Type 1 Diabetes In Adults: Diagnosis And Management.
Go to: 12.1. Ketone monitoring  12.1.1. Introduction Ketosis and ketonuria reflect a greater degree of insulin deficiency than hyperglycaemia alone. The presence of ketones indicates that insulin concentrations are too low not only to control blood glucose concentrations but also to prevent the breakdown of fat (lipolysis). Because ketones are acid substances, high ketone concentrations in the blood may create acidosis. Diabetic ketoacidosis (DKA) is a medical emergency and in its established state carries a 0.7–5% mortality in adults.459,476,784 High ketones in the blood are associated with high levels of fatty acids and together create insulin resistance. The patient with significant ketonaemia will require more insulin than usual to control the blood glucose. Traditionally, ketonaemia has been assessed by urine testing. This has been applied in three main settings: it is recommended as part of guidance for patient self-management of acute illness at home, when patients are advised to increase their usual corrective insulin doses in the presence of significant ketonuria; in the assessment of patients presenting to emergency services with hyperglycaemia, where presence of ketonuria may influence management decisions, including need for admission and in the management of established DKA, where resolution of ketonuria is an important indication of recovery. However, not all ketone bodies are detected by urine testing. For example, beta-hydroxybutyrate (β-OHB) is not detected with current strip tests and if there is a high β-OHB:acetoacetate ratio, urine testing may give a falsely low estimate of ketosis. Furthermore, after an episode of ketoacidosis, where measurement of blood ketones may provide a more accurate assessment of re-insulinisation than blood glucos Continue reading >>
5 Ways To Measure Your Ketones
5 Ways to Measure Your Ketones A ketogenic diet is a very low carbohydrate, moderate protein and high fat based nutrition plan. A ketogenic diet trains the individual’s metabolism to run off of fatty acids or ketone bodies. This is called fat adapted, when the body has adapted to run off of fatty acids/ketones at rest. Research has demonstrated that this nutrition plan improves insulin sensitivity and reduces inflammation throughout the body. This leads to greater fat metabolism and muscle development as well as a reduced risk of chronic disease. (1, 2). I get asked all the time how to measure the state of ketosis. There are several major ways and we will discuss those in this article. Measuring Your Ketones There are three types of ketone bodies: Acetone, Acetoacetate and Beta-Hydroxybutryate (BHB). Each of these three can be tested as acetone is a ketone released through the breath, acetoacetate is a ketone released through urine and BHB is (although not technically a ketone it acts like a ketone) in the blood stream and used by the cells for energy. 1. Blood Ketone Meter This measures BHB and is considered to be the most accurate way to measure ketone bodies. These have the ability to determine the ketone level in your blood precisely but they are also pricey and invasive. Personally, I freak out every time I have to prick my finger!! The Precision Xtra blood glucose and ketone meter is a good buy at $28-$30. The expensive part is the ketone test strips here which can cost $4 each. If you are looking at testing yourself every day it is going to cost you $120 a month and the $30 meter. Here is a starter kit you can get on Amazon Most people will enter into a light nutritional ketosis (between 0.5-1.0 mmol/L on the meter) within two or three days. It typically takes Continue reading >>
What Are The Optimal Ketone Levels For A Ketogenic Diet?
If you’ve just started a ketogenic diet, then you’ll know that it can be really tough to figure out if you’re doing keto right. Am I eating too many carbs? Too much protein? Should I still be feeling tired? When is the fat burning supposed to start? It’s confusing, and one of the most confusing aspects is what your optimal ketone levels are supposed to be. Unlike most other diets, the ketogenic diet is designed to put your body into a state of ketosis in order to get your body to start burning ketones instead of the glucose that it usually burns when you eat a high carb standard American diet (SAD). But to know whether you’re in ketosis and whether your body has enough ketones circulating for you to use as energy instead of glucose, you have to measure your actual ketone levels and then determine whether they’re high enough for you to be reaping the benefits of the ketogenic diet. If you’ve tried searching for this information already, then you’ll know that there’s some controversy depending on which expert you follow. So in this article, we’ll tell you exactly what the different experts are suggesting are the optimal ketone levels as well as give you recommendations for what ketone levels you should be aiming for depending on your goals with a ketogenic diet. A Few Quick Notes Before We Start… If you’re looking for signs other than testing your actual body ketone levels as to whether you’re in ketosis or not, then please check out this article instead that provides you with signs you’re in ketosis. If you’re a type 1 diabetic, then this article is not for you and the optimal ketone levels suggested below are not applicable to you. Please check out the tons of other ketone level articles on the web to ensure your ketone levels do not reach Continue reading >>
- The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus
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- Does the Ketogenic Diet Work for Type 2 Diabetes?
Tweet Ketone testing is a key part of type 1 diabetes management as it helps to prevent a dangerous short term complication, ketoacidosis, from occurring. If you have type 1 diabetes, it is recommended that you have ketone testing supplies on your prescription. Ketone testing may also be useful in people with other types of diabetes that are dependent upon insulin. Why test for ketones? Ketones are produced by the body as an alternative source of energy to sugar. The body produces ketones by breaking down fats, this process is known as ketosis. Ketones may be produced as part of weight loss, however, it’s important for people with diabetes on insulin to note that ketones can be produced when the body has insufficient insulin. When the body has too little insulin, it means that cells of the body cannot take in enough sugar from the blood. To compensate for this, the body will start to break down fat to provide ketones. However, if a high level of ketones is produced, this can cause the blood to become acidic which can lead to illness and even potential danger to organs if not treated in time. This state is referred to as diabetic ketoacidosis. Where can I get ketone testing kits and sensors? The most accurate way of testing for ketones is to use a meter that measures blood ketone levels. The following blood glucose meters are able to test blood ketone levels in addition to blood glucose levels: Abbott - FreeStyle Optium Neo Menarini - GlucoMen LX Plus If you take insulin, you should be able to get these prescribed by your GP. You can also test urine for ketone levels, however, urine ketone testing is not as accurate as blood ketone testing as the levels of ketones in the urine will usually only reflect a level of up to a few hours previously. When to test for ketones? Continue reading >>
On This Site Tests: Urine Ketones (see Urinalysis - The Chemical Exam); Blood Gases; Glucose Tests Elsewhere On The Web Ask a Laboratory Scientist Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, the American Society for Clinical Laboratory Science (ASCLS). Click on the Contact a Scientist button below to be re-directed to the ASCLS site to complete a request form. If your question relates to this web site and not to a specific lab test, please submit it via our Contact Us page instead. Thank you. Continue reading >>
Tracking Blood Ketones: Behind The Scenes Data On The Ketogenic Diet
Tracking Blood Ketones: Behind the Scenes Data on the Ketogenic Diet I’ve tried a lot of diets. I first went vegetarian, then slow carb, then gluten-free, then Paleo. I even did a 28-day Chipotle diet, which is exactly as awesome as it sounds. Eventually I found the Ketogenic diet. For me, like for many people in our communities, this all started with a health concern. I was born with a heart condition. It never impacted my life, but it was there, lingering. When I was a junior in college, a few classmates and I were out enjoying late night pizza. Out of nowhere, one classmate suddenly jolted upright and fell off his stool. He died. I found out the next morning it was from a lingering heart condition, not too unlike my own. I started to think about my health a lot more after that. I read about nutrition and started exploring the confusing world of diets. As I learned more and as I became more involved in Quantified Self, I found myself wanting to quantify these diets. That’s what drew me to Keto. It’s the most measurable diet. Quick Summary of the Ketogenic Diet Keto is a high-fat, very-low-carb diet, usually with 70% of calories coming from fat. The idea is to switch your body from using glucose as its primary energy to breaking down fats into ketones for energy. You can measure the macros that you eat and you can measure the ketones in your urine, breath, and blood. In 2013, I did my first experiment with the ketogenic diet. In that experiment, I tracked everything I ate in MyFitnessPal and compared it to other data I was collecting. I found my energy increased, my sleep quality went up (according to my Zeo data), my cholesterol levels improved, and my food cravings went away. However, I also found that measuring everything I ate was a pain, I didn’t really kn Continue reading >>
How To Test Your Blood With A Home Ketone Meter
testing is used by people with diabetes and by people on a ketogenic diet. You can test your urine or your blood for ketones. But because urine testing is not as accurate, the American Diabetes Association recommends blood ketone testing with a ketone meter as the preferable method. If you have diabetes, you should discuss home blood ketone testing with your doctor to learn whether it is recommended in your case and when you should perform the testing. Ketone testing is particularly important during periods of illness. Blood Ketone Meters for Testing at Home You will need a blood ketone meter and a kit that include the lancet pen and ketone test strips. These meters also will read blood glucose test strips, and both will download their results to your computer. Other brands and models may be available, including: Precision Xtra: This meter from Abbott Diabetes Care can store up to 450 measurements and will display your blood glucose averages over different time periods. You need to enter a code to switch from glucose testing to ketone testing. Users seem happier with the Precision brand, and researchers find it to be the more accurate. The strips require 1.5 microliters of blood. It also features a backlit display. Nova Max Plus: This meter from Nova Biomedical is often provided free with the purchase of two boxes of test strips. You don't have to enter a code to switch it from blood glucose to ketone testing; it does that automatically when you insert a ketone test strip. If you are using it primarily for blood glucose, it will remind you to test for ketones if your blood sugar level is 250 mg/dL or higher. The test strips for the Nova Max are less expensive but also flimsier and give more error messages, requiring retesting. The strips require less blood than the Prec Continue reading >>
How To Measure Ketones And Optimize Ketogenic Diets
The problem with diets is that we think that one diet should be good for everyone. But research and N=1 experiments show that’s not the case. Learn about measuring ketones and ketosis to understand how your low carb or high fat diet is really affecting you. If there is one area of our bodies that is debated to extremes, with literally hundreds of differing strong opinions on it, it’s nutrition. For many, beliefs about nutrition and diet are tribal. We put ourselves in different camps and we war agains the other camps. Whether it be paleo, low fat, low carb, Atkins, high fat, low protein, vegan, raw vegan and so on. It’s exactly this sort of area where I see data as essential. Without data we have no hope of cutting through the maze of opinions to get to what really works. Part of the problem with nutrition and diets is that we tend to think that one diet should be good for everyone. But increasingly, research and N=1 experiments, are showing that that isn’t the case. And this is exactly why you should pay attention to today’s show. Today, we’re looking at what has relatively recently become the fastest growing nutrition or diet trend. The high fat diet. Also known in different guises as the ketogenic diet, or the low carb diet. And specifically how this can affect our different individual biochemistries, how we can measure “Ketosis” and other biomarkers to understand how our specific biology is reacting to it… and allowing us to troubleshoot and course correct when it isn’t getting the desired results we’re looking for from it. Today’s guest is Jimmy Moore. In 2004, Jimmy, at 32 years, weighed 410 pounds. Since then he has transformed his own biology, shedding all that additional weight with low carb and ketogenic diets. He has also interviewed n Continue reading >>
Advantages Using Ketonix
KETONIX is an excellent alternative to monitor and record your levels of ketosis compared to urine and blood tests. KETONIX Ketone Breath Monitor is a one-time cost and is simple to use while being extremely portable and robust. It has never been easier to see and monitor metabolic ketone production So what are the advantages of using KETONIX instead of urine strips and/or blood ketone meters? KETONIX vs. Urine Strips Urine strips indicate the excess concentration of Acetoacetate in the urine. KETONIX indicates the acetone in your breath. Acetone is produced from the breakdown of acetoacetate in blood. Measurement units are not the same as the concentration of acetoacetate in blood is higher due to less volume (higher density) and is typically measured in mmol/l. The concentration of acetone in breath is lower due to much more volume (lower density) and is measured in PPM. Again, urine strips measures acetoacetate in urine, blood meters measures beta-hydroxybutyrate in blood and KETONIX measures acetone in breath (air). Urine strips can only be used once. KETONIX is reusable and can be used over and over again. Urine strips show a historical value of the excess production. KETONIX shows a real-time value of what is in the blood via exhaled ketones! Urine strips tests need urine and somewhere private to do the test. You can perform tests using KETONIX wherever you can access a powered USB port or the optional KETONIX battery pack. KETONIX may be stored in the bag that was included with the product. Urine strips cost per test. KETONIX is a one-time investment! KETONIX vs. Blood Ketone Meter Blood ketone meters measures Beta-Hydroxybutyrate in blood, not Acetoacetate or acetone. Blood ketone measure requires test strips which are expensive and often require a prescription. Continue reading >>
Lose Weight By Achieving Optimal Ketosis
Do you want to lose weight? Here’s number 16 of my 18 best tips. All of the published tips can be found on the How to Lose Weight page. Before we get started, here’s a short recap of the tips so far: The first and most crucial piece of advice was to choose a low-carb diet. The next were eating when hungry, eating real food, eating only when hungry, measuring progress wisely, being persistent, avoiding fruit, beer and artificial sweeteners, review your medications, stressing less and sleeping more, eating less dairy and nut products, stocking up on vitamins and minerals, using intermittent fasting and finally, exercising smart. This is number sixteen: 16. Get into optimal ketosis Warning: Not recommended for type 1 diabetics, see below. We’ve now arrived at tip number 16. If you’re still having trouble losing weight, despite following the 15 pieces of advice listed above, it might be a good idea to bring out the heavy artillery: optimal ketosis. Many people stalling at weight plateaus while on a low carb diet have found optimal ketosis helpful. It’s what can melt the fat off once again. So how does this work? A quick run-through: The first tip was to eat low carb. This is because a low-carb diet lowers your levels of the fat-storing hormone insulin, allowing your fat deposits to shrink and release their stored energy. This tends to cause you to want to consume less calories than you expend – without hunger – and lose weight. Several of the tips mentioned above are about fine-tuning your diet to better this effect. Video course Do you know exactly how to eat a low-carb and high fat diet (LCHF)? This is required for ketosis. If not the easiest way is watching this high quality 11-minute video course on how to eat LCHF, and the most important things to think a 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 >>
- Tiny sensor placed under the skin to replace finger prick tests for diabetes: Smartphone app will alert patients if their blood sugar level drops or is too high
- Insulin, glucagon and somatostatin stores in the pancreas of subjects with type-2 diabetes and their lean and obese non-diabetic controls
- Are ketones dangerous?
An important aspect of the Ketogenic Diet is knowing how high your ketone levels are. There are three types of Ketones; beta-hydroxybutyrate (BOHB) which is measured in the blood, acetoacetate (AcAc) which is typically measured in the urine, and acetone which is typically measured in the breath. Measuring Acetone in the breath is becoming a good option, and I believe that this is probably the future of ketone measurement. It's an area of rapid development, and it was not available when I performed my Ketogenic Experiment, so I'm still gathering data. Measuring BOHB is the most accurate, and it's now practical at home using a similar technique to measuring blood glucose, but it's really expensive at several dollars per test. The easiest and cheapest technique is to measure AcAc in the urine using a test strip. However, this approach is too inaccurate to be useful. Acetone levels correlate well with body fat loss, but are also elevated by the Ketogenic Diet, MCT  intake, and exercise even in the absence of weight loss. One study found that a one pound (0.5 Kg) per week fat loss correlated with 1.7 PPM of acetone (67 nmol/L). Each ~40% increase in breath acetone was an additional ∼0.5 Lb (250g) of weekly fat loss. Breath acetone correlates well (though not linearly) with blood (BOHB) ketone levels. This makes it useful for monitoring the progression of a ketogenic diet, as well as for measuring weight loss. The formula below was developed based on 12 adults consuming Ketogenic meals over a short period: For Breath Acetone (BrAce) in mmol/L: BOHB = 0.11 * BrAce0.47 - 0.18 Note that the relationship is far from exact (r=0.5 or so.) Breath acetone levels can vary dramatically, with healthy individuals on a regular diet having less than 1 PPM (parts per Continue reading >>
Ketones are a chemical produced by your body when, due to a lack of insulin, it is not able to use glucose as its source of energy, and instead start breaking down fat ••••• Ketones are a chemical produced by your body when it is not able to use glucose as its source of energy due to a lack of insulin. When glucose can’t be used as energy, your body will start breaking down fat for energy instead and this is when ketones are produced. This is a short term solution for the body as over time the level of ketones will increase and can become dangerously high. If this happens, diabetic ketoacidosis (DKA) can develop which can be life threatening. Having ketones is more common in Type 1 than Type 2 diabetes. You may have continued high glucose readings because you are finding it difficult to manage your diabetes, have missed a few injections, you are ill, have an infection, or for any other reason. It is important to test your level of ketones if you have Type 1 diabetes and your glucose readings are above 15mmols/L. Checking for ketones may be advised by your healthcare professional as part of your diabetes management program. You can test your level of ketones by using urine sticks or blood test strips with a meter that can test for ketones. Not all meters have the ability to test for ketones and you will need separate test strips for ketones to do this. Blood ketone test results Normal blood ketone levels are slightly different from person to person. This table will help you decide if you need to do anything and what you should do. Remember, it is far better to be careful, so if you are not sure contact your diabetes care team straightaway. Blood ketone level What you should do Below 0.6 mmol/L Readings below 0.6 mmol/L are in the normal range. Follow your hea Continue reading >>
Ketonuria is a medical condition in which ketone bodies are present in the urine. It is seen in conditions in which the body produces excess ketones as an indication that it is using an alternative source of energy. It is seen during starvation or more commonly in type I diabetes mellitus. Production of ketone bodies is a normal response to a shortage of glucose, meant to provide an alternate source of fuel from fatty acids. Pathophysiology Ketones are metabolic end-products of fatty acid metabolism. In healthy individuals, ketones are formed in the liver and are completely metabolized so that only negligible amounts appear in the urine. However, when carbohydrates are unavailable or unable to be used as an energy source, fat becomes the predominant body fuel instead of carbohydrates and excessive amounts of ketones are formed as a metabolic byproduct. Higher levels of ketones in the urine indicate that the body is using fat as the major source of energy. Ketone bodies that commonly appear in the urine when fats are burned for energy are acetoacetate and beta-hydroxybutyric acid. Acetone is also produced and is expired by the lungs. Normally, the urine should not contain a noticeable concentration of ketones to give a positive reading. As with tests for glucose, acetoacetate can be tested by a dipstick or by a lab. The results are reported as small, moderate, or large amounts of acetoacetate. A small amount of acetoacetate is a value under 20 mg/dl; a moderate amount is a value of 30–40 mg/dl, and a finding of 80 mg/dl or greater is reported as a large amount. One 2010 study admits that though ketonuria's relation to general metabolic health is ill-understood, there is a positive relationship between the presence of ketonuria after fasting and positive metabo Continue reading >>
3 Ways To Measures Ketones: Which Is Best?
Intro: the age of Do-It-Yourself at-home medical technology The medico-technological age we’re in goes by many names, such as biohacking, self-experimentation or the quantified self. A lot of it is about tracking biochemical markers and performance metrics that can tell you something about your past and present state, usually in an attempt to predict or change it in the future. Ketones are one such biochemical marker of metabolism that can be measured in blood, breath and urine (see our What’s a ketone? section for more details). Some people use a ketogenic diet to manage cancer, epilepsy, obesity or diabetes and may find it helpful to monitor their ketone levels. Alternatively, they may simply be curious and interested in physiology. Whatever the case may be, since ketones can be measured in blood, breath and urine, which method might you chose for your circumstance and why? Measuring blood ketones The ketone bodies measured in blood are acetoacetate and is β-hydroxybutyrate (BhB), the latter being the most commonly measured. A well-known at-home device for doing so is the Precision Xtra. It can also measure blood glucose using glucose-specific strips. The portable device can measure BhB concentrations ranging from 0.1 mmol/L (1.0 mg/dL) to 8 mmol/L (or 83.3 mg/dL). Measuring blood ketones is the most accurate method compared to breath and urinary ones but the ketone strips are still quite expensive. One case in which blood ketones are measured is when doctors ask their diabetic patients to monitor their blood BhB levels so as to stay below 0.6 or 1.5 mmol/L. These doctors are worried that a rise above these levels may lead to a pathological condition called diabetic ketoacidosis (DKA). DKA is distinct from the normal physiological state of ketosis, where insulin Continue reading >>