Ketones.....?

Have you got an illness mgt leaflet or anything? I was given one (I’ll try and attach pic!) and yes was told over 0.6mmol to start to worry
I’ve tested occasionally and get around 0.2, I believe it increases slightly naturally when you’ve not eaten but I’m not sure on that!!

Ketones can be caused be a lack of insulin. These are bad ketones and to be avoided and this is where the over 0.6 guidence comes from.

Ketones can also be caused by your body perfectly happily burning fat, instead of glucose for fuel. This is nutritional ketosis and not anything to be concerned about.

Whether ketones are a good thing or a bad thing depends on why you are getting them.

If you have 0.5 ketones and you are not low carbing then I would suggest the best way to get them down is to follow sick day rules, because they would be caused by lack of insulin.

If you have 0.5 ketones because you are low carbing then thers no need to do anything, additional insulin won't "correct" nutritional ketones but will just cause hypos.

Firstly you can’t get Diabetic ketoacidosis (DKA) unless your body is producing little or no insulin, hence most people with Type2 are NEVER at risk of DKA however high their BG is. (But they may have Type1 even if they have been told they have Type2, one very good reason why insulin levels should be measured in everyone, but the NHS does not do so.)

DKA happens when the insulin level is very low so that cells are not able to take in energy from glucose or ketenes, the body keeps making ketenes but the cells can’t use them. The risk is increased by dehydration, so drink water.

When you are “burning fat” a normal body create a little insulin that lets the cells use ketenes, but not enough insulin to let the cells use glucose.

If you are taking SGLT2 inhibitors (Forxiga, Dapagliflozin, Invokana, Canagliflozin, Jardiance, Empagliflozin, and maybe other brand names) then you can get DKA at low BG levels and if there are any symptoms of DKA you must go to A&E to get a blood gas test regardless of your BG level. (This is one of the reasons that SGLT2 inhibitors are not licensed for Type1 at present.)

Otherwise, your BG must have been over 10 for some time or over about 20 to have a real risk of DKA.

So high BG plus high ketenes => Ring NHS 111