Ketones — The 6 Must-knows
WRITTEN BY: Kyla Schmieg, BSN, RN Editor’s Note: Kyla Schmieg (BSN, RN) is a practicing pediatric endocrinology nurse in Cincinnati, OH, USA, and Type 1 Diabetic, working on the same unit she was diagnosed at 26 years ago. 1 – What are ketones? Ketones are chemicals that build up when your body starts to burn fat for energy. The most common cause of ketones in diabetics is insulin deficiency. Without enough insulin, glucose builds up in the blood stream and can’t enter cells. The cells then burn fat instead of glucose. This results in ketones forming in the blood and eventually spilling into urine. 2 – Why can ketones be dangerous? Having ketones can indicate that your body needs more insulin. (Always monitor your blood sugar levels to know how much insulin you need.) If you have a build up of ketones, this can lead to Diabetic Ketoacidosis (DKA). Signs of DKA include moderate or large ketones, nausea, vomiting, abdominal pain, fruity or acetone (think nail polish remover) breath, rapid breathing, flushed skin, and lack of energy. If left untreated, it can lead to a serious and life-threatening diabetic coma or death. High levels of ketones are toxic to the body and if you’re experiencing these, you should seek out medical attention. 3 – When should you check for ketones? You should be checked anytime your blood sugar is above 240 mg/dl (13.3 mmol/l) or any time you are sick. This includes any minor illness such as a cold. 4 – Can you get ketones with a high blood sugar? Ketones typically accompany high blood sugar. They indicate that your body needs more insulin. Most often if your body needs more insulin, it means you probably have a high blood sugar. Also, when an illness is present, your body releases hormones in response to the stress. These hormones Continue reading >>
What Is Diabetic Ketoacidosis?
Diabetic ketoacidosis is a serious condition characterized by high blood sugar (hyperglycemia), low insulin, and the presence of moderate to large amounts of ketones in the blood. It's a medical emergency that requires treatment in a hospital. If not treated in a timely fashion, ketoacidosis can lead to coma and death. While diabetic ketoacidosis (or DKA) is much more common among people with type 1 diabetes, it can also occur in people with type 2 diabetes, so ketone monitoring is something everyone with diabetes should understand. Diabetic Ketoacidosis Symptoms Signs and symptoms of ketoacidosis include: Thirst or a very dry mouth Frequent urination Fatigue and weakness Nausea Vomiting Dry or flushed skin Abdominal pain Deep breathing A fruity breath odor What Are Ketones? Ketones, or ketone bodies, are acidic byproducts of fat metabolism. It's normal for everyone to have a small amount of ketones in the bloodstream, and after a fast of 12 to16 hours, there may be detectable amounts in the urine. As is the case with glucose, if blood levels of ketones get too high, they spill over into the urine. An elevated level of ketones in the blood is known as ketosis. People who follow low-carbohydrate diets often speak of ketosis as a desirable state — it's evidence that their bodies are burning fat, not carbohydrate. But the level of ketosis that results from low carbohydrate consumption isn't harmful and is much lower than the level seen in diabetic ketoacidosis. When Should Ketones Be Monitored? Ketone monitoring is less of a concern for people with type 2 diabetes than for those with type 1 diabetes. This is because most people with type 2 diabetes still make some of their own insulin, making diabetic ketoacidosis less likely to develop. Nonetheless, people with type 2 d Continue reading >>
Making Sense Of Ketones With Diabetes
Learn what ketones are, how they are measured, and what to do with the information Some people with diabetes have a higher risk for diabetic ketoacidosis (DKA) which can be a frightening complication (click here for a background on DKA). Type 1 patients are at higher risk than type 2 patients, and among type 1 patients, those who are on a class of drugs called SGLT-2 inhibitors are more susceptible to DKA. The good news is that keeping tabs on ketone levels at home can help lower the chance of this complication. This article will break down what ketones are, how and when to measure ketones, and what to do with different ketone levels. For more in-depth information on when it is most important to measure ketones, click here for our deep dive on DKA. Ketones are alternative fuels for the body when its cells are low on glucose (sugar) for a prolonged period of time; this mechanism originally evolved to help humans cope with long periods without food. When body cells are low on sugar (in diabetes, usually as a result of lack of insulin, the key needed for sugar to enter cells), the body releases fat stored in fat cells; the fat then travels to the liver, where it is broken down into ketones, which are used as fuel instead of glucose. This is usually not problematic. Having too many ketones in the blood is called ketosis, and its common to be in a low-level state of ketosis when waking up in the morning, as the body was fasting during the night. Because ketosis is the result of fat breakdown, a popular weight loss method is the ketogenic (keto) diet, which uses specific foods low in carbs and thus, low in sugar to move the body toward burning fat for energy. The risk with ketones, however, is that too many in the blood makes it acidic, leading to DKA. To be clear, eating a Continue reading >>
Diabetic Ketoacidosis
Print Overview Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. If you have diabetes or you're at risk of diabetes, learn the warning signs of diabetic ketoacidosis — and know when to seek emergency care. Symptoms Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice: Excessive thirst Frequent urination Nausea and vomiting Abdominal pain Weakness or fatigue Shortness of breath Fruity-scented breath Confusion More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include: High blood sugar level (hyperglycemia) High ketone levels in your urine When to see a doctor If you feel ill or stressed or you've had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit. Contact your doctor immediately if: You're vomiting and unable to tolerate food or liquid Your blood sugar level is higher than your target range and doesn't respond to home treatment Your urine ketone level is moderate or high Seek emergency care if: Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 mill Continue reading >>
Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is a potentially lifethreatening complication that may occur in people who have diabetes, most often in those who have type 1 (insulin-dependent) diabetes. It involves the buildup of toxic substances called ketones that make the blood too acidic. High ketone levels can be readily managed, but if they aren't detected and treated in time, a person can eventually slip into a fatal coma. DKA often leads to people being newly diagnosed with type 1 diabetes. It can also occur in people already diagnosed with type 1 diabetes who have missed an insulin dose, have an infection, or have suffered a traumatic event or injury. Although much less common, DKA can occasionally occur in people with type 2 diabetes under extreme physiologic stress. With type 1 diabetes, the pancreas is unable to make the hormone insulin, which the body's cells need in order to take in glucose from the blood. In the case of type 2 diabetes, the pancreas is unable to make sufficient amounts of insulin or your body can't use the insulin it makes properly. Glucose, a simple sugar we get from the foods we eat, is necessary for making the energy our cells need to function. People with diabetes can't get glucose into their cells, so their bodies look for alternative energy sources. Meanwhile, glucose builds up in the bloodstream, and by the time DKA occurs, blood glucose levels are often greater than 14mmol/L while insulin levels are very low. Since glucose isn't available for cells to use, fat from fat cells is broken down for energy instead, releasing ketones. Ketones accumulate in the blood, causing it to become more acidic. As a result, many of the enzymes that control the body's metabolic processes aren't able to function as well. A higher level of ketones also affects levels o Continue reading >>
Ketone Testing: What You Need To Know
Ketones are produced when the body burns fat for energy or fuel. Theyare also produced when you lose weight or if there is not enough insulin to help your body use sugar for energy. Without enough insulin, glucose builds up in the blood. Since the body is unable to use glucose for energy, it breaks down fat instead. When this occurs, ketones form in the blood and spill into the urine. These ketones can make you very sick. You can test to see if your body is making any ketones by doing a simple urine test. There are several products available for ketone testing and they can be purchased, without a prescription, at your pharmacy. The test result can be negative, or show small, moderate, or large quantities of ketones. Anytime your bloodglucose is over 250 mg/dl for two tests in a row. When you are ill. Often illness, infections, or injuries will cause sudden high bloodglucose and this is an especially important time to check for ketones. When you are planning to exercise and the bloodglucose is over 250 mg/dl. If you are pregnant, you should test for ketones each morning before breakfast and any time the bloodglucose is over 250 mg/dl. If ketones are positive, what does this mean? There are situations when you might have ketones without the blood glucose being too high. Positive ketones are not a problem when blood glucose levels are within range and you are trying to lose weight. It is a problem if blood glucose levels are high and left untreated. Untreated high blood glucose with positive ketones can lead to a life-threatening condition called diabetic ketoacidosis (DKA). What should I do if the ketone test is positive? Call your diabetes educator or physician, as you may need additional insulin. Drink plenty of water and fluids containing no calories to "wash out" the Continue reading >>
Type 1 Diabetes - Ketones Diabetes New Zealand
Ketones are very easy to test for. When your body is high in ketones, it tries to get rid of them very quickly. It does this by pushing them out in your urine.Testing your urine for ketones will give you a clear indication of how high your blood ketones are. You develop ketones if you are not having enough insulin. Your insulin needs will change in certain situations. When you are sick or injured, your body becomes resistant to the action of insulin (your insulin cant work properly) and your bodys need for energy increases. This is because your body needs extra energy to fight infection or heal from an injury. So to put it simply, having ketones means your body needs more insulin. You should test for ketones either when your blood glucose is more than 17mmol/L OR if your blood glucose is climbing and you feel unwell, OR if you are injured and your ketone levels are increasing. That depends on what sort of ketone testing strips you have. At the moment ketone testing that you do at home is always done on your urine. At what level of ketones in my urine should I be concerned? A trace to a small amount of ketones in your urine is usually okay. However, if you are showing small amounts of ketones and you are unwell you should keep a careful eye on whether they are increasing or coming down. Get help if they continue to increase. If you are showing a moderate or large amount of ketones in your urine you need to act quickly to bring them down. You should ALWAYS contact your doctor or diabetes nurse educator if you have a moderate or large amount of ketones in your urine. If you cant get immediate advice, you should go to the nearest hospital. If your ketones are high and you are feeling unwell this trip to the hospital should be in an ambulance. Other things you can do for yo Continue reading >>
What Are Ketones And Their Tests?
A ketone test can warn you of a serious diabetes complication called diabetic ketoacidosis, or DKA. An elevated level of this substance in your blood can mean you have very high blood sugar. Too many ketones can trigger DKA, which is a medical emergency. Regular tests you take at home can spot when your ketone levels run too high. Then you can take insulin to lower your blood sugar level or get other treatments to prevent complications. What Exactly Are Ketones? Everyone has them, whether you have diabetes or not. Ketones are chemicals made in your liver. You produce them when you don't have enough of the hormone insulin in your body to turn sugar (or “glucose”) into energy. You need another source, so your body uses fat instead. Your liver turns this fat into ketones, a type of acid, and sends them into your bloodstream. Your muscles and other tissues can then use them for fuel. For a person without diabetes, this process doesn’t become an issue. But when you have diabetes, things can run out of control and you build up too many ketones in your blood. If the level goes too high, it can become life-threatening. Who Needs a Ketone Test? You might need one if you have type 1 diabetes. In this type, your immune system attacks and destroys cells in your pancreas that make insulin. Without it, your blood sugar rises. People with type 2 diabetes can also get high ketones, but it isn't as common as it is with type 1. Tests can show you when your level gets high so you can treat it before you get sick. When Should You Test? Your doctor will probably tell you to test your ketones when: Your blood sugar is higher than 250 milligrams/deciliter (mg/dl) for two days in a row You're sick or you've been injured You want to exercise and your blood sugar level is over 250 mg/dl Continue reading >>
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- Are ketones dangerous?
Ketones
Excess ketones are dangerous for someone with diabetes... Low insulin, combined with relatively normal glucagon and epinephrine levels, causes fat to be released from fat cells, which then turns into ketones. Excess formation of ketones is dangerous and is a medical emergency In a person without diabetes, ketone production is the body’s normal adaptation to starvation. Blood sugar levels never get too high, because the production is regulated by just the right balance of insulin, glucagon and other hormones. However, in an individual with diabetes, dangerous and life-threatening levels of ketones can develop. What are ketones and why do I need to know about them? Ketones and ketoacids are alternative fuels for the body that are made when glucose is in short supply. They are made in the liver from the breakdown of fats. Ketones are formed when there is not enough sugar or glucose to supply the body’s fuel needs. This occurs overnight, and during dieting or fasting. During these periods, insulin levels are low, but glucagon and epinephrine levels are relatively normal. This combination of low insulin, and relatively normal glucagon and epinephrine levels causes fat to be released from the fat cells. The fats travel through the blood circulation to reach the liver where they are processed into ketone units. The ketone units then circulate back into the blood stream and are picked up by the muscle and other tissues to fuel your body’s metabolism. In a person without diabetes, ketone production is the body’s normal adaptation to starvation. Blood sugar levels never get too high, because the production is regulated by just the right balance of insulin, glucagon and other hormones. However, in an individual with diabetes, dangerous and life-threatening levels of ketone Continue reading >>
Urine Tests For Diabetes: Glucose Levels And Ketones
The human body primarily runs on glucose. When your body is low on glucose, or if you have diabetes and don’t have enough insulin to help your cells absorb the glucose, your body starts breaking down fats for energy. Ketones (chemically known as ketone bodies) are byproducts of the breakdown of fatty acids. The breakdown of fat for fuel and the creation of ketones is a normal process for everyone. In a person without diabetes, insulin, glucagon, and other hormones prevent ketone levels in the blood from getting too high. However, people with diabetes are at risk for ketone buildup in their blood. If left untreated, people with type 1 diabetes are at risk for developing a condition called diabetic ketoacidosis (DKA). While rare, it’s possible for people with type 2 diabetes to experience DKA in certain circumstances as well. If you have diabetes, you need to be especially aware of the symptoms that having too many ketones in your body can cause. These include: If you don’t get treatment, the symptoms can progress to: a fruity breath odor stomach pain trouble breathing You should always seek immediate medical attention if your ketone levels are high. Testing your blood or urine to measure your ketone levels can all be done at home. At-home testing kits are available for both types of tests, although urine testing continues to be more common. Urine tests are available without a prescription at most drugstores, or you can buy them online. You should test your urine or blood for ketones when any of the following occurs: Your blood sugar is higher than 240 mg/dL. You feel sick or nauseated, regardless of your blood sugar reading. To perform a urine test, you urinate into a clean container and dip the test strip into the urine. For a child who isn’t potty-trained, a pa Continue reading >>
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Ketones And Exercise What You Need To Know
In a new set of guidelines for Type 1 diabetes and exercise, I and my fellow researchers warn that people with Type 1 diabetes need to monitor for elevated levels of ketones during exercise. If you have Type 1 and exercise regularly, testing for ketones could save your life. Ketones develop in our bodies when we mobilize fat as fuel. Fat is an important energy source that is used by the body at rest and during exercise. Ketones are a general term in medicine used to describe the three main ketone bodies that the liver produces acetoacetate, beta-hydroxybutyrate, and acetone. Read Too Many with Type 1 Dont Test for Ketones. Ketone bodies help fuel the brain and skeletal muscle during times of prolonged fasting or starvation, so in a way ketones are very important for survival. We actually have enough stored fat to generate energy for days, but this can cause a number of metabolic problems, the most important of which is ketoacidosis. In Type 1 diabetes, ketone levels can rise even without starvation, if insulin levels drop too much and levels of other hormones like glucagon and catecholamines rise. This rise in ketone levels in diabetes can cause a life-threatening condition called diabetic ketoacidosis (DKA). Nausea and vomiting, stomach pain, decreased appetite The reasons for developing high ketone levels in Type 1 diabetes include: Bad insulin (e.g. expired, previously frozen, exposed to very high temperatures, etc.) Loss of insulin flow in an insulin pump infusion set or bent cannula A ketogenic diet (low carbohydrate) with low total daily insulin dose Prolonged vigorous exercise in a setting of very low insulin levels Exercise has long been known to increase ketone production, even in people without diabetes. Increases in fat mobilization and increased blood flow Continue reading >>
What Are Ketones, And Why Are They Important To Diabetes Self-management?
All blood tests are tools. Some are to diagnose diabetes, some are to help you manage your diabetes on a daily or long term basis and some are to keep you safe. People with diabetes are told about blood testing and how important testing is to manage their blood glucose. It is a critical part of diabetes management. Whether it is done in the physician’s office or the patient’s home it is an invaluable tool, Unfortunately a very important test, ketone testing is often not taught or taught only to people with type 1 diabetes. This test can be life saving and should be part of every person with diabetes knowledge and skills. It is simple and if you have diabetes you should know about it. What Are Ketones? When the body is unable to burn glucose it burns fat and this produces a chemical called ketones. This occurs when there is too little insulin for the amount of glucose in the body. Possible causes for this could be: Experiencing stress or illness such as fever, Having an infection. Omitting or taking too little insulin Eating more food than planned Improper storage of insulin If left untreated, ketones continue to rise and can result in a condition called Diabetic Ketoacidosis, or DKA. This condition is quite serious and requires immediate medical attention. DKA is the most common cause of hospitalization and death among children and young adults with diabetes, and the leading cause of adverse events for insulin pump users. Why Measure Blood Ketones? Studies suggest that most, if not all emergency department and hospital admissions beyond initial diabetes diagnosis could be prevented if people better managed their diabetes care and knew the warning signs when ketoacidosis was developing. Blood ketone testing provides a rapid, accurate, and early warning sign that keto Continue reading >>
How To Test Ketones For Diabetes
If you live with diabetes, then there is no doubt that you know how crucial it is to check your blood on a regular basis. But you should also keep an eye on ketones, particularly if you have type 1 or advanced type 2 diabetes and you useinsulin. The need for ketone testing is not often communicated to people with diabetes or may be restricted to individuals with type 1 diabetes only. However, testing ketones for diabetes are highly essential and should be part of every individual looking to effectively manage diabetes. The test is relatively simple and it is important you know about it if you have diabetes. Ketones are organic chemicals that build up and accumulate when your body begins to burn fat for energy instead of carbohydrate and sugars. This often occurs in diabetics as a result of insulin deficiency. When insulin is not enough in the body, glucose will find it difficult to enter into cells and so build up in the bloodstream. The cells will then have to turn to an alternative; burning fat for energy instead of glucose. This will increase the concentration of ketones in the blood and eventually spill into the urine. Ketones could be a sign that your body is deficient in insulin and could result in a condition known as Diabetic Ketoacidosis (DKA). Therefore, it is important diabetics regularly keep an eye on their insulin level to ensure they are not falling short. Some common signs of DKA could include moderate to large ketones, vomiting, nausea, fruity breath, abdominal pain, rapid breathing, and lack of energy. When DKA is left untreated could lead to serious and life-threatening issues in diabetics, including coma or death. Ketones can also be present even in the blood with normal blood sugar levels. A condition usually called nutritional ketones or starvatio Continue reading >>
How The Ketogenic Diet Works For Type 2 Diabetes
Special diets for type 2 diabetes often focus on weight loss, so it might seem crazy that a high-fat diet is an option. But the ketogenic (keto) diet, high in fat and low in carbs, can potentially change the way your body stores and uses energy, easing diabetes symptoms. With the keto diet, your body converts fat, instead of sugar, into energy. The diet was created in 1924 as a treatment for epilepsy, but the effects of this eating pattern are also being studied for type 2 diabetes. The ketogenic diet may improve blood glucose (sugar) levels while also reducing the need for insulin. However, the diet does come with risks, so make sure to discuss it with your doctor before making drastic dietary changes. Many people with type 2 diabetes are overweight, so a high-fat diet can seem unhelpful. The goal of the ketogenic diet is to have the body use fat for energy instead of carbohydrates or glucose. A person on the keto diet gets most of their energy from fat, with very little of the diet coming from carbohydrates. The ketogenic diet doesn’t mean you should load up on saturated fats, though. Heart-healthy fats are the key to sustaining overall health. Some healthy foods that are commonly eaten in the ketogenic diet include: eggs fish such as salmon cottage cheese avocado olives and olive oil nuts and nut butters seeds The ketogenic diet has the potential to decrease blood glucose levels. Managing carbohydrate intake is often recommended for people with type 2 diabetes because carbohydrates turn to sugar and, in large quantities, can cause blood sugar spikes. If you already have high blood glucose, then eating too many carbs can be dangerous. By switching the focus to fat, some people experience reduced blood sugar. The Atkins diet is one of the most famous low-carb, high-p Continue reading >>
Ketones: Clearing Up The Confusion
Ketones, ketosis, ketoacidosis, DKA…these are words that you’ve probably heard at one point or another, and you might be wondering what they mean and if you need to worry about them at all, especially if you have diabetes. This week, we’ll explore the mysterious world of ketones, including if and how they may affect you. Ketones — what are they? Ketones are a type of acid that the body can form if there’s not enough carbohydrate to be burned for energy (yes, you do need carbs for fuel). Without enough carb, the body turns to another energy source: fat. Ketones are made in the liver from fat breakdown. This is called ketogenesis. People who don’t have diabetes can form ketones. This might occur if a person does extreme exercise, has an eating disorder, is fasting (not eating), or is following a low-carbohydrate diet. This is called ketosis and it’s a normal response to starvation. In a person who has diabetes, ketones form for the same reason (not enough carb for energy), but this often occurs because there isn’t enough insulin available to help move carb (in the form of glucose) from the bloodstream to the cells to be used for energy. Again, the body scrambles to find an alternate fuel source in the form of fat. You might be thinking that it’s a good thing to burn fat for fuel. However, for someone who has diabetes, ketosis can quickly become dangerous if it occurs due to a continued lack of insulin (the presence of ketones along with “normal” blood sugar levels is not necessarily a cause for concern). In the absence of insulin (which can occur if someone doesn’t take their insulin or perhaps uses an insulin pump and the pump has a malfunction, for example), fat cells continue to release fat into the circulation; the liver then continues to churn Continue reading >>
