DIABETIC KETOACIDOSIS AND KETONES
The first thought that often comes to mind when we hear the word diabetes is blood sugar and monitoring glucose levels in the blood. We typically don’t correlate diabetes with urine samples and tests, but diabetes is a complex disease that has many layers and affects the entire body.
We are often so laser focused on blood glucose levels that we often overlook another level that is very important – ketone levels. The presence of ketones in the urine can be very serious and life-threatening for someone living with diabetes, and it’s an important lesson to understand as part of our diabetes education.
WHAT ARE KETONES?
“Ketones are chemicals produced by the liver. The body produces them when it doesn’t have enough insulin to convert sugar into energy.”1 Insulin is the body’s normal source of energy, but when the body lacks insulin due to diabetes then the body starts to use fat to do insulin’s job. When this happens, the liver turns these fats into ketones, a type of acid, and sends them into the bloodstream. A buildup of ketones present in the blood causes it to become overly acidic. For patients without diabetes, this process is typically not an issue and can be regulated. But for someone living with diabetes it can be life-threatening. It is a warning sign that a patient’s diabetes is out of control. In addition to diabetes, certain conditions can cause high ketones, like strenuous exercise, pneumonia, an eating disorder, high fever, sepsis, stroke, or heart attack. High levels of ketones can be dangerous to anyone and for that reason should be taken seriously.
CHECKING FOR KETONES
Checking for ketones is simple and all that is needed is a test strip and a urine sample. The test can be done at home or anywhere. A ketone test is typically recommended when blood sugar levels are higher than 240 mg/dl. Other factors, like illness, may require that someone living with diabetes check for the presence of ketones more often. It’s important to have a plan and consult with a healthcare professional to help prevent high levels of ketones.
UNDERSTANING KETONE LEVELS
Small amounts of ketones in urine are considered normal. Here is a breakdown to use as a guide to help monitor ketone level presence in the urine3:
- 20 mg/dl is considered small.
- 30 to 40 mg/dl is considered moderate.
- 80 mg/dl or higher is considered large.
If large amounts of ketones are present in the urine, a blood check may be required for further results. A blood ketone meter and kit with ketone strips enables patients living with diabetes to check at home or anywhere. Here’s a breakdown of how to read blood ketone results4:
- A level of 0.6 mmol/L up to 1.0 mmol/L is considered normal for most people with diabetes.
- A level between 1.0 and 1.5 mmol/L is typically considered the range to contact the doctor.
- A level between 1.5 and 2.9 mmol/L indicates a risk for ketoacidosis and the doctor should be called immediately.
- A level of 3.0 mmol/L is considered a medical emergency and requires a trip to the emergency room or a call to 911.
If ketone presence is small to moderate, there are ways to bring ketone levels down. Drinking extra water can help to flush them out. It is also recommended that patients do not exercise when ketone levels are higher than average because exercise can increase ketone production as well.
WHAT IS KETOACIDOSIS (DKA)?
A high level of ketones in the body is dangerous and can cause damage and poison the system. High ketone levels can cause a serious condition known as Ketoacidosis which can lead to a diabetic coma or even death. Ketoacidosis is typically linked to Type 1 Diabetes. It can develop in patients with Type 2 Diabetes, but it is considered rare. Monitoring blood glucose and ketone levels often can help to avoid complications and a trip to the hospital.
WARNING SIGNS OF KETOACIDOSIS
The symptoms begin slowly but can escalate quickly. When they do, it’s time to seek medical attention immediately. A trip to the hospital is typically necessary to treat the ketoacidosis. Monitoring ketone levels can help avoid high levels and prevent symptoms. Here are some of the signs to watch out for:2
- Dry mouth or constant thirst
- Frequent urination
- High blood sugar levels
- High levels of ketones in the urine
- Fatigue
- Dry skin
- Abdominal pain
- Nausea or vomiting
- Difficulty breathing
- Fruity breath odor
- Reduced attention span and confusion
Like blood glucose levels, ketone levels can be controlled. It just takes effort. With proper monitoring, blood and ketone levels can be managed. Understanding the warning signs can help to keep all systems in check and prevent a medical emergency.
FINDING RESOURCES
At Quest Health Solutions, we know there is much to learn about this complex disease. That is why it is our mission to create awareness, provide support, resources and diabetes education to our patients and healthcare providers. By working together, we can all learn how to take control and manage diabetes. A strong support network is key, and we are here for you. To learn more, contact us 1-877-888-7050 Option 3, Ext. 1011, email [email protected] or schedule an appointment today. In the meantime, please continue to check our blog for more information and let us know about any topics you would like to learn more about in the future.
- (2020) WebMD. What are Ketones? Available at https://www.webmd.com/diabetes/qa/what-are-ketones#:~:text=Ketones%20are%20chemicals%20your%20liver,sends%20them%20into%20your%20bloodstream accessed on 12 March 2021.
- (2020) DKA (Ketoacidosis) & Ketones. Available at https://www.diabetes.org/diabetes/complications/dka-ketoacidosis-ketones accessed on 12 March 2021.
- (2018) Everyday Health. Ketones in Urine: When and Why to Test for Them and What They Mean available at https://www.everydayhealth.com/urine/ketones-urine-test-what-it-measures-what-results-mean/ accessed on 13 March 2021.
(2020) Very Well Health. How to Test Your Blood with a Home Ketone Meter. Available at https://www.verywellhealth.com/how-to-test-your-blood-for-ketones-2241625 accessed on 13 March 2021