Ketones (pronounced key-tones) are produced by the liver. They occur when the body breaks down fat for energy instead of getting energy from the carbohydrates found in your diet. If your diet does not contain enough carbohydrates to supply the body with sugar(glucose) for energy or if your body cannot use blood sugar (glucose) properly, stored fat is broken down and ketones are made.
Why do we care about ketones when we have type 1 diabetes?
People with type 1 diabetes need to worry about ketones because they make the blood acidic. As the acid in the blood builds up it can quickly lead to a life-threatening condition called ketoacidosis or DKA.
What are the symptoms of diabetic ketoacidosis (DKA)?
The symptoms of DKA include:
- Dry mouth
- Feeling thirsty
- Frequent need to urinate
- Extreme fatigue
- Flushed skin
- Fruity breath
- Labored breathing
- Stomach pains
The most severe symptoms of diabetic ketoacidosis are loss of consciousness, diabetic coma, and death.
How do I check for ketones?
The two main ways to check for ketones are through urine or blood. You can purchase sticks from your pharmacy that can be peed on or dipped in urine. They will change colour and give you a historic indicator of ketones in your body. This method is preferred by some because of its low cost.
The more immediate and reliable way to check is with a blood ketone meter. Just like using a glucometer, you apply blood to the ketone test strips and it will provide a blood ketone reading. This reading will tell you if you have ketones in your system at that moment. Test strips for a blood ketone meter are around a dollar each versus the few cents to purchase Ketostix®.
When should I check for ketones?
You should check
- any time your blood glucose level is over 17 mmol (300 mg/dL)
- Any time your blood glucose level has been over 13mmol (234mg/dL) for an extended period
- When you are ill
- If you have experienced a pump failure
- You are vomiting
- You are showing any of the above-mentioned symptoms
- At times indicated by your clinic and/or their sick day protocol
What causes ketones?
They can occur when your blood glucose levels are high for an extended period of time. This could be because
- You forgot to take your insulin
- You didn’t take as much insulin as prescribed or as needed
- Your insulin pump failed
- You are sick or have an infection
- You are on a carb restrictive diet
What do the readings mean?
Trace amounts of ketones may occur after fasting, when following a ketogenic diet, or even upon waking up. If these levels increase or are over 3mmol, you should consult your doctor.
What to do if I have ketones?
As mentioned, ketones can be very dangerous for a person with type 1 diabetes. It is important to begin to flush them out of your system with large amounts of water. You also want to bring down your blood sugar levels with insulin. The amounts required to do this will vary. You should always contact your doctor if you are spilling ketones and unsure what to do.
If you are vomiting or the ketones have persisted for a period of hours, contact your doctor or head straight to the nearest emergency room. Diabetic Ketoacidosis can escalate to a dangerous level very quickly. IV fluids may be required to help you get things back under control.
Stay prepared by keeping a copy of our chart handy.