What are ketones?

Ketones are chemicals that build up when there isn’t enough insulin to help fuel the body’s cells. Insulin works as the ‘key’ that allows glucose to enter cells. When the body doesn’t have enough insulin, it cannot efficiently move glucose into your cells and use it as fuel. Glucose then builds up in the bloodstream and the body releases fat stored in fat cells. The fat travels to the liver where it is broken down into chemicals called ketones that are used as energy instead of glucose. Having too many ketones in the blood makes it acidic and can lead to a serious and dangerous condition known as Diabetic Ketoacidosis (DKA).

Who needs to be aware of ketones?

High levels of ketones are more common in people with type 1 diabetes or people with advanced type 2 diabetes, especially on days when you are unwell.

Ketoacidosis usually develops slowly, but there are situations such as missed or inadequate insulin treatment, fever, illness (like the flu), certain medications, dehydration or an imbalance in your diet that can cause the condition to develop within a few hours1.

Symptoms of ketoacidosis include:

  • Thirst
  • Nausea or vomiting
  • Abdominal pain
  • Confusion
  • Dry or flushed skin
  • Heavy breathing
  • Feeling sleepy

Your breath may also smell sweet and fruity. This is because one of the ketones, acetone, can cause your breath to smell like nail polish and is a clear sign that your ketones are too high.

High levels of ketones as well as high blood sugar is a serious condition. If you have type 1 diabetes, you will need to monitor your blood sugar levels frequently. If you have sugar values between 250-400 mg/ dL or more it is necessary to also check for ketones in your urine 2. For this test you need a special urine dipstick that you can get from your attending medical team. In general, if you have high blood sugar, ketones in your urine and any of the following – vomiting, abdominal pain, or change in consciousness – you should seek immediate emergency treatment.

DON’T FORGET TO DISCUSS YOUR DIABETES MANAGEMENT WITH YOUR CARE TEAM.

 

Diabetes Care, American Diabetes Association, 2019

Type 1 diabetes in adults: diagnosis and management, National Clinical Guideline Centre, 2015.

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