From the Guidelines
Ketones in urine should be immediately addressed by contacting a healthcare provider, especially if blood glucose is above 240 mg/dL, as they can indicate a serious condition called diabetic ketoacidosis (DKA), particularly in people with diabetes 1.
Importance of Ketone Monitoring
Ketones in urine indicate that the body is breaking down fat for energy instead of using glucose, which can occur due to insufficient insulin, causing the liver to convert fat into ketones for fuel 1.
- Small amounts of ketones may appear during fasting, intense exercise, or low-carbohydrate diets.
- Moderate to high levels can signal a serious condition called diabetic ketoacidosis (DKA), particularly in people with diabetes.
Recommendations for Ketone Testing
Individuals prone to ketosis, such as those with type 1 diabetes, history of DKA, or treated with sodium-glucose cotransporter 2 inhibitors, should measure ketones in urine or blood if they have unexplained hyperglycemia or symptoms of ketosis 1.
- Specific measurement of b-hydroxybutyrate in blood should be used for diagnosis of DKA and may be used for monitoring during treatment of DKA.
- Blood ketone determinations that rely on the nitroprusside reaction should not be used to monitor treatment of DKA.
Action Plan for Positive Ketone Tests
If ketones are detected in urine through home testing strips and diabetes is present, it is crucial to contact a healthcare provider immediately, especially if blood glucose is above 240 mg/dL 1.
- For those experiencing symptoms like excessive thirst, frequent urination, nausea, vomiting, abdominal pain, or fruity-smelling breath alongside positive ketone tests, seek medical attention promptly.
- Treatment typically involves insulin administration and fluid replacement to restore normal metabolism.
- Regular monitoring of ketones is recommended for people with type 1 diabetes during illness or when blood glucose levels are consistently elevated, as early detection can prevent the development of dangerous ketoacidosis 1.
From the Research
Ketones in Urine
- Ketones in urine are often associated with diabetic ketoacidosis (DKA), a serious complication of diabetes 2
- DKA is characterized by high blood glucose levels, acidosis, and ketosis, and can be precipitated by factors such as infection, insulin omission, and myocardial infarction 2, 3
- The presence of ketones in urine can be an indicator of DKA, but it is not a definitive diagnostic tool 2
- Beta-hydroxybutyrate is a more accurate measurement of ketosis than serum ketones, and is often used to diagnose and monitor DKA 2
- Treatment of DKA typically involves intravenous insulin and fluid replacement, as well as careful monitoring of electrolyte levels and management of underlying precipitating factors 2, 4
Relationship to Diabetes
- Ketones in urine are more commonly associated with type 1 diabetes, but can also occur in type 2 diabetes, particularly in the context of hyperglycemic crisis 3, 4
- The development of DKA is often related to insufficient insulin levels, which can lead to accelerated lipolysis and ketone body production in the liver 5
- Individuals with type 1 diabetes may have an intact feedback suppression of lipolysis in response to 3-hydroxybutyrate, which suggests that the development of DKA is not due to a disruption in this feedback mechanism 5
Clinical Implications
- The presence of ketones in urine should prompt further evaluation and management, particularly in individuals with diabetes or those who are at risk for DKA 2, 3
- Intravenous insulin therapy is a common treatment for DKA, and can be effective in reducing blood glucose and ketone levels 3, 4
- Careful monitoring of electrolyte levels, particularly potassium, is crucial in the management of DKA 2, 4