Ketones Information

Why are ketones important?

If you have diabetes, especially type 1, knowing about ketones is very important. In fact, if you get ill, knowing what to do about them could be life-saving! So read on…

What are ketones?

Ketones (pronounced key-tones) are produced when your body gets energy by breaking down fat instead of sugar.

This can happen for one of two reasons:

if you do not have enough insulin in your blood;
if there simply isn’t enough sugar available.

Using fat as an energy source is perfectly natural. For example, if you are fasting, whether by choice (on a diet) or because you are stranded without food, you need to be able to use stored fat for energy. But the process needs to be controlled by insulin.

When ketones get out of control…

Ketones become a problem when you do not have enough insulin to control ketone production properly or you are truly starving because of lack of food.

When too many ketones are produced too quickly they upset the delicate balance of the body’s chemistry and can lead to a problem called diabetic ketoacidosis (DKA). DKA is dangerous, but the good news is that you can usually stop it from developing.

Who is most at risk from ketones?

People who use insulin
Illness, and sometimes stress, can make ketone levels rise.

Young children with diabetes
Sometimes it can be difficult to tell the symptoms of rising ketones from other childhood illnesses.

Pregnant women with diabetes
High ketone levels can affect the unborn baby, so pregnant women with diabetes need to take extra care.

Insulin pump users
If an insulin pump fails blood glucose and ketone levels can rise very quickly.

Know when you are at risk

Get to know when you may be at risk of DKA.

When you are ill
If you are ill with an infection or other acute illness the body burns up sugar faster and this triggers the ketosis process. The situation is made worse when the illness stops you from eating properly.

People with type 1 diabetes are particularly at risk during illness. People with type 2 diabetes usually have enough insulin to cope with illness, but they may also develop DKA if the stress of an acute illness or infection overwhelms their ability to produce insulin.
When insulin levels are low
If you have type 1 diabetes you are at risk if you have not taken your insulin for several hours, perhaps because you forgot an insulin injection or because your insulin pump wasn’t working properly.

Even a few hours without insulin may be enough time for ketosis to start. (Note: exercising when excess ketones are present will not lower your blood sugar. You need insulin first.)

Recognise the symptoms

Learn to spot the signs and symptoms of ketosis before it develops into DKA.

Because there is too little insulin, your blood sugar levels will usually be high. You will also be experiencing one or more of the following:

Feeling thirsty all the time
Urinating more frequently
Having dry or flushed skin
Feeling sick or being sick
Feeling tired and/or confused
Finding it hard to breathe
Pain in your stomach
Breath that smells of pear drops

Some of these symptoms arise because as your ketone level rises, your blood becomes more acidic. Acidic blood, combined with dehydration, cause diabetic ketoacidosis (DKA).

React quickly

Prevent DKA arising and avoid an emergency hospital admission!

Don’t wait for symptoms to appear. The best way to find out if your blood ketone level is above normal is to check it.

When you have diabetes, especially if you have type 1 diabetes, test your ketone levels when:

You have flu or any other infection
You are under severe stress, either emotionally or physically
Your blood glucose levels are 16.7mmol/L or above
Your blood glucose levels are above 10.0mmol/L and go on rising or you feel ill
You have any of the symptoms of DKA
Your doctor has recommended testing
You are pregnant

Blood or urine ketone testing?

There are two ways to test for ketones – blood testing and urine testing. Blood testing for ketones is more accurate and reliable than urine ketone testing.

Urine tests for ketones

The results of urine tests lag 2-4 hours behind actual blood values
Other substances in the urine (such as vitamin C or medicines like captopril- commonly used by people with diabetes) may interfere with the test, leading to inaccurate results

Blood tests for ketones

Tell you what your ketone levels are right now
Measure the most important type of ketone in the blood
Are not made inaccurate by common medicines or vitamins
Give you quantifiable results which means you can act with confidence

There is only blood glucose meter which can test also for blood ketones, Optium Xceed™ from Abbott Diabetes Care. Testing with this meter is as simple as blood glucose testing. You simply use a different kind of test strip.

What should you do if you do get ill?

Illness can make you particularly at risk of developing DKA. Here are some practical suggestions for you to follow if you are unwell.

Make a plan
Have a plan of what you will do when you are ill BEFORE it happens. Your healthcare professional will be able to help you, but even with a great plan you may still need their help, so keep their phone number handy.
Keep taking your diabetes treatment
It is ESSENTIAL that you keep taking your insulin and/or tablets. Missing your diabetes treatment can trigger the process which leads to ketosis.
Keep drinking
It is very important not to become dehydrated when you are ill, particularly if you are being sick or have diarrhoea. Take small quantities of fluids such as sugar-free drinks, tea or clear soup every 15-30 minutes.
Keep eating too
You must continue to eat when you are ill. Try taking normal meals if you can but if you don’t feel like eating try small meals and eat more frequently.

Soft foods and liquids are often the easiest to eat when you feel unwell. Foods you could try include:
- A bowl of soup
- A glass of fruit juice
- A small bowl of ice cream
- A glass of milk or mug of milky drink
- A small carton of ordinary fruit yoghurt
- A small bowl of jelly
During the day, try to eat one portion of these foods each hour.

If you are being sick and can’t keep anything down take regular sips of sugary drinks such as Lucozade® , 7up or fruit juices (not diet variety drinks).
Measure your blood glucose regularly
To find out what to do with your blood glucose results, follow the guidelines on the following pages.

How to use your test results

Blood glucose test results
Before testing for ketones test your blood glucose. The results will help you to decide what to do next.

Blood glucose level	Level before meals or when you haven’t eaten	What you should do
Normal	4.0–7.0 mmol/L	No need to do anything. Carry on with your usual blood glucose testing.
A little bit high	7.0–10.0 mmol/L	Carry on with your usual blood glucose testing. Contact your diabetes care team to have your treatment checked if your levels are often in this range before meals.
High	10.0–16.7 mmol/L	Carry on checking your blood glucose every 2–4 hours until it is below 10 mmol/L. If it goes on rising, or if you feel ill, check your blood ketones and follow the advice below.
Very high	Over 16.7 mmol/L	Check your blood ketones and follow the advice below. Carry on checking your blood glucose every 2–4 hours until it is below 10 mmol/L.

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 0.6mmol/L are in the normal range. Follow your health professional’s advice before making any changes to your diabetes medication programme.
Between 0.6 and 1.5 mmol/L	Readings in this range with a blood glucose level higher than 16.7mmol/L, may indicate the development of a problem. Follow your healthcare professional’s instructions.
More than 1.5 mmol/L	Readings above 1.5mmol/L, with a blood glucose level higher than 16.7mmol/L, suggest you may be at risk of developing diabetic ketoacidosis (DKA).

Urine ketone test results

You may have been instructed by your diabetes team to test your urine for ketones using the special strip provided. Unlike blood testing, it is not easy to determine how much ketones are present because of the varying concentration of the urine. Therefore, any positive result indicates increased risk of a problem developing. Once ketones are detected in the urine, you should follow the sick day regime given to you by your diabetes team and contact the team if ketones remain.

Call your doctor or diabetes care team if you are worried