From the Guidelines
If your ketone level is 2.2 mmol/L, you should contact your healthcare provider immediately as this indicates moderate to high ketones, which can be dangerous. Drink plenty of water (at least 8 ounces every hour) to help flush ketones from your body. If you have diabetes, check your blood glucose levels frequently and follow your sick day management plan. You may need to take additional insulin as directed by your healthcare provider - typically rapid-acting insulin every 2-4 hours until ketones decrease, as suggested by 1. Do not exercise when ketones are elevated as this can make levels rise further. If you experience symptoms like persistent vomiting, difficulty breathing, fruity-smelling breath, confusion, or severe abdominal pain, seek emergency medical care immediately as these may indicate diabetic ketoacidosis (DKA), a serious condition. Elevated ketones occur when your body burns fat instead of glucose for energy, often due to insufficient insulin, illness, missed meals, or in some cases, very low-carbohydrate diets. Regular monitoring and prompt action when ketones are elevated can prevent the development of more serious complications, as emphasized by 1.
Some key points to consider:
- Increased ketone concentrations in those with known diabetes mellitus or in previously undiagnosed individuals presenting with hyperglycemia suggest impending or established DKA, a medical emergency, as stated in 1.
- The two major mechanisms responsible for the high ketone concentrations in people with diabetes are increased production from triglycerides and decreased utilization in the liver, both a result of absolute or relative insulin deficiency and increased counterregulatory, as explained in 1.
- Ketonemia typically takes longer to clear than hyperglycemia, and direct measurement of ketones may be necessary to monitor the resolution of the ketoacidosis, as mentioned in 1.
- Insulin therapy, fluid replacement, and electrolyte management are crucial in the treatment of DKA and HHS, as outlined in 1.
It is essential to prioritize your health and take immediate action if you experience any symptoms of DKA or HHS, and to work closely with your healthcare provider to manage your condition effectively, as recommended by 1.
From the Research
Ketone Levels and Diabetes Management
- Ketone levels are an important indicator of diabetic ketoacidosis (DKA) risk in patients with type 1 and type 2 diabetes 2, 3.
- A ketone level of 2.2 mmol/L is considered elevated and may indicate an increased risk of DKA 3, 4.
Monitoring and Management Strategies
- Routine capillary blood ketone testing may help predict future DKA events in patients with type 1 diabetes using sodium-glucose cotransporter inhibitors (SGLTi) 3.
- Continuous glucose monitoring (CGM) and insulin data can be used to predict elevated ketone bodies in patients with type 1 diabetes 4.
- The use of continuous ketone monitoring (CKM) and education strategies may help mitigate the risk of DKA in patients with type 1 diabetes taking SGLTi 5.