DKA & Ketones

Urine Ketones 101

NOTE. Since many things can cause ketones to register in urine, including following a low-carbohydrate diet, please note that the information on this page is intended as a guideline specifically for persons with diabetes testing for ketones as a means of detecting diabetic ketoacidosis (DKA). For those who have diabetes, ketones should not be ignored. Those on ketogenic low-carbohydrate diets or very low-calorie diets may show urine ketones that some refer to as “Benign Dietary Ketoacidosis.”

If your blood sugar is too high, or has been ever moderately high for more than a day, you could be producing ketones.  Ketones are a sign that your body is having a hard time and your diabetes is not under control.  You may need to help of a medical professional to help you avoid — or get safely out of a potential deadly state called “diabetic ketoacidosis”  (DKA).

A ketone urine test can be performed to measure either the absence or presence of ketones in the urine to detect for DKA.  The test is simple, painless, and can be done in the privacy of your own home — and you get results in seconds.

What are Ketones?

Ketones are formed when your body uses fat for energy; they are a byproduct of rapidly burned fat (or excessive fat burning) and in the case of diabetes, along with hyperglycemia, can build up in the bloodstream to dangerous levels if not corrected. Urine ketones may also be referred to as acetone, acetoacetic acid, and beta-hydroxybutyric acid.

Web MD‘s definition of Ketones:   When fat is broken down for energy, the body produces by-products called ketones (or ketone bodies) and releases them into the urine. Large amounts of ketones in the urine may signal a dangerous condition known as diabetic ketoacidosis. A diet low in sugars and starches (carbohydrates), starvation, or prolonged vomiting may also cause ketones in the urine.

From NHS Direct:  If you are diabetic and you fail to have your injections o. insulin for a prolonged period, you can experience ketoacidosis. The lack of insulin means that your body cannot use glucoseto create energy and ketosis occurs. If left untreated, your body will release so many ketones into your blood that your blood will quickly become dangerously acidic. Untreated diabetic ketoacidosis can lead to coma and death.

What things can produce ketones?

Several things can contribute to the presence of ketones in urine, including:

  • Metabolic disorders, including diabetes or glycogen storage disease
  • Abnormal nutritional conditions, like starvation, fasting, anorexia, bulimia, high protein/low carbohydrate diets, and very low-calorie diets (VLCDs)
  • Protracted vomiting, including hyperemesis gravidarum and cyclic vomiting syndrome (CVS)
  • Disorders of increased metabolism, including hyperthyroidism, fever, acute or severe illness, burns, pregnancy, lactation or post-surgical condition
  • Alcoholism, and
  • Glucocorticoid drugs appear to produce ketones but only give a false positive reading.

Why do ketones form?

Glucose, the simplest form of sugar, is what your body normally uses for energy. Food and drink, especially those containing carbohydrates (fat and protein, to a lesser extent, can also provide energy) is converted by the body into this useable form of energy (glucose).

In order to move glucose from the bloodstream into cells, insulin is required. If not enough insulin is present (or, if a person is resistant to insulin as in the case of some with type 2 diabetes and other metabolic disorders) glucose does not move into the cells and can build up in the bloodstream. Without insulin, two can things happen:

  • hyperglycemia (high blood sugar)
  • cells, organs, tissues, and the brain begin to starve and look for an alternative source of energy (fat stores)

When the body senses cells are not being fed it will turn to fat stores and lean muscle mass as a source of energy. This happens mainly when a person does not eat enough or there is not enough insulin is in the blood stream. People often experience weight loss with type 1 diabetes when blood glucose is too high, especially when they are first diagnosed, and may have very high levels of ketones in their urine.

Using fat for energy causes your body to make even more glucose. This is in addition to the glucose already circulating in the bloodstream that is unable to center cells because there is not enough insulin. Blood glucose levels rise higher, more fat is burned as the body starves, and more ketones are produced by the burning of fat.

The kidneys try to cleanse the bloodstream by excreting blood glucose and ketones through the process of urination. This is why people with high blood glucose levels have to urinate frequently. But the kidneys become overworked and can no longer keep with the demand and ketones and glucose levels can build up enough to cause organ damage, coma, and even death. To make matters even worse, the constant urinating can dehydrate a person with diabetes which concentrates glucose and ketones making their effects even more damaging.

Having ketones in your blood or urine causes fruity smelling breath. This odor is sometimes mistaken for alcohol. (When my daughter Elizabeth was first diagnosed at age 4, I recall her breath smelled sweet, like corn, all the time..

Where can I buy urine ketone test strips? Do I need a prescription?

Ketone test strips should be covered by most insurance plans that cover other diabetes supplies, but your doctor needs to write a prescription for them.

You can purchase ketone test strips over the counter at any pharmacy without a prescription. They usually cost less than $10.00 for a bottle of 50 strips.

How should I store urine keytone test strips?

Once the vial is opened the bottle of ketone test strips is only good for another 30 days. The expiration date may indicate much longer but ketone strips should be thrown away 30 days after opening.

When you open the bottle, mark the date to help you remember when they were opened. Chances are, if your diabetes is under control you won’t be using them very often.

Your doctor can also prescribe ketone test strips that are individually wrapped and sealed. They are more expensive but you don’t have to worry about throwing away unused strips after only 30 days.

Do not store ketone strips in bathrooms where you bathe or shower. While this may seem convenient the strips are sensitive to changes in humidity and temperature. Instead, store them in a cool, dark place (not the refrigerator) like a closet, or powder room.