Ketones
A ketone is byproduct of an alternative source of fuel for the body. Ketones are created as a result of fat breakdown and are the end-product of fat metabolism in the body.
 
Relative to diabetes, ketones are formed when the body is starving. The body struggles to find an alternative food source and ketones are formed. Ketones can also form as a result of extremely high or “out of control” sugars. Ketones can overpower the body, rise in the blood, and prove to be a nuisance or go on to become a life-threatening problem, known as DKA.  Staying in a tight range for blood sugar numbers and defining what’s “acceptable” for your loved one with their providers is key.
 
Ketone Complications
Ketones at a lower level can cause less life-threatening, but still significantly worrisome complications. These complications include risks for Urinary Tract Infection or UTI, Weight Loss and Failure to Thrive, Malnutrition, and Ketone presence on an ongoing basis can show the fact that sugars are often falling out of the ideal range.
 
Testing for Ketones:
  • Elevated Blood Sugar – If blood sugars are more than 240mg/dL, it is recommended to check for ketones. Ketones can be tested in a simple urine test strip.  Use our Provider Locator Search Bar to help find a provider who specializes in Diabetes in your area. These providers can help define parameters for testing for ketones, controlling blood sugar, and more!
  • Sickness – When Diabetic patients are ill, with a cold or flu or other viral illness, or have prolonged periods of not eating, urine should be checked every 4-6 hours for ketone bodies.
  • Positive urine dip for ketones should always generate a call to the provider managing the diabetes.
  • Patients with Type 1 Diabetes need to test more regularly and frequently for urinary ketones. It is imperative to have a trusted Local Provider and Diabetes Educator who can both help answer questions about blood sugar levels and ketones.
  • Be aware that weight loss inherently increases the baseline ketone level.

 

Ketone Levels
Urine Ketone Levels
Risk Level
Instructions
None/Negative
Normal
No action needed
Small to Moderate
Moderate
Call Local Provider for Goal Range, Advice, Testing Parameters
High
High!
Call Doctor or Diabetes Educator immediately! High risk for DKA!
Very High
Life Threatening!
Seek Emergency medical care immediately! Go to Emergency Room!
Diabetic Ketoacidosis (DKA)
Diabetic patients are vulnerable to Diabetic Ketoacidosis, or DKA. Diabetic patients begin burning fat after prolonged periods of fasting or extremely high, out of control sugars, and thus creating ketones. Ketoacids are also formed as a result. The increase in ketoacids makes the blood acidotic (a severe, life-threatening change in the pH of the blood) which requires emergency treatment to correct this imbalance. DKA can result in both coma and ultimately death.
 
Symptoms of DKA can have a sudden onset and it’s important to be aware of them. These symptoms include excessive thirst, abdominal pain, weakness and fatigue, shortness of breath, confusion, frequent urination, nausea and vomiting, and a distinct fruity-scented breath. Specific symptoms include significantly elevated blood sugars (hyperglycemia) and a high ketone level in your urine.
 
Call your Provider if your Diabetic loved one has vomiting or sickness that inhibits them from consuming normal foods, has a blood sugar that’s consistently “out of range” and not responding to treatment at home, and have ketones in their urine.
 
Seek Emergency Medical care if your loved one’s blood sugar is consistently higher than 300mg/dL, you have ketones in your urine and are unable to reach your Provider, or you have multiple of the above symptoms. DKA, left untreated, can be fatal.
 
Staying Home vs. Long term care
It’s often safe for a Diabetic family member to live at home. It’s imperative to understand blood sugar, ketones, and symptoms of DKA. When Diabetics stay at home under the care of a loved one they can have better glucose control, keep a good log of sugars, see patterns in high and low sugars, and keep sugars in a range that isn’t going to generate ketones.
 
Long Term Care Facilities often have a glucose target range of between 70 and 200 mg/dL of glucose. Given this wide range of sugars, ketones are generated at the high end of the spectrum.
 
When family members are home it is easier to have a tighter range, set and discussed with your Local Healthcare Provider, who you can find using our Provider Locator Tool, and check ketones more regularly.
Bottom Line
Know what a Ketone is. Know how it’s formed. Know what it means and when to test. Find a supportive team who can come around you to help you determine what is a safe range of blood sugars, when to check for Ketones, when to present to the office, and when you might need to go to the Emergency Room, or ER. Build a strong team of Educators, Providers, Counselors, and Support Staff using our Provider Locator Tool.
 
Being informed is one of the greatest gifts you can give your loved one and it’s vital to helping them stay home and stay safe.
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