Diabetes and Ketones
The presence of high levels of ketones
in the bloodstream is a common complication of diabetes, which if left
untreated can lead to ketoacidosis.
Ketones
build up when there is insufficient insulin to help fuel the body’s cells.
High
levels of ketones are therefore more common in people with type 1 diabetes or
people with advanced type 2 diabetes.
If you are
suffering from high levels of ketones and seeking medical advice, contact
your GP or diabetes healthcare team as soon as possible.
What
are ketones?
Ketones
are an acid remaining when the body burns its own fat.
When the
body has insufficient insulin, it cannot get glucose from the blood into the
body's cells to use as energy and will instead begin to burn fat.
The liver
converts fatty acids into ketones which are then released into the bloodstream
for use as energy.
It is
normal to have a low level of ketones as ketones will be produced whenever body
fat is burned.
In people
that are insulin
dependent, such as people with type 1 diabetes, however, high
levels of ketones in the blood can result from taking too little insulin and
this can lead to a particularly dangerous condition known as ketoacidosis.
How do I test for ketones?
Ketone
testing can be carried out at home.
The most
accurate way of testing for ketones is to use a blood glucose meter which can test
for ketones as well as blood glucose levels.
You can
also test urine for ketone levels, however, the testing of urine means that the
level you get is representative of your ketone levels up to a few hours ago.
·
Read
about testing for ketones and how to interpret the results
Who needs to be aware of ketones?
The
following people with diabetes should be aware of ketones and the symptoms of
ketoacidosis:
·
Anyone
dependent on insulin – such as all people with type
1 diabetes
·
People
with type 2 diabetes that are taking SGLT2
inhibitors (such as Forxiga, Invokana and Jardiance)
It is
essential to know what the symptoms are, and when you should test for ketones. Finding
high levels of ketones present in your urine is a
sign that the management of your diabetes needs adjusting.
Ketone
testing will be important within pregnancy for
anyone with diabetes on insulin. Pregnant women with type 2 diabetes or gestational diabetes that is not treated with
insulin should contact their health team if experiencing the symptoms of
ketoacidosis.
Ketones
and weight loss
As noted
above, ketones are produced when the body burns fat. Therefore people that are
losing a significant amount of weight may experience higher than normal ketone
levels.
Ketone
testing has also become used by people with type 2 diabetes on ketogenic diets to assess whether
they are burning fat effectively. Use of ketone testing in this way is not
recommended by the NHS and so ketone testing strips prescribed by doctors are
not to be used for this purpose.
Ketogenic
diets are not usually recommended for people with insulin dependent diabetes as
aiming for higher ketone levels could present a higher risk of ketoacidosis
occurring.
When should I test for ketones, and how will this affect the management of my diabetes?
The
following information is of relevance to people who need to take insulin.
·
Blood
glucose levels rise above 17 mmol/L
·
Blood
glucose levels are consistenly above 13 mmol/L
·
If
blood glucose levels rise in response to illness
·
If
you notice symptoms of ketoacidosis such as vomiting or suffering from
diarrhoea
If
you record high levels of ketones, contact your health team immediately for
advice on how best to manage your diabetes.
I think I might have diabetic ketoacidosis, how would I know?
If you are
suffering from diabetic ketoacidosis the early
signs are likely to include:
·
Stomach
pains
·
Nausea
and/or vomiting
·
Breathlessness
·
Breath
that smells fruity
In this
instance, call your doctor as soon as possible as ketoacidosis is an extremely
severe condition.
.
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