From the Guidelines
You should trace ketones in your urine if you have type 1 diabetes, a history of diabetic ketoacidosis (DKA), or are treated with sodium–glucose cotransporter 2 (SGLT2) inhibitors, and experience unexplained hyperglycemia or symptoms of ketosis, such as abdominal pain or nausea, as recommended by the most recent guidelines 1.
Key Situations for Urine Ketone Testing
- Type 1 diabetes with unexplained hyperglycemia or symptoms of ketosis
- History of diabetic ketoacidosis (DKA)
- Treatment with sodium–glucose cotransporter 2 (SGLT2) inhibitors
- Symptoms of ketosis, such as abdominal pain or nausea
Testing Method
To test for ketones, use ketone test strips available at pharmacies without a prescription. Dip the strip in urine, wait for the indicated time (usually 15-40 seconds), and compare the color change to the chart on the container. Testing is best done in the morning or when you feel unwell, as suggested by various studies 1.
Importance of Ketone Testing
Ketones appear in urine when your body breaks down fat for energy instead of using glucose, which can be normal in some circumstances but dangerous in others, particularly for people with diabetes where it may signal diabetic ketoacidosis, a potentially life-threatening condition requiring immediate medical attention 1.
Clinical Considerations
It is crucial to follow the guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus, which emphasize the importance of ketone testing in specific situations to prevent and manage diabetic ketoacidosis 1.
From the FDA Drug Label
If instructed by your doctor, test your ketones and report the results to your doctor.
You should trace ketones in your urine when instructed by your doctor, especially in situations such as:
- Illness, especially with nausea and vomiting
- Pregnancy
- When your insulin requirements may be changing
It is essential to follow your doctor's advice and instructions regarding ketone testing. 2
From the Research
Tracing Ketones in Urine
When to trace ketones in urine is a critical question for individuals with diabetes, particularly those at risk of diabetic ketoacidosis (DKA). The decision on when to trace ketones should be based on clinical guidelines and individual risk factors.
- Risk Factors: Individuals with type 1 diabetes, those who are pregnant, on medications such as sodium-glucose linked transporter (SGLT) inhibitors, people with recurrent DKA, those undertaking high-intensity exercise, socially or geographically isolated individuals, or those on low carbohydrate diets may particularly benefit from tracing ketones in urine 3.
- Symptoms: Tracing ketones in urine should be considered when symptoms such as polyuria, polydipsia, nausea, vomiting, abdominal pain, weight loss, severe fatigue, dyspnea, and preceding febrile illness are present, as these can be indicative of DKA 4.
- Testing Methods: Urine ketone dip tests can be used as a screen for ketonemia in diabetic ketoacidosis and ketosis, with studies showing high sensitivity for detecting ketonemia 5, 6.
- Frequency: The frequency of tracing ketones in urine may depend on individual risk factors and clinical guidelines. Continuous ketone monitoring (CKM) via interstitial fluid with a sensor inserted subcutaneously is a recent development that can provide ketone readings every 5 minutes, which may be beneficial for high-risk individuals 3.
- Clinical Insights: Tracing ketones in urine can provide important clinical insights, particularly when used in conjunction with other diagnostic tools such as blood glucose monitoring and electrolyte panels 4, 7.
Considerations for Tracing Ketones
- Urine Ketone Dip Test: This test has been shown to be highly sensitive for the detection of ketonemia in patients with DKA and diabetic ketosis, making it a useful screening tool 5, 6.
- Blood β-Hydroxybutyrate Testing: Compared to urine acetoacetate testing, blood β-hydroxybutyrate testing may offer advantages in reducing the frequency of hospitalization, time to recovery from DKA, and potentially lowering healthcare expenditure 7.
- Clinical Judgment: The decision to trace ketones in urine should be made based on clinical judgment, considering the individual's medical history, current symptoms, and risk factors for DKA.