From the Guidelines
Ketones in the urine of a person with Type 1 diabetes (DM1) indicate diabetic ketoacidosis (DKA) or the beginning stages of it, requiring immediate attention. The first step is to check blood glucose levels and administer insulin as prescribed, typically using rapid-acting insulin according to your correction factor 1. Increase fluid intake with sugar-free beverages to help flush ketones from your system. Continue monitoring both blood glucose and ketone levels every 2-4 hours until ketones clear. Contact your healthcare provider promptly, as they may need to adjust your insulin regimen. If you're experiencing symptoms like vomiting, difficulty breathing, confusion, or severe abdominal pain, seek emergency medical care immediately.
Key Considerations
- Ketones develop when your body lacks sufficient insulin to use glucose for energy and burns fat instead, producing these acidic byproducts 1.
- This situation is dangerous because the resulting acidity can disrupt normal bodily functions and potentially lead to coma if left untreated.
- Regular insulin administration, proper hydration, and carbohydrate intake when appropriate are essential preventive measures.
- Individuals who are prone to ketosis (those with type 1 diabetes, history of diabetic ketoacidosis [DKA], or treated with sodium-glucose transport protein 2 inhibitors) should measure ketones in urine or blood if they have unexplained hyperglycemia or symptoms of ketosis (abdominal pain, nausea) and implement sick-day rules and/or seek medical advice if urine or blood ketones are increased 1.
Monitoring and Treatment
- Measurement of -OHB in the blood is the preferred method for monitoring DKA 1.
- Blood ketone determinations that rely on the nitroprusside reaction should not be used to monitor treatment of DKA 1.
- Insulin therapy, unless the episode of DKA is mild, regular insulin by continuous intravenous infusion is the treatment of choice 1.
From the FDA Drug Label
Early signs of diabetic ketoacidosis include glycosuria and ketonuria The presence of ketone in urine, also known as ketonuria, is an early sign of diabetic ketoacidosis. Key points to consider:
- Diabetic ketoacidosis is a serious complication of diabetes that can occur if the patient takes less insulin than needed to control blood glucose levels.
- Ketonuria is a sign of this condition, along with glycosuria (glucose in the urine).
- Patients with diabetes should be monitored closely for signs of diabetic ketoacidosis, including ketonuria and glycosuria 2, 2.
From the Research
Diabetic Ketoacidosis and Ketone in Urine
- Diabetic ketoacidosis (DKA) is a serious metabolic complication of diabetes mellitus (DM) that can occur in both type 1 and type 2 DM 3.
- DKA is characterized by hyperglycemia, ketone body formation, and metabolic acidosis, with precipitating causes usually being infection or insulin omission 3.
- The presence of ketones in the urine is one of the diagnostic criteria for DKA, along with hyperglycemia and metabolic acidosis 4, 5.
- The diagnosis of DKA is confirmed when all three criteria are present: elevated blood glucose levels or a family history of diabetes mellitus, the presence of high urinary or blood ketoacids, and a high anion gap metabolic acidosis 5.
- Treatment of DKA involves fluid and electrolyte replacement, insulin, treatment of precipitating causes, and close monitoring to adjust therapy and identify complications 4, 6.
Ketone Detection in Urine
- Urinary ketones are a key indicator of DKA, and their detection is crucial for diagnosis and management 4, 5.
- The presence of ketones in the urine can be detected using urine ketone tests, which are an essential tool for diagnosing and monitoring DKA 4.
- Elevated serum or urine ketones are a diagnostic criterion for DKA, and their measurement is critical for confirming the diagnosis 4, 5.
Management and Prevention
- Treatment of DKA requires frequent monitoring of patients, correction of hypovolemia and hyperglycemia, replacement of electrolyte losses, and careful search for the precipitating cause 6.
- Prevention strategies include identifying diabetes before DKA develops, educating patients to manage high-risk situations, and ensuring uninterrupted access to therapies for diabetes 4, 6.
- Early diagnosis and management are paramount to improve patient outcomes, and prevention of DKA is largely possible through early detection and education of patients, healthcare professionals, and the general public 3, 6.