Understanding Ketone Testing

Understanding Ketone Testing

th_KetoneAction_GuideEveryone needs insulin in order for their body to use the food they eat for energy. When you have diabetes, the body does not have enough insulin to use glucose from food for energy. When this happens, the body will break down fat for energy, which causes compounds called ketones to form in the blood. 1, 2 When your body detects ketones it tries to dispose of them through the urine. If enough ketones build up in your blood, they can make it acidic, which can lead to a life threatening metabolic condition called diabetic ketoacidosis (DKA).

DKA is more common in patients with type 1 diabetes because they do not make any insulin. Patients with type 2 diabetes are less likely to have DKA, but can still have ketones produced if they aren’t making enough insulin and under certain situations such as trauma, infections or surgery. Anyone with diabetes should be familiar with the symptoms. Symptoms include: confusion, excessive thirst and urination, tiredness, extremely high blood sugar levels, fruity–smelling breath, dry/flushed skin, difficulty breathing, and nausea/vomiting. 3 It becomes dangerous if these are left untreated because it can eventually lead to coma or even death.

Similar to how patients with diabetes can test their blood sugars, there are tests available to measure ketones. Two types of ketone tests are currently used: urine ketone tests and blood ketone tests.

Urine tests consist of reagent strips, which require a small amount of urine be placed onto a strip. When urine touches the reagent strip, a chemical reaction occurs and the color of the strip changes. In order to know if there are too many ketones in your body, you would match the color of the strip with the color chart provided along with its specified ranges. There is a specified time that the strip needs to be read, usually within 15 seconds. The strips will darken as it is exposed to the air, so once the 15 seconds elapsed, another test should be repeated.

Ketone blood tests consist of the ketone test strips and a meter, similar to a glucometer. The method is very similar to checking your blood sugar. You simply lance one of your fingers with a lancing device and place a drop of blood on the correct strip and wait for the meter to return a reading. 4 You should have a plan in place with your provider on what to do if you measure ketones in your blood. It may be to inject insulin or if very high emergency care may be needed.

Urine testing is not as accurate as ketone blood tests and may delay appropriate treatment. Urine tests may give false negative tests. There are meters available that will measure both blood sugar and ketones using the same meter with different strips. With a prescription, this meter and strips are covered by insurance. You would check with your insurance company to find out which meter is covered.

Having type 1 diabetes and missing or skipping insulin doses is a common risk factor for DKA. An infection or other illnesses such as pneumonia, sepsis, or urinary tract infections may increase blood sugars. If not enough insulin is used, this may lead to DKA. All individuals with diabetes who are under physical stress (injury or illness), or have blood sugars over 300 mg/dl should test for ketones. If you have type 1 diabetes you should test for ketones if your blood sugar is over 250 mg/dl for two readings in a row. 5

As a rule of thumb, it is always a good idea to test for ketones when your blood sugar levels are greater than 250 mg/dl or when you are feeling ill. Ketone testing is an effective way for you and your provider to manage your diabetes. The test helps to prevent a dangerous short-term complication, DKA, from occurring. Ketone urine and blood tests available at any pharmacy, but ketone blood tests are more accurate than urine tests.

This Article is Brought to you By Our Guest Staff Writers:
Lyna Pham, PharmD Candidate 2016, MCPHS University
Damian Bialonczyk, PharmD, MBA, Fellow, MCPHS University
Jennifer Goldman, PharmD, CDE, BC-ADM, ‎FCCP, Professor of Pharmacy Practice, School of Pharmacy-Boston, MCPHS University, Boston, MA Clinical Pharmacist, Well Life Medical-Peabody, MA

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