Ketones and Diabetic Ketoacidosis

Without timely treatment, DKA can lead to severe complications, such as:^7-9

• Cardiac arrest
• Kidney damage
• Fluid inside the lungs
• Swelling in the brain
• Dangerously low potassium levels
• Nerve damage
• Dehydration
• Coma
• Death

High glucose leading to elevated levels of ketones can be an early sign of DKA. So anytime you're sick and your glucose is persistently at or above 200 mg/dL for several hours, be sure to test for ketones.¹⁰ (See below for details on how DKA is diagnosed.)

Other signs and symptoms of DKA include:^11-13

• Nausea and vomiting
• Extreme thirst or hunger
• Having to urinate more often than usual
• Dry mouth or skin
• Fruity-smelling breath
• Headache
• Trouble breathing
• Muscle stiffness or pain
• Stomach pain
• Feeling very tired
• Confusion

"Sometimes DKA is the first noticeable sign of diabetes in people who haven't yet been diagnosed," adds the U.S. Centers for Disease Control and Prevention.¹⁴

If you have any possible signs or symptoms of DKA, call your health care professional or seek care at your closest emergency department right away.

If your glucose is at or above 200 mg/dL — persistently and not coming down even after additional medications — you should check your ketone levels every four to six hours.

Ketone Tests and At-Home Diagnosis

At-home ketone test kits can help you know if you're at risk for DKA. These are widely available in pharmacies and online, and no prescription is needed. The most common options are blood, urine, and breath ketone tests.

Ask your health care professional which type of test is right for you. Then, make sure you always have some test kits on hand in case you have any concerning symptoms.

Based on test results, your health care professional may recommend that you seek immediate emergency care, adjust your insulin dosage, or make other changes to lower your ketones.

Blood Ketone Tests

Blood ketone tests — the gold standard for ketone tests — are designed to detect high ketone levels in the blood. They are more accurate and deliver results faster than urine ketone tests. This is critical because receiving timely care is essential if you have high ketone levels in the blood.

At-home blood ketone tests involve pricking your finger to collect a blood sample. You place a drop of blood on a test strip, which is inserted in a blood ketone meter. The meter tells you the concentration of ketones in your blood. A higher concentration indicates a greater risk for DKA.

Urine Ketone Tests

Urine ketone tests are designed to detect high ketone levels in the urine. They may be more convenient and less expensive than other ketone testing methods. But because urine accumulates in the bladder for some time before you urinate, results may reflect ketone levels from one to three hours earlier rather than current levels.

With most urine ketone tests, you collect a small urine sample in a container. Next, you dip a test strip in the urine sample. A change in color on the strip indicates the presence of ketones. A color chart included with the test kit lets you interpret the results, ranging from negative (no trace of ketones) to large (maximum level).

Be sure to carefully review the instructions prior to using a urine ketone test. If you have any questions, contact your health care professional.

Breath Ketone Tests

Handheld breathalyzers are designed to detect acetone, a type of ketone. However, since the technology is new and unproven, they're not recommended in people at risk for DKA.

Diagnosis by a Health Care Professional

Your health care professional may use a blood or urine ketone test to diagnose DKA in a hospital or office setting. Other tests may help find what factors caused DKA, such as:^16-17

• Blood tests to measure electrolytes (minerals in your body)
• Electrocardiogram, or EKG (a simple test to check your heart's electrical activity)
• Urine sample
• Chest X-ray

If you have DKA, you'll need to be treated in an emergency room or admitted to a hospital. Your treatment likely will include all three of the following:^18-20

• Fluids: Intravenous (through the vein) fluids correct dehydration, help clear ketones through the urine, and lower glucose levels.
• Electrolytes replacement: DKA causes several electrolyte imbalances, including low potassium, magnesium, sodium, phosphate, and bicarbonate levels. These electrolytes are important to maintain normal bodily functions. Treatments may be either intravenous or by mouth.
• Insulin: Insulin treatment stops ketone production, lowers glucose, allows cells to use glucose for energy, and helps correct the acid buildup in the blood. Insulin treatment may be either intravenous or subcutaneous (injected under the skin).

Treat the trigger: If an underlying illness or infection caused DKA, your health care professional will treat it.

The following steps can help prevent DKA:^21-24

• Manage your diabetes: Take your medications in a timely manner and follow a healthy diet. These practices can help protect your body and prevent complications from diabetes.
• Check your glucose (sugar): Your health care professional may recommend that you monitor your glucose level before meals and snacks, at bedtime, or more often. You may be prescribed a standard glucose meter or a continuous glucose monitor. Check your glucose often if you're sick or stressed. Follow your health care professional's guidance on glucose monitoring. Being aware of your glucose trends is essential to maintain safe and steady glucose management.
• Check your ketones: If you experience nausea, dehydration, or abdominal pain — especially if you have missed an insulin dose or are ill — check your ketone levels. Ketone tests are available (as described above), and newer technologies are being developed that may expand real-time monitoring options in the future.
• Adjust your medications and lifestyle: With the guidance of your health care professional, you may need to change the type or dose of medications, including insulin. Your health care professional may also provide specific guidance regarding diet, activity, and lifestyle.

If your glucose or ketone levels are high — or if you have any signs or symptoms of DKA — call your health care professional or seek emergency care right away.

Sometimes, DKA can occur for reasons that we don't understand. Remember that it's not your fault. As Cleveland Clinic notes, "Sometimes, the perfect storm of factors triggers DKA — and they're often outside of your control. The best thing you can do is get help as soon as possible to prevent it from becoming severe."²⁵

With prompt treatment, most patients recover from DKA within 24 hours. If DKA is more severe, it may take several days to treat.^26-27

After a DKA episode, follow-up care focuses on prevention. You also should have regular follow-up visits with your diabetes care team to:

• Receive guidance on maintaining a healthy lifestyle.
• Watch for recurrence of DKA and/or other complications of poorly controlled diabetes.
• Learn about adjusting insulin dosage during illness, infection, or times of stress.