Confused by ketones

MrsA2 said:

OK, I'm a type 2 and as I understand it as I have been keto or low carb for about 6 months now I should be in fat burning mode. I lost quite a bit of weight quite rapidly in the beginning but this has now plateaued.
I have some urine test strips which test for ketones among other things and whenever I use them they show me with ketones at the top end of the range, the line marked 160(16)++++
I get this reading every single time I test. I have tested about 20 times over the 6 months at random times.
BUT I thought that ketones were supposed to disappear from urine after a few weeks as my body starts using them rather than expelling them.
My blood sugar is usually comfortably in the 6s, with some 5s. I only go higher if I eat something I shouldn't, the highest has been 12, once (cake!)

Is all this OK? Should I still be having these levels in my urine?

(I have no diabetes nurse, the position is vacant at our surgery, and sadly our gp has passed away so we are on locums who are under pressure so I don't want to trouble them with anything trivial)

Grateful for any knowledge

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Hi @MrsA2,

Don't know if I can help with this, but I had a similar experience.

For me, ketones in the urine have never really dropped even after years of low-carbing (like you I read that that having ketones in your urine usually stops after some time on a ketogenic woe). Ketones were usually in the range of ++ to ++++ (suspect this is still this way even though I stopped measuring after a while). I also have to admit I often do not have enough calories and also exercise a lot, which can contribute to the problem (inducing levels above nutritional ketosis).

At one point, my GP sent me to the hospital to get a blood gas analysis to see if my blood was acidic. The test actually confirmed this. Most other parameters were generally in normal range except for HCO3, which seemed to be depleted. The function of HCO3 is to serve as a buffer for blood acidity. Since then I started supplemeting it in the form of bicarbonate of soda (or baking soda), hoping that this will solve the problem (with approval of my GP).

It seems the only other way would have been to stop this way of eating -- but I rather supplement than see blood sugar levels rise and/or start taking anti-diabetic medications for life.

Thanks for the tag @DCUKMod and hi @MrsA2

I have the same understanding as you @MrsA2, that as your body starts using ketones, they no longer show up in your urine. However, I’ve never used ketostiks to test whether I’m in ketosis, have always used a ketone meter and strips and tested my blood, or occasionally a breathalyser.

I don’t test for ketones so often these days, but when I do, I rarely see the high numbers I did a year to two ago - quite often would be up to 3 or 4. These days I usually hover around 1.

It’s quite normal for weight loss to plateau from time to time - it’s rarely a linear process. Has anything else changed for you? How are your blood sugars doing?

MrsA2 said:

Around 6 average, some 5s some 7s. Over that only when I eat something carby 12 after a cake (once) 10 after a pub meal last week that had unexpected apple and sugar in

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How low carb do you think you are?

Could be you are dropping in and out of ketosis so your urine ketones are coming and going?

I've never measured using urine sticks myself only blood levels but like @Goonergal seem to run at lower overall levels when eating mainly meat but still in nutritional ketosis at all times.