Diabetes
and Ketones
The presence
of ketones in the bloodstream is a common complication
of diabetes, which if left untreated can lead to ketoacidosis.
If you are looking for medical advice, think you may
have ketones, or would like ketone testing please
contact your GP or diabetes healthcare team as soon
as possible.
Ketones –
advice for people with diabetes
- Ketones are acids which appear
in your blood and urine when there is not enough
insulin in your body.
- They can make you very ill
very quickly (this is called ketoacidosis)
- You can test for ketones in
urine with test strips (Ketostix) or in blood if
you have the medisense Optium meter
- Moderate or large amounts of
ketones in the urine, or above 1.5 mmol/L in blood
usually means more insulin is needed.
When to check for ketones?
- You should check for ketones
if you have a higher blood sugar than usual, or
if you are:
Feverish
Very thirsty Vomiting
Passing too much urine Having
abdominal pain
What to do if ketones are present
- Test blood sugar 4 times each
day.
- Test for ketones every time
urine is passed.
- Give extra insulin (see guide
above).
- ALWAYS contact your doctor
if the urine ketone tests stay positive or you start
vomiting.
What exactly are ketones, and what do they
have to do with diabetes?
Ketones
are an acid remaining when the body burns its own
fat. When the body cannot get enough glucose from
the blood to use as energy (in the case of type 2
diabetics it may receive very little glucose, in type
1 cases it will receive none), it will begin to burn
fat. When the body is burning too much fat, it may
cause ketones to become present in the bloodstream.
So,
my body can’t get enough sugar. Why is this
a problem?
Sugar
is the primary fuel that the body uses for energy.
Insulin, a hormone produced in the pancreas that metabolises
blood sugar, is either deficient or non-existent in
the blood of diabetes patients. If the body cannot
burn sugar, it will burn stored fat, and ketone build
up will begin. When ketone levels become too high,
the risk of ketoacidosis is raised, and this emergency
condition can lead to coma and even death in serious
cases.
I am type 2 diabetic, should I be tested for
ketones?
All
people with type 1 diabetes should be tested for ketones,
and although type 2 diabetics are less likely to suffer
the complications caused by ketones, it is essential
to know what the symptoms are, and when you should
test. Finding ketones present in your urine is a sign
that the management of your disease needs adjusting.
Ketone testing should also be a matter of course for
pregnant diabetics and women who develop gestational
diabetes.
When
should I test for ketones, and how will this affect
the management of my diabetes?
Your
GP or healthcare team will be able to inform you of
the best possible time for you personally to test
for ketones. However, it is generally understood that
testing should take place when fasting (i.e: when
food has not been consumed for eight hours or more)
and any of the following occurs:
Blood
sugar is on or above 250 mg/dl for two consecutive
tests
When any illness occurs (as even the most minor can
cause ketones)
If you vomit or suffer from diarrhoea
You suffer from depression or stress
You fall pregnant
The
test will not interfere with the management of you
diabetes.
How
does ketone testing work?
The
ketone test is simple and involves a dip and read
urine test strip. If the colour changes, there are
ketones in your urine. Ketone test strips are available
over the counter in some chemists.
I
am diabetic and my ketone test is positive, what should
I do?
Contact
your healthcare team, and explain the situation to
them. Should the tests show very small amounts of
ketones take the following actions: Drink water every
hour, and continue testing every three hours. Do not
exercise. If your ketone levels do not fall after
two tests contact your healthcare team. If the test
shows moderate or high ketone numbers then telephone
your doctor at once, and drink water.
I
think I might have ketoacidosis, how would I know?
If
you are suffering from DKA (diabetic ketoacidosis)
then early signs would be likely to include: stomach
pains, nausea and/or vomiting, breathlessness, breath
that smells of fruit. In this instance, call your
doctor as soon as possible. Ketoacidosis is an extremely
severe condition.
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