Ketones and Diabetes

What do you know about ketones? These molecules come up often in diabetes discussions and sometimes cause serious problems. What are they and how do they matter to you?

Ketones are simple carbon compounds[1]. They are everywhere: in nature, in our bodies, and in industry. Ketones contribute to the scents of plants. Solvents such as acetones are a type of ketones. So are sugars like fructose and many others.

We need ketones, but too many of them can be dangerous. They are acidic and can make your blood too acidic. This is called “ketoacidosis” and is a life-threatening complication of Type 1 diabetes. It happens in Type 2 less often.

Our bodies create ketones when they break down fats for energy. This usually happens when there is not enough glucose to power our cells (like in starvation or a crash diet), or not enough insulin to get glucose into cells (like in diabetes). There can be a lot of glucose in the blood, but if it can’t get into cells, they need something else to survive. They use fats instead, the breakdown of which releases ketones into the blood.

Having ketones in the blood is called “ketosis.”[2] Ketosis is not necessarily bad. Some very-low-carb weight-loss diets are called “ketogenic,”[3] meaning they try to raise your ketone levels as an indication that the body is burning fat. Only when the levels get high enough to make the blood excessively acidic can ketones cause coma and death.

The high-ketone state called ketoacidosis[4] is a medical emergency. According to the American Diabetes Association (ADA), the key symptoms[5] are:

• Thirst or a very dry mouth
• Frequent urination
• High blood glucose levels
• High levels of ketones in the urine

Other symptoms include:

• Constantly feeling tired
• Dry or flushed skin
• Nausea, vomiting, or abdominal pain
• Difficulty breathing
• Fruity odor on breath
• A hard time paying attention, or confusion

The fruity smell is acetone. The confusion comes because the brain is not getting enough fuel. If you are having any of these symptoms, check your blood or urine for ketones. If you have them, or if you can’t check for them, call your doctor.

Checking your ketones
As noted above, ketones can be measured[6] in your blood or your urine. There are home tests for both of them. In a healthy person who is not dieting, a normal level would be 0. When a person with diabetes gets out of control, or when that person has an infection or injury, ketones levels may rise.

Urine tests are easier and cheaper. Test strips cost 10–20 cents each, compared to about $4 per strip for blood tests. Urine strips[7] have instructions on the box or vial that need careful following. You can place the strip in your urine stream, or pee in a clean cup and dip the stick in the urine. Then wait the set amount of time, often 15 seconds. The strip changes color if ketones are present, so have the color code on the jar in front of you. Disregard color changes after the set amount of time stated in the directions.

If you have visual problems in seeing the colors, get someone else to read the strip for you.

It’s important to use strips that are not expired. Expired strips aren’t accurate. Strips in a vial usually expire about six months after the package is opened, but check the box to get the exact dates. If you can find them, individually packaged test strips in foil cost more, but will last much longer than those in a vial.

What to do if you have ketones in your urine? Diabetes Self-Management wrote, “General treatment[8] guidelines for ketones include drinking plenty of water, taking insulin to bring down the blood glucose level, and rechecking for ketones, as well as checking blood glucose every three to four hours. If the ketone level does not go down, or if it goes up, go to the hospital — this constitutes a medical emergency.”

I would also consider taking a bitter melon[9] capsules or tea in this situation to get more glucose into the cells.

Even if you’re not feeling sick, the Diabetes Self-Management article continues, “Check for ketones if your blood glucose level is over 250 mg/dl (13.9 mmol/l) twice in a row, or even only once if you intend to exercise soon.” Don’t exercise with a high blood sugar and ketones.

The most important preventive steps are to get blood sugar down, hydrate as much as possible, and treat underlying causes of ketones such as infections or injuries.

  1. simple carbon compounds:
  2. “ketosis.”:
  3. “ketogenic,”:
  4. ketoacidosis:
  5. key symptoms:
  6. be measured:
  7. Urine strips:
  8. General treatment:
  9. bitter melon:

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David Spero: David Spero has been a nurse for 40 years and has lived with multiple sclerosis for 30 years. He is the author of four books: The Art of Getting Well: Maximizing Health When You Have a Chronic Illness (Hunter House 2002), Diabetes: Sugar-coated Crisis — Who Gets It, Who Profits, and How to Stop It (New Society 2006, Diabetes Heroes (Jim Healthy 2014), and The Inn by the Healing Path: Stories on the road to wellness (Smashwords 2015.) He writes for Diabetes Self-Management and Pain-Free Living (formerly Arthritis Self-Management) magazines. His website is His blog is

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