Many people with diabetes know or have heard about testing their ketone levels. High ketone levels are very dangerous and can potentially lead to a life-threatening condition called diabetes ketoacidosis in people with Type 1 and in some people with Type 2 diabetes. In pregnancy, ketones cross the placenta and can affect the baby. (1) This blog will help explain some of the information regarding diabetes and ketones. 

what you need to know about diabetes ketoacidosisWhat are ketones? Ketones or ketone bodies are produced as an end product of fat metabolism when calories from carbohydrates are not available for use as energy.  In diabetes, ketone levels may be important for 2 different reasons:

1. Weight Loss or not enough carbohydrates in Pregnancy. During pregnancy when the blood glucose levels are normal but the woman is not eating enough carbohydrates, fat will be used for energy and ketones are formed. The Academy of Nutrition and Dietetics (formerly called The American Dietetic Association) recommends women with gestational diabetes test ketones who have insufficient calorie and or carbohydrate intake and/or weight loss. This advice is based on conclusions of two studies regarding ketonemia (ketones in plasma) and ketonuria (ketones in urine) during diabetic pregnancy and poor metabolic control which report a positive association with a lower IQ in the children of the pregnancy.  The Academy of Nutrition and Dietetics also states that not all healthcare professionals recognize the value of ketone testing. (2)

The National Diabetes Education Clearinghouse suggests women with gestational diabetes test urine or blood ketones in the morning (before eating). If ketones are found at high levels, alert your medical team/dietitian as they may adjust the types of food in your meal or the times you eat. (3) offers a video called Monitoring your Blood Glucose, Ketones and your Health. A demonstration of testing urine ketones can be found in this video.

2. Insufficient Insulin. Ketones are also formed when there is not enough insulin available in the blood to stimulate the entry of glucose into the cells that need it for energy. This can happen in type 1 diabetes and in some people with type 2 diabetes. In this situation, blood glucose is elevated (high) and fat is broken down to be used as energy. As mentioned before, an end product of fat metabolism is ketones. This can lead to a very dangerous situation called diabetes ketoacidosis. If unchecked, this condition can be life threatening. (4) 

The California Diabetes and Pregnancy Program (Sweet Success), suggests measuring ketones in pregnant women with all types of diabetes if ill or if she has persistent hyperglycemia over 200 mg/dl. The health care provider should also be contacted for advice at this time. (5) 

Men and women with type 1 or type 2 diabetes need to have instruction on when to test ketone levels from their health care providers. Information from The National Diabetes information Clearinghouse recommends that ketone testing may be necessary if blood glucose is over 240 mg/dl or if you are sick. This is to alert you to possible diabetic ketoacidosis. Since this condition can cause death if untreated, it is very serious. (6)

The Mayo Clinic warns that diabetes ketoacidosis can come on very quickly, even within 24 hours. Besides high blood glucose and ketones, other symptoms may include, extreme thirst and frequent urination, nausea and/or vomiting, fatigue, a sweet or fruity smelling breath, shortness of breath and confusion. (7)

Due to the serious nature of diabetes ketoacidosis (DKA) it is advised that treatment takes place in the intensive care unit of a hospital. The medical staff needs to take care of problems of fluid loss, hyperglycemia, blood electrolyte disturbances, correction of acid-base metabolism and possible infection. (8) 

Make sure you understand from your health care team what steps to take if you have diabetes, your blood glucose levels are high, and ketones are potentially present. Make sure you know when to call your physician, call for emergency help, or go to the hospital. When calling for assistance, it is helpful to know your blood glucose values, your ketone levels and related symptoms if you are sick. In patients using an insulin pump, when no instructions are provided on what to do when the pump fails or if proper supplies to handle this emergency are not available, ketoacidosis may develop rapidly. A diabetes educator or physician can provide proper instruction on what to do in individual situations.

Read more information available on about Diabetes Ketoacidosis.  

Additional information is available about Diabetes Ketoacidosis on Medscape.