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Living Well with Diabetes (Series 5/6) – Blood Ketones and the Management of Diabetes

Carbohydrates are the primary fuel for the body to perform most of the bodily functions. If our diet does not contain enough carbohydrates to supply the body with glucose for energy, or if the body cannot use glucose properly, then stored fat in the liver is broken down. When this happens, ketones are produced.

Ketoacidosis refers to alarmingly high levels of ketones or a build up of acids in the blood. Ketones can poison the body and they usually spill over into the urine when the body is short of insulin. It is a warning sign that your diabetes is out of control, or that you are getting sick. So sick, that it can lead to diabetic coma, or even death.

Rising blood glucose level and rising blood ketones can go together. When you don't have enough insulin in your blood, your body will begin to turn fat into ketones to be used as fuel instead. This is not good news for people with diabetes because without insulin, your body goes on and on making ketones and the levels can get dangerously high. This is when Diabetic Ketoacidosis occurs.

Diabetic ketoacidosis, or DKA in short – is one of the two medical ‘emergencies' risks faced by people with diabetes (the other being hypoglycemia). People with Type I insulin-dependent diabetes are particularly at risk of DKA, although those with adult-onset Type II diabetes are also at risk.

There are three occasions when you are most susceptible to DKA

• If your diabetes has recently been diagnosed or your medication has been changed. If you have Type I diabetes, you probably had raised ketone levels when you were first diagnosed. In fact, you may even have had ketoacidosis. Then, once your diabetes has been diagnosed, or when you change your treatment, establishing the right insulin dose can take time. This short period of time may see a risk of rising ketones.
• If you don't monitor your blood glucose regularly. With a host of occasions to eat and be merry, it is so easy to let your blood glucose levels creep up without the slightest intention. A special meal at a social function, a drink with friends – all these simple things can tip the balance. If you aren't monitoring your blood glucose regularly and your blood glucose levels stay high, ketoacidosis is a real risk.
• If you are ill. More glucose is produced as a result of the body's defense mechanism for fighting illness. When insulin supply is not sufficient to meet the extra demand, your body turns fat into fuel. This natural phenomenon produces ketones.

Treatment for ketoacidosis usually takes place in the hospital. However, if you equip yourself with vital information by learning the warning signs, and more importantly - by checking your ketones levels, you can go a long way to prevent your diabetes from progressing into DKA.

In the past, those with diabetes who admitted themselves for treatment in a hospital were mostly instructed to check their urine ketone. Urine ketone testing is done with a 'dip stick', based on a chemical reaction with acetoacetate. This method is problematic because the tests cannot tell how high the ketone level is. It merely verifies the existence of ketones. In addition, a urine ketone test cannot detect β-hydroxybutyrate – the most common ketone. And, as you become dehydrated, urine samples can be difficult to obtain.

Measuring ketones in the blood has several potential advantages:

• The test strips measure Β-hydroxybutyrate, the main ketone present during episodes of ketoacidosis.
• It tells you your ketone levels almost immediately.
• You can tell when your levels are getting better, or becoming worse.

Owners of Optium^TM and Optium Xceed^TM blood glucose meter can, in addtion to their blood glucose, also measure their blood ketone levels using a separate test strip called an Optium Ketone Blood B-Ketone test strip. The test requires only a small drop of blood and takes just 10 seconds.

While there is no need to monitor regularly for ketones, there are some occasions when a test might provide an early warning of rising levels.

• If you have Type I diabetes, your blood glucose is over 16.7mmol/L and you feel unwell.
• To tell the difference between simple raised blood glucose – which could have many different causes, one of which is ketoacidosis.
• If you experience symptoms of ketoacidosis.

If the test results show a trace of ketones, you need to drink plenty of water, avoid exercise, and test yourself for ketones every 4 hours. If there is no improvement, consult your doctor immediately.

When is it recommended to test?

During acute illness

• During acute illness, infection or fever
• Test for ketones every 2-4 hours until better

Whenever symptoms of DKA are present

• Nausea
• Vomiting or diarrhoea
• Abdominal pain
• Fruity breath odour
• Rapid breathing
• Thirst and frequent urination
• Fatigue or lethargy

When blood glucose remains elevated

What does my blood Β-Ketone result mean?

Below 0.6 mmol/L
Readings below 0.6 are in the normal range.

0.6 to 1.5 mmol/L
Readings between 0.6 and 1.5 may indicate the development of a problem that may require medical assistance. Follow your healthcare provider's instructions.

1.6 to 3.0 mmol/L
Readings above 1.5 indicate you may be at risk of developing diabetic ketoacidosis or DKA. Contact your healthcare provider immediately for advice.

This article is intended for reference and information purposes only. Please consult your doctor for more information on diabetes mellitus and interpretation of blood glucose results.

This article is the fifth in a series of six.

Missed out on LIVING WELL WITH DIABETES series? Visit our Diabetes Care's section. More »

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