From the Guidelines
If you have trace ketones in your urine, it is crucial to check your blood glucose levels and increase your fluid intake, especially if you have diabetes, as this could be an early sign of diabetic ketoacidosis, a serious condition. Trace ketones in urine indicate that your body has started breaking down fat for energy instead of using glucose, which can occur during fasting, significant carbohydrate restriction, or when diabetes is poorly controlled 1. According to the guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus, individuals who are prone to ketosis, such as those with type 1 diabetes or a history of diabetic ketoacidosis, should measure ketones in urine or blood if they have unexplained hyperglycemia or symptoms of ketosis 1.
Key Considerations
- The presence of urine ketones is highly sensitive for DKA or significant ketosis, with high negative predictive value, suggesting utility in ruling out DKA 1.
- The American Diabetes Association recommends that ketosis-prone people with diabetes mellitus check urine or blood ketones in situations characterized by symptoms of illness and/or deterioration in glycemic control to detect and preempt DKA 1.
- If you have diabetes and are finding ketones in your urine, it is essential to contact your healthcare provider, especially if you're feeling unwell or have high blood glucose readings, as they may recommend adjusting your insulin dosage or other medications 1.
Monitoring and Management
- Regular monitoring of ketones is important for people with diabetes, particularly type 1 diabetes or insulin-dependent type 2 diabetes 1.
- Ketosis-prone individuals and/or their caregivers should receive periodic education about what to do when they have symptoms of ketosis or increased ketones, including oral hydration, taking additional short- or rapid-acting insulin and oral carbohydrates, and seeking medical advice if symptoms worsen or ketone concentrations increase 1.
From the Research
Tracing Ketones in Urine
- Ketone bodies, such as beta-hydroxybutyrate and acetoacetate, can be measured in urine to assess diabetic ketoacidosis (DKA) and ketosis 2.
- Urine ketone tests can be used to detect ketonemia, but may have limitations, such as false negative or false positive results, and may not be as accurate as blood ketone tests 3.
- The sensitivity of urine ketone dip tests for detecting ketonemia in patients with DKA and diabetic ketosis is high, ranging from 97% to 98% 4.
- Quantitative measurement of ketone bodies in urine using reflectometry is possible, with good reproducibility and agreement with biochemical data 5.
- Urine ketone tests can be useful in clinical practice, particularly in emergency settings, for screening and detecting ketone body production in diabetes 2, 5.
- However, blood ketone tests may be more effective than urine ketone tests in certain situations, such as in patients with type 1 diabetes, especially children, and in those with recurrent DKA 3, 6.