4. FALSE. Ketones can be measured either by using a urine dipstick (such as Ketostix or Acetest) or by testing a drop of blood using a handheld meter. Both the Abbott Precision Xtra and the Nova Biomedical Nova Max Plus blood glucose meters are also capable of testing blood ketones using special strips. Urine dipsticks change color in the presence of acetoacetic acid and, to a lesser degree, acetone; the level of ketones is then assessed by comparing the color of the stick to a color chart that comes with the stick. The blood test measures the level of beta-hydroxybutyric acid. Since beta-hydroxybutyric acid is the type of ketone that contributes the most to acidity in the blood, blood testing is preferred, especially for people with Type 1 diabetes. Blood testing also gives a more accurate depiction of the metabolic state of the body in real time; urine testing indicates the blood ketone levels approximately three hours previously.
5. A and C. In diabetic ketoacidosis, a lack of insulin leads to high levels of ketones and glucose in the bloodstream. Ketones make the blood more acid, and high blood glucose (not ketones) leads to excessive urination and dehydration. Excessive urination also causes depletion of electrolytes such as sodium, potassium, calcium, magnesium, and phosphorous. Excretion of ketones in the urine leads to further losses of electrolytes.
DKA is a life-threatening medical emergency that must be treated in the hospital.
6. FALSE. Although rare, people with Type 2 diabetes whose blood glucose levels are very high for a significant period can enter a state called glucose toxicity, which causes beta-cell function in the pancreas to cease temporarily. With no beta-cell function, no insulin is produced, creating a temporary state physiologically similar to Type 1 diabetes, and DKA can occur. In many instances, these people are misdiagnosed as having Type 1 diabetes when they arrive in the emergency room in DKA. Hispanic and African-American people with Type 2 diabetes are more prone to developing DKA than other racial and ethnic groups.
7. A, B, and D. Increasing the level of insulin in the body allows it to switch back from burning fat to burning primarily glucose. This halts the production of ketone bodies. As the body’s cells start using glucose for fuel again, the excess ketones are flushed into the urine. Increasing fluid intake accelerates their elimination from the body by increasing urination. High levels of ketones usually result from insufficient insulin, which is commonly caused by increased insulin requirements (because of illness, for example) or therapy errors (missing doses or insulin pump malfunctions).
Glucagon is used to treat low blood glucose (hypoglycemia) by causing the liver to release stored glucose. It does not lower ketones.