All About Ketones and Diabetes

Urine Testing
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Definition: Ketones are organic compounds that result when body fat is broken down for energy.

When Do Ketones Occur in the Body?

Glucose is usually used by cells for energy. But, when there's no insulin to help transport it out of the blood and into the cells, the body has an "energy crisis" and starts to break down body fat into ketones as an alternative fuel source. High levels of ketones in the body can be toxic.

High blood glucose levels (over 250 mg/dl) are one sign that the body may have high levels of ketones circulating in the blood. This can progress to a serious complication called diabetic ketoacidosis. Ketoacidosis can occur in anyone with diabetes, but occurs more commonly in people with Type 1 diabetes. According to the American Diabetes Association, ketoacidosis can occur when:

  1. Your body does not have enough insulin either because you did not inject enough or you may need more than usual because you are sick.
  2. You are sick and are unable to eat enough food.
  3. Your blood sugar drops too low while you are sleeping and results in high levels of ketones in the morning. 

For more information on ketoacidosis go to: Diabetes and Diabetic Ketoacidosis

When Should You Check for Ketones? 

Some experts recommend that you check for ketones when your blood sugar is repeatedly over 240 mg/dl for no apparent reason, while other sources say to check when you blood sugar is above 300 mg/dL.

Ask your health care provider what's best for you. Another time to test for ketones would be if your blood sugar is high (250-300 mg/dL or more) and you are feeling ill (for instance, with cold or flu symptoms, nausea, vomiting, or excessive tiredness). 

How do You Check for Ketones? 

Testing the urine is one way to check for ketones.

Most pharmacies carry ketone strips or you can ask your physician to get you a prescription. Some blood glucose meters also check for ketones. 

Are There Different Levels of Ketones? 

Yes. Depending upon how long your body has been using fat for fuel you may have trace, small or moderate to high levels of ketones in your urine. If your results are trace or small this can mean that ketone buildup is starting and you can retest in a few hours. However, moderate or large amounts of ketones is dangerous and should result in a phone call to health care provider right away. If you are ever uncertain of what to do in the event of ketones, call you doctor immediately. Depending on the severity of the ketones and how you are feeling you maybe instructed to hydrate and take more insulin or be told to go to the emergency room.

For More Information on When High Blood Sugar Can Be an Emergency: 

Hyper and Hypoglycemia Emergencies in Diabetes


American Diabetes Association.DKA (Ketoacidosis) and Ketones. Accessed on-line. October 22, 2015:

American Diabetes Association. Checking for Ketones. Accessed on-line. October 22, 2015:

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