to what to do at different levels of ketones.

below 0.6 normal range
0.6.-1.5mmol/l may indicate the development of a problem. Follow your healcare providers instructions (ALL PEOPLE USING INSULIN SHOULD ASK FOR ADVICE FOR WHEN THEY ARE SICK , BEFORE IT HAPPENS!)
1.5- 3mmol/l readings above 1.5mmol/ may indicated a risk for DKA. Contact healthcare provider immediately for advice.

Here is another source about ketones in diabetes.
It includes a useful chart comparing levels from urine and blood tests. It is aimed at parents and of course DKA develops very quickly in children so it's level at which ask for advice is slightly lower (1mmol/l) than the advice from Bayer.
)
http://www.ucdenver.edu/academics/colle ... s/ud05.pdf


and another thread which discusses ketones/glucose levels/vomiting etc
viewtopic.php?f=19&t=22993&p=211845&hilit=blood+ketones+phoenix#p211845