How to Test Your Blood With a Home Ketone Meter

Instructions and Tips for Home Blood Ketone Testing With a Meter

Woman checking blood with a meter
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Blood ketone testing is used by people with diabetes and by people on a ketogenic diet. You can test your urine or your blood for ketones. But because urine testing is not as accurate, the American Diabetes Association recommends blood ketone testing with a ketone meter as the preferable method.

If you have diabetes, you should discuss home blood ketone testing with your doctor to learn whether it is recommended in your case and when you should perform the testing.

 Ketone testing is particularly important during periods of illness.

Blood Ketone Meters for Testing at Home

You will need a blood ketone meter and a kit that include the lancet pen and ketone test strips. These meters also will read blood glucose test strips, and both will download their results to your computer. Other brands and models may be available, including:

  • Precision Xtra: This meter from Abbott Diabetes Care can store up to 450 measurements and will display your blood glucose averages over different time periods. You need to enter a code to switch from glucose testing to ketone testing. Users seem happier with the Precision brand, and researchers find it to be the more accurate. The strips require 1.5 microliters of blood. It also features a backlit display.
  • Nova Max Plus: This meter from Nova Biomedical is often provided free with the purchase of two boxes of test strips. You don't have to enter a code to switch it from blood glucose to ketone testing; it does that automatically when you insert a ketone test strip. If you are using it primarily for blood glucose, it will remind you to test for ketones if your blood sugar level is 250 mg/dL or higher. The test strips for the Nova Max are less expensive but also flimsier and give more error messages, requiring retesting. The strips require less blood than the Precision strips, only 0.3 microliters.

    Ketone Test Strips

    You must purchase ketone test strips as glucose test strips won't test for ketones. You will also need to use blood from your fingertip rather from an alternate site. The strips can be the expensive part of testing, especially if they are not covered by your insurance.

    Follow these tips and precautions when purchasing test strips:

    • Be sure to get the correct test strips for the correct meter (they are not interchangeable).
    • Pay attention to expiration dates on the strips, both when you receive your purchase and when you test your blood. Expired strips will not give accurate results.
    • The FDA warns against buying previously-owned test strips, as you might see on eBay. While it may be legal, you risk getting a product that hasn't been properly stored and could be expired.
    • The FDA warns against purchasing strips that have not been cleared by the FDA for sale in the United States.

    How to Test Your Blood for Ketones

    1. Load a needle into the lancet pen according to package directions.
    2. Wash your hands with soap and dry them well.
    3. Remove a test strip from the packaging and insert it into the meter.
    4. Place the lancet pen on the side of your fingertip and push the button.
    5. Gently squeeze your finger to get a drop of blood. You will need a large drop to load the strip properly. After you do it two or three times, you'll get a sense of how much blood you need. With the Precision meter, you need a bigger drop of blood than when you are testing blood glucose (even using the same meter).
    6. Touch the end of the test strip to the drop of blood until it fills the little opening and the meter registers.
    1. Wait for the meter to give you a reading (just a few seconds).
    2. Record your results.

    Ketone Testing in Diabetes

    People with diabetes test for ketones to look for signs of ketoacidosis. Studies have found that blood ketone monitoring is effective in decreasing emergency room visits and hospitalizations. It also improves the time to recovery in people who develop diabetic ketoacidosis. If you have diabetes, you should test for ketones when:

    • Your blood sugar is over 250.
    • You are feeling ill.
    • You have signs of dehydration.
    • Increased blood ketones can be a sign that your blood sugar dropped too low overnight.

      Learn how to read your blood ketone results and discuss with your doctor at what level you need to call her, which will depend on individual factors. These are general guidelines:

      • A level of 0.6 mmol/L up to 1.0 mmol/L is considered normal for most people with diabetes.
      • A level between 1.0 and 1.5 mmol/L is usually considered the point at which you call your doctor.
      • A level between 1.5 and 3.0 mmol/L indicates a risk for ketoacidosis. You should call your doctor immediately.
      • A level over 3.0 mmol/L is a medical emergency. You need to go to the emergency room or call 911.

      Ketone Testing for Ketogenic Diets

      If you have normal blood glucose, your blood ketones may be the highest in the morning after your overnight fast. However, many people report that their ketones rise over the course of the day. If you want to track your blood ketones day-to-day, picking one time of day and sticking with it will give you the best comparison. Some factors besides the overall diet which may cause fluctuations include exercise and consuming fats with medium-chain triglycerides, such as coconut oil or MCT oil. And, of course, eating something (usually high in carbs) that knocks you out of ketosis will cause your ketone level to plummet.

      How to Interpret the Results for Ketogenic Diets

      If you are new to ketogenic diets and have a goal of nutritional ketosis (often defined as between 0.5 and 3 mmol/L), know that it can take two to four weeks to get consistently into this range. It often takes a fair amount of tweaking to figure out what you can and can't eat, even for people who are low-carb veterans.

      The ketone meter was developed to alert people with insulin-dependent diabetes to the signs of dangerous diabetic ketoacidosis. However, if you do not have diabetes and are on a ketogenic diet, you are using it for a different reason entirely. In this case, high ketones are not a sign of high blood glucose, are not caused by protein breakdown, and are not toxic. For detailed information about nutritional ketosis, check out the books by Jeff Volek and Stephen Phinney: "The Art and Science of Low Carbohydrate Living" and  "The Art and Science of Low Carbohydrate Performance."

      A Word From Verywell

      If you have diabetes, taking your blood ketone levels can lower your risk of hospitalization and complications of diabetes such as ketoacidosis. Discuss home ketone testing with your doctor. If you don't have diabetes, you may not be familiar with using fingerstick home blood testing and you will need to learn how to do it correctly. When buying an FDA-approved ketone meter, it comes down to individual choice and which you find easiest to use. Always follow the directions scrupulously and repeat the test if you think you have made an error, as it will affect the results.

      Sources:

      Klocker A, Phelan J, Twigg S, Craig M. Blood β-Hydroxybutyrate vs. Urine Acetoacetate Testing for the Prevention and Management of Ketoacidosis in Type 1 Diabetes: A Systematic Review. Diabetic Medicine. 2013. 30(7):818-24.

      Misra S, Oliver N. Utility of Ketone Measurement in the Prevention, Diagnosis and Management of Diabetic Ketoacidosis. Diabetic Medicine. 2015. 32(1):14-23.

      Paoli, A et al. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition. May 2014; Epub ahead of print. doi:10.1038/ejcn.2013.116

      Volek JS, Phinney SD, Kossoff E, Eberstein JA, Moore J. The Art and Science of Low Carbohydrate Living: an Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable. Lexington, KY: Beyond Obesity; 2011.

      Volek JS, Phinney S. The Art and Science of Low Carbohydrate Performance. Lexington, KY. Beyond Obesity LLC. 2012.

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