Ketone Testing

• What are Ketones?
• Why Would My Body Have Trouble Using Glucose?
• Who Should Test for Ketones?
• Ketone Testing in Gestational Diabetes
• When Should I Test for Ketones in My Urine?
• How Do I Test for Ketones in My Urine?
• What Do I Do if My Ketone Test Is Positive?

Ketone testing involves checking how many ketones, or acids are in your blood or urine. Testing for ketones gives an early warning of a medical emergency, called ketoacidosis, which can lead to coma or death.

Ketones are a type of acid that is left over when your body burns some of its own fat for fuel. Your body burns fat if it can't get enough glucose to use for energy. When your body burns too much fat too quickly, there may be ketones in your blood. Ketones pass from your bloodstream into your urine.

Glucose is the first fuel your body burns for energy. To help move glucose from your bloodstream into body cells for fuel, your body needs insulin. Insulin is a hormone that is made in the pancreas. If there is too little insulin in the bloodstream to help the glucose get into cells, the body looks for other kinds of fuel to burn. When the body burns stored fat, ketones begin to build up in the body. Too many ketones in the bloodstream can lead to a serious problem called ketoacidosis. Without proper treatment, this can lead to coma or death.

People with type 1 diabetes develop ketones more easily than people with type 2 diabetes. Everyone with type 1 diabetes should test for ketones in their urine or blood when their blood glucose levels are elevated. People with type 2 diabetes should test for ketones when they are ill or have very high blood glucose levels. Ketone testing, like blood glucose testing, is very important. Finding ketones in your urine when you are ill or have high blood glucose levels may be a sign of trouble, you should contact your doctor or health care team.

Women with gestational diabetes are often asked to test for ketones every morning. This is not to determine if they are developing DKA, but rather to see if they are eating enough to provide nutrition for the baby throught the night.

Your health care team will tell you when you should test for ketones. You should test if:

• Your blood glucose is 14 mmol/L (250 mg/dl) or higher for two tests in a row.
• You are sick (even with a cold) because being sick can cause you to have ketones.
• You are vomiting or have diarrhea.
• You are under stress or are upset.
• You are pregnant.

Testing your urine for ketones is very easy. You can use a simple dip-and-read urine test strip. The test strip is dipped into a sample of your urine. If the colour changes, there are ketones in your urine. You may want to try Ketostix® Reagent Strips, which are for testing only ketones in your urine. For testing your urine for both glucose and ketones, you may want to try Keto-Diastix® Reagent Strips.

You can get these strips at your drugstore. Ketone test strips are available in bottles and in individually foil-wrapped strips. They are sensitive to light and moisture, so it is a good idea to keep them stored in the container with the lid on tight. Always check the expiration date on the bottle and do not use strips that are outdated.

If the results show trace or small amounts of ketones:

1. Drink a glass of water every hour.
2. Test your blood glucose and ketones every three to four hours.
3. If your blood glucose is higher than 14 mmol/L and you have ketones, DO NOT exercise. Also, be sure to contact your health care team.
4. If your blood glucose and ketones numbers are NOT going down after two tests, call your health care team.

If the results show moderate or high ketones:

1. Call your doctor IMMEDIATELY.
2. Drink a glass of water every hour.

Ketoacidosis can quickly develop into a very serious problem. Be sure to contact your health care professional if tests stay high or if you have any of the early signs of diabetic ketoacidosis (DKA).

Early signs of DKA include:

• Pain in your stomach
• Nausea or vomiting
• Rapid breathing
• Fruity-smelling breath

If you have any of these symptoms and have ketones in your urine, call your health care professional or go to the emergency room.