Diabetes Self-Management Articles

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Getting to Know Ketones

by Richard M. Weil, MEd, CDE

The Precision Xtra blood glucose meter can measure ketones in your blood with special strips that take a fingerstick blood sample, just like the procedure for blood glucose monitoring. (Click here for information about both urine and blood ketone strips.) The device has been carefully tested in studies and is very accurate. Blood testing for ketones is superior to urine testing because it measures beta-hydroxybutyric acid, the primary ketone that’s formed in diabetic ketoacidosis, while urine testing measures acetoacetic acid. Urine testing can lead to a false negative result (which means it might show negative ketones when in fact you do have ketones), and there is a time delay to diagnosis of ketosis with urine testing since it takes some time for ketones to get from the blood to the urine. Another possible advantage to blood ketone testing is convenience. In a recent study of teenagers with Type 1 diabetes, teens preferred and were more likely to test their blood for ketones than they were to test their urine.

Here’s what the results mean when testing blood for ketones:

  • Greater than 3.0 millimoles per liter (mmol/liter) is a serious metabolic condition and emergency medical care is necessary.
  • 1.6–3.0 mmol/liter is a high level of ketones and means you are at risk for diabetic ketoacidosis. Your doctor or diabetes educator should be contacted immediately.
  • 0.6–1.5 mmol/liter is a moderate level of ketones and probably indicates fat metabolism and weight loss, but not a deficiency of insulin. You should speak with your doctor or diabetes educator about what to do when ketones are in this range.
  • Below 0.6 mmol/liter is a normal blood level of ketones.

Ketogenic diets
While low-carbohydrate diets are usually discussed as tools for weight loss, that is not their only role. So-called ketogenic diets (diets that intentionally cause ketosis) have been used to treat epileptic seizures in children since the 1920’s. The diets, which do not work in adults, are high in fat, low in protein, and virtually carbohydrate-free. The precise mechanism of how ketones work to prevent epilepsy is unknown, but for some children with difficult cases of epilepsy that do not fully respond to medication, the ketogenic diet is another treatment option. There are several centers in the United States that provide the diet. You can find out more at the following Web site:

Ketogenic diets are also being tested for treatment of Parkinson disease. Some evidence suggests that ketones in the brain may help resolve some of the symptoms that people with Parkinson disease experience. Like epilepsy, the mechanism of action has not been discovered, and much more work needs to be done in this area.

Another piece of the puzzle
Understanding how your body works — and why it sometimes breaks down — puts you in the driver’s seat when it comes to your health and diabetes care. Knowing about ketones is vital mainly for people with Type 1 diabetes, but it doesn’t hurt for anyone to know what these substances are and what they can and can’t do for you.

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Also in this article:
Ketone Strips



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