From the Guidelines
DM1 ketone in urine is a concerning sign that requires immediate attention, and individuals should contact their healthcare provider right away as this could indicate diabetic ketoacidosis (DKA), a serious complication. According to the guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus 1, individuals who are prone to ketosis, such as those with type 1 diabetes, should measure ketones in urine or blood if they have unexplained hyperglycemia or symptoms of ketosis.
The presence of ketones in urine can indicate impending or established DKA, which is a medical emergency 1. It is essential to increase fluid intake with sugar-free, non-caffeinated beverages to help flush ketones from the body. Blood glucose levels should be checked more frequently, every 3-4 hours, and insulin should be administered as prescribed by the doctor. Additionally, ketones should be tested every 3-4 hours until they are negative.
If symptoms like persistent vomiting, difficulty breathing, fruity-smelling breath, confusion, or severe abdominal pain are experienced, emergency medical care should be sought immediately 1. Regular monitoring of both blood glucose and ketones is crucial for people with Type 1 diabetes, especially during illness, stress, or when blood glucose levels are consistently above 240 mg/dL. Key points to consider include:
- Increased ketone concentrations in those with known diabetes mellitus or in previously undiagnosed individuals presenting with hyperglycemia suggest impending or established DKA
- 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 hormones
- Specific measurement of b-hydroxybutyrate in blood should be used for diagnosis of DKA and may be used for monitoring during treatment of DKA 1
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diabetic Ketoacidosis and Ketone Levels
- Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 and type 2 diabetes, characterized by hyperglycemia, metabolic acidosis, and elevated serum or urine ketones 2.
- The presence of ketones in the urine is a key diagnostic criterion for DKA, along with hyperglycemia and metabolic acidosis 3.
- In patients with type 1 diabetes, the use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors has been associated with an increased risk of euglycemic DKA, which can occur without significant hyperglycemia 4, 5.
Ketone Measurement in Urine
- Urine ketone measurement is an important tool for diagnosing and monitoring DKA, particularly in patients with type 1 diabetes who are at risk of euglycemic DKA 4, 6.
- The presence of ketones in the urine can indicate the need for prompt evaluation and treatment to prevent complications of DKA 2.
- Patients with type 1 diabetes who experience nausea, vomiting, or malaise, or develop a metabolic acidosis, should be promptly evaluated for the presence of urine and/or serum ketones, especially if they are taking SGLT-2 inhibitors 4.
Clinical Implications
- The risk of DKA and euglycemic DKA should be carefully considered when prescribing SGLT-2 inhibitors to patients with type 1 diabetes, and patients should be closely monitored for signs and symptoms of DKA 4, 5.
- Healthcare providers should be aware of the potential for DKA and euglycemic DKA in patients with type 1 diabetes, particularly during the first month of initiating SGLT-2 inhibitors 5.
- Early diagnosis and treatment of DKA are critical to improving patient outcomes, and urine ketone measurement can play an important role in this process 3.