Diabetes Control: Checking for Ketones

Having ketones in your urine can put you at risk for a dangerous diabetes complication. Know the warning signs to check for ketones.

By Beth W. Orenstein

Medically reviewed by Farrokh Sohrabi, MD

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If you have diabetes, you need to know about ketones (pronounced KEY-tones). When your body doesn’t have enough insulin to burn sugar (glucose) for energy, it burns fat instead, and when it burns fat, it produces acids called ketones.

“The more fat a person metabolizes, the more ketones he or she produces,” says Andrew J. Drexler, MD, professor of medicine, co-chief of the division of clinical endocrinology, diabetes, and hypertension, and director of the Gonda (Goldschmied) Diabetes Center at the University of California, Los Angeles.

A rise in ketones can cause a life-threatening condition known as diabetic ketoacidosis, or DKA, which needs immediate medical attention. Dangerously high levels of ketones could cause you to become dehydrated, go into a coma, or even die. Although DKA is more common in people with type 1 diabetes, in rare cases it can still occur in people with type 2 diabetes. Take steps to avoid this dangerous condition by checking for ketones at specific times when you may be at greater risk.

How to Check for Ketones

Ketones form in the blood and can spill over into your urine, so you can check for ketones in urine and blood samples. Most people check for ketones in urine because it’s easier, although it may not be as accurate as a blood sample. You can buy urine test strips for ketones at your local drugstore without a prescription.

“Normally you won’t have ketones in your urine,” Dr. Drexler says. However, you should check for ketones in your urine if you have any of these warning signs:

• Your blood sugar is higher than 240 milligrams per deciliter.
• You feel sick to your stomach and are vomiting or have stomach pain.
• You’re sick with a cold or the flu.
• You’re tired or exhausted all the time.
• You’re thirsty all the time or your mouth is very dry.
• You seem confused or “in a fog.”
• You have difficulty breathing or your breath smells unusually sweet or “fruity.”
• You feel flushed and your skin is clammy.

How to Use Ketones Test Strip

You can collect a sample of urine in a sterile container and dip a ketones test strip in the sample, or simply position the strip so that your urine stream passes over it.

Gently shake the strip to remove excess urine. The strip will change color depending on the level of ketones in your urine — none, or a small, moderate, or large amount. The directions on the package will tell you how long you have to wait for the strip to change color and what the different ketone levels mean.

Keep a record of your test results and the time of your test. This can help your doctor make the necessary adjustments in your diabetes management plan.

What Ketones Results Mean

If your test shows a trace or small amount of ketones, it could mean that they’re starting to build up. Repeat the test in a few hours.

If you have a moderate or large amount of ketones, call your doctor immediately. “You may need to be hospitalized if you’re at risk for or have ketoacidosis,” Drexler says.

Also, know that exercise can cause you to produce more ketones. Don’t exercise if ketones are present and on the rise. Drink water or no-calorie beverages to help flush the ketones from your urine.

Even if the presence of ketones is slight, talk to your doctor. You may need to adjust your diabetes management plan — your medication, diet, or both — for better diabetes control and to reduce your chances of producing ketones and developing a serious diabetes complication.