Diabetes ketone monitoring

What are ketones?

Ketones are made when your body begins using fat instead of carbohydrates for energy. When there is not enough insulin to get glucose (sugar) from the blood into the cells, the body will turn to fat for energy. When fat is broken down, ketones are made which can accumulate in the body. High levels of ketones are toxic to the body. The build-up of ketones in the blood is called ketoacidosis. The body will try to get rid of these ketones by spilling them into the urine.

Do I need to monitor for ketones?

You should monitor for ketones if you have type 1 diabetes.

When should I test for ketones?

You should monitor for ketones when:

your blood glucose level is 14 mmol/L or more; or
you have an illness (cold, flu), infection, or injury and your blood glucose level is 14 mmol/L or more.

How do I test for ketones?

A urine test is one way to test for ketones. Urine ketone testing strips are available for a small fee through the Diabetes Control Program. Another way to test for ketones is with a blood glucose meter which test for ketones in the blood.

To obtain good results, follow package instructions carefully. Record your results in a log book with the date and time.

What do the results mean?

The acceptable range for urine ketones is negative or trace. If you find ketones (small, moderate or large) in the urine and have high blood glucose levels on two or more occasions, contact your family physician / nurse practitioner.

The acceptable range for blood ketones is less than 0.6 mmol/L.

Blood ketone	What to do?
0.6 – 1.5 mmol/L	Recheck blood glucose and ketones in 2-4 hours.
1.5 – 3.0 mmol/L	May be at risk for developing ketoacidosis.
More than 3.0 mmol/L	Requires immediate emergency medical treatment. See your family physician / nurse practitioner or go to the nearest emergency department.

What are the signs and symptoms of ketoacidosis?

Signs and symptoms of diabetic ketoacidosis include:

blood glucose levels persistently greater than 14.0 mmol/L;
ketones in urine and/or blood (most of the time);
weakness, fatigue and weight-loss;
dry mouth, excessive thirst and urination;
flushed and dry skin;
blurred vision;
nausea and vomiting;
abdominal pain;
fast pulse;
rapid deep breathing;
a fruity smell to breath (like an over-ripe banana or Juicy Fruit gum); and
drowsiness and unconsciousness.

How can I prevent ketoacidosis?

To help prevent ketoacidosis, you should:

always take your insulin as prescribed;
follow your meal plan; and
exercise regularly.

Remember: If you are sick or under stress, your insulin dosage many need to be changed. Talk to your family physician / nurse practitioner or diabetes health care team.

What should I do if I have ketoacidosis?

Ketoacidosis is treated with insulin and fluids. If the condition is not treated in the early stages of detection, hospitalization may be required. Contact your family physician / nurse practitioner or go to the nearest emergency department if:

your blood glucose levels are persistently greater than 14.0 mmol/L for more than 1 day;
you find blood ketones between 1.5 and 3.0 mmol/L and have high blood glucose levels on 1 occasion; or
you find urine ketones (moderate or large) and have high blood glucose levels on 2 or more occasions.