What are Ketones? Blood or Urine Tests, Levels and Treatment

What are ketones ?

Our bodies rely heavily on glucose for energy and to be able to run efficiently. When the body has a decrease in glucose, your body starts breaking down fats for energy, which is not a natural process.

When this happens, ketone bodies are produced which is the topic of discussion today. Ketones are a byproduct of the breakdown of fatty acids and can in some cases, become dangerous for your health or life threatening. 

The buildup of ketones is a natural process as they can even increase if a person lacks food for too long or even when they sleep. But, if the body lacks essential nutrients and fluids for too long of a period, ketones can spike and become dangerous. 

Today, we will discuss what exactly ketones are, how they work, the dangers they can impose and how to manage them:

What are Ketones?

Ketones are bodies that live in the body which act as water-soluble molecules. The ketones bodies are produced by the liver from fatty acids. These fatty acids are a consequence of low calorie intake, diets that restrict carbohydrates, intense exercise, starvation and most commonly, type 1 diabetes.

When ketones build up in the blood it can cause diabetic ketoacidosis, also known as DKA. DKA is easier to attain if you suffer from type 1 diabetes due to low insulin levels. Low insulin levels mean you have low glucose, and glucose is what the body needs for fuel burning.

If the body is low on insulin and glucose, which it is for type 1 diabetes patients, then the body starts to break down fats to use as energy. This process is what causes ketones as they are a byproduct of fatty acids, which develop during low glucose periods. 

Normal people that are non diabetic can also develop diabetic ketoacidosis, as can those with type 2 diabetes, but is it rare. This is because normal levels of insulin, glucose and other hormones can inhibit ketones levels from getting too high in the blood. If people without type 1 diabetes develop DKA it is usually due to starvation, alcoholism and overactive thyroid. 

Here is a quick video that sum up what are ketones :

If diabetic patients leave DKA untreated, it can sometimes be life threatening. To avoid the complications worsening, it is important to be aware of the symptoms:

Symptoms of Ketones

Being aware of the symptoms is vital for understanding when you should seek medical advice and get the help you need. Due to ketones and their most common condition being a life threatening situation, it is key to notice the symptoms and act as soon as possible. 

All symptoms of ketones are physical and therefore, quicker to notice. Mental symptoms have not yet been reported, however mental stress and conditions can be a cause of ketones, which you will read about in the next section. 

For now, let’s take a look at the most common symptoms to help you understand and to recognise if the issue occurs:

  • Dry mouth 
  • Blood sugar levels higher than 240 mg/dL
  • Strong thirst
  • Frequent urination
  • Confusion
  • Extreme fatigue
  • Flushed skin
  • Strong fruity breath
  • Vomiting
  • Stomach pain

If your ketones get too high, this will most likely cause DKA. These are even more important to know so you can seek medical attention right now. Here are the symptoms to look out for:

  • Swelling in the brain
  • Loss of consciousness
  • Diabetic coma

For most people, symptoms may not seem easily noticeable or may be considered as symptoms of other conditions. 

For those with type 1 diabetes, the symptoms listed above will be most common, especially dry mouth, a spike in blood sugar levels and thirst. 

For all, it is important to notice the symptoms and seek medical attention as soon as possible to prevent DKA or worsening of symptoms. 

As mentioned, mental symptoms are not yet a concern, but they can be a cause of ketones. To know a bit more about the causes and risk factors, here is more information:

Ketones: Causes and Risk Factors

Everyone should do what they can to prevent ketones from increasing and becoming a medical concern, such as DKA. Knowing what can cause and put your body at risk on increased ketones is important to be aware of in order to inhibit the process. 

There are many factors that can cause ketones. Most of which can be avoided for normal or type 2 diabetic people, or in many cases there is no obvious trigger. 

However, for those with type 1 diabetes, it is much harder to prevent as for most patients, it is a natural occurrence due to low levels of insulin and glucose. 

Here are the most common causes and risk factors of ketones to be aware of:

Physical causes

The most common causes of ketones and DKA are physical. Most can be prevented, but it is important to be aware of what can increase the chance of developing them. 

  • Common flu, infection or a urinary tract infection (UTI) can cause increased ketones due to the shift in low insulin levels. An infection most likely decreases insulin levels further. 
  • Excessive alcohol, medications and illegal drug use can increase the chance of DKA. Overuse of unnecessary substances can cause body malnourishment, which is a big factor for increased ketones.
  • Missing doses of insulin can have a significant impact on ketones and is a major cause of DKA for those with type 1 diabetes. Making sure you stay on track with your recommended insulin dosages is essential from inhibiting any life threatening or dangerous medical concerns, like DKA. 
  • Unpreventable causes are for women who have type 1 diabetes. It is important to be aware that pregnancy or a period can be a cause of increased ketones. These are both natural occurences that cannot be prevented, but for many it can be a cause that can impose high risk.

Whilst most causes and risk factors are physical, there are some mental causes that are important to be aware of.

Mental causes

Ketones can be caused by mental stress and disorders, as much as they can become a risk factor. Mental consequences can happen pre or post increased ketones.

For many years, there have been studies on the correlation between blood ketones and mental disorders. Scientists sought to see if mental disorders can cause an increase in blood ketones and if so, why this can happen.

Research found abnormalities in blood ketones amongst those with mental disorders, such as schizophrenia. It seems that the increase in brain and body activity can cause a spike in ketones.

Those with mental disorders typically have overactive brain activity which expends more energy, thus increasing blood activity and can result in increased ketones. 

The same research found that mental stress, post diabetes or post life experience for normal patients, can also increase blood ketones. The brain needs and expends energy in a similar way that the body does. 

Ketones and diabetic ketoacidosis are not to get confused with ketosis and ketogenic diets, they are in fact very different. Many link the keto diet with a decrease in mental disorders as a diet can help a person lose weight and therefore rebuild confidence and thus, a stable mental state. Ketogenic is linked with weight and external physicality, whereas ketones are linked with internal physicalities. 

The causes of ketones may have given you an idea of how they can increase in the blood and the urine, and also how they cause concern for a patient. Here is how to diagnose them, should you be concerned or effected:

Diagnosis of Ketones

You can check both your blood or your urine for ketones. Usually, the results differ depending what source you test. Blood testing offers real time results whereas urine testing gives back delayed results of what your ketone levels were a few hours earlier that day. 

Both methods involve strip testing and can be done at home. Urine tests are more popular for those wanting to test at home and blood tests are commonly done at the doctors. A test should be done if any of the following ensue:

  • Symptoms of DKA
  • Feeling nauseous often, without having high blood sugar levels
  • Having a blood sugar level higher than 240 mg/dL

If these issues occur, it is advised to get a test right away. The tests are then use the following diagnostic methods: 

Diagnosing via blood sample

For blood samples to check your ketone level and development of DKA, a ketone monitor if used which is very similar to a blood sugar monitor. The patient pricks their finger with a lancing device, puts the blood on a testing strip which is then put into the testing device. 

You can purchase a ketone monitor for at home use, of those with type 1 diabetes can often get free tests done at their local doctors. 

Diagnosing via urine sample 

Urine sampling is a much easier process that can be done without a machine or monitor. It is often done at home. 

The patient simply has to urinate on a test strip and waits for the colour to change. You match the complete test strip against the chart, which will come with your kit, and to see what level of ketones you have.

Both diagnosis methods are effective, however blood samples are most used in a professional setting as they are more reliable and show more recent results. To know what the readings mean, here are what the number signify:

What do my results mean?

Results vary from person to person. A high number for one individual may be slightly different to someone else. A rough guide of the numbers are as follows:

  • Normal/negative = less than 0.6 millilitres per liter (mmol/L)
  • Low to moderate = 0.6 to 1.5 mmol/L
  • High = 1.6 to 3.0 mmol/L
  • Very high = greater than 3.0 mmol/L

Although your reading may be low, it is important to be aware of the ways in which you can prevent ketones from occuring in the first place. This is to avoid complications or developing DKA. The following things can be done to prevent ketones:

How to prevent Ketones

There are a few ways that you can act upon yourself to help inhibit ketones from increasing or developing at all. This includes: 

Regularly check your blood sugar levels 

So that you can easily spot an increase. A spike can occur quickly so it is important to keep up with your blood sugar and insulin levels as often as possible. Diabetic patients are already recommended to do this, so see this as a reminder if this involves you. For those that are non-diabetic, practice checking your blood sugar often.

Stick to your insulin plan

If you are required to take insulin, it is vital to stick to your insulin plan. Forgetting your regular doses can have severe impact and is more likely to make your ketone level spike. Never stop taking insulin unless advised to.

Adopt a healthy lifestyle

If you become ill, do everything you can to have a healthy recovery. For normal people, this involves rest to prevent fatigue, eating well and not exercising. Your blood sugar level automatically drops when an illness occurs, so do everything you can to stop it from dropping lower. For diabetic patients, your doctor will usually give a “sick day plan” which is important to follow and abide by. Diabetic patients are at much higher risk and must take healthcare advice seriously. 

Ask your doctor before taking any new medicines

Be cautious if you start or want to take a new medicine, drug or supplement. Some medicines can stop or reduce your blood sugar level from being stable. Seek advice before taking any new medication. 

Stick to a balanced diet

In most cases, if a strict diet is necessary, this will be provided by a dietician as is normally for diabetic patients. For normal people, sticking to a healthy balanced diet is essential for managing your ketone levels as well as having many other health benefits.

Have a plan to seek medical assistance

Lastly, be prepared to act quickly. Having a plan to seek medical assistance as soon as you notice a ketone level spike can be a matter of life or death in some cases. DKA is a life threatening condition and should be taken seriously.

Knowing how to prevent them is essential for managing and reducing the impact. If you do see a spike and need treatment, this is a guide for the most common and effective methods:

Treatment of Ketones

Getting the right treatment can avoid hospitalisation and developing DKA. You can work with a healthcare professional or your doctor to get the right treatment for you.

In most cases, ketone levels can be treated at home if they are at a moderate to high level. When the ketone level becomes very high, this is the most concerning and is when you should get immediate help. The most common methods to manage ketone levels include:

1 – Intravenous fluid replacement (IV):  fluids to rehydrate the body

A common symptom of DKA is frequent urination, which leads to dehydration. To treat this the easiest method is fluid replacement. Intravenous fluid is packed with glucose and is essential to boost glucose levels in the blood as well as rehydrate after loss of body fluids. 

2 – Insulin: given directly to the veins in emergencies

Insulin is often used in emergencies when a patient’s blood glucose level is dangerously low. When this happens, energy is hard to obtain from anywhere else in the body as glucose is what energy maintenance relies on. Therefore, an instant replacement of glucose helps the body obtain energy again. 

Insulin will be provided on an hourly basis until the blood sugar and ketone levels balance back out to a normal or negative level. 

3 – Electrolyte replacement: acts as a nutrient replacement 

When electrolytes are low, the body will lack essential nutrients such as potassium, sodium and chloride. If a person’s electrolytes are too low, their heart and muscles lack proper function. It is vital to replace these to attain the person’s strength and ability to function. 

When a patient becomes ill and needs medical attention due to high ketones or DKA, fluid and nutrient replacement treatments are most successful and the easiest way to boost the body’s essential needs. 

If you still have some underlying questions or concerns, here are a few more facts and important information regarding ketones and DKA:

FAQ

Does drinking water reduce ketones?

Water can reduce your ketone levels science proves. It is recommended to drink one glass of water or carbohydrate/caffeine free liquid every 30 to 60 minutes to flush away ketones. However, water is not a solution to get rid of ketones, it can only reduce them. Keeping up regular water intake will improve the levels but it is important to seek medical help and increase your insulin levels to improve ketones more effectively. 

What is a dangerous level of ketones?

Ketones are measured in mmol/L. Around 1.6 – 3 mmol/L is considered to be a high level of ketones. Anything above 3 mmol/L is considered a dangerously high level and requires medical care. To measure ketones, you will need to do a test. It is a simple test, like checking glucose levels, and requires a finger prick to take a blood sample. 

Why are my ketones so high on a keto diet?

A keto diet involves low carbohydrate intake, which can sometimes be a cause of ketosis and an increase in ketones levels. Although your ketones level can increase, it is rarely enough to cause ketoacidosis. Instead, it can cause ketosis which simply means the presence of ketones. Ketoacidosis is the diabetic condition, which is harmful but is rarely caused by the keto diet alone. 

If you are on a keto diet and worry about increasing your ketone level, make sure to seek medical advice. Other recommendations are to drink plenty of water to flush away any excess ketones that may develop and not exercise, as this can decrease insulin levels. 

If you would like to learn more about the Keto Diet, check out our Ketogenic Diet complete guide with all the information you need to know here. 

How do I bring down my ketones?

There are a few ways that you can bring down your ketone levels. This includes drinking water regularly to flush away ketones, not exercising to maintain insulin levels, taking insulin to bring your blood glucose down and checking your ketone levels several times a day to keep an eye on them. 

Is Raspberry Ketones dangerous for Ketosis ?

It’s important to know that Raspberry Ketones (Frambinone or Rheosmin) is not a cause or a treatment to Ketones. This common misunderstanding is normal. Raspberry Ketones have nothing to do with ketosis !

Is DKA an emergency?

Diabetic ketoacidosis (DKA) is a minor but life threatening illness that must be treated as an emergency. It is a complication that can cause an acute state of diabetes and requires medical treatment to provide insulin and fluids. 

When symptoms such as dehydration, weakness, shortness of breath, vomiting and chest or abdominal pain occur, you must seek medical attention right away. These are signs that your ketones are at a dangerously high level.

Can DKA cause brain damage?

DKA can become very serious and cause many complications. If left untreated, swelling of the brain or a coma can occur. There have been studies showing that DKA can cause brain injury and other neurological complications. There seems to be a parallel link in the study which shows a correlation between untreated DKA in those who have type 1 diabetes. 

How do you know when DKA is resolved?

The only way to know if DKA is resolved is by having a blood test. If your plasma glucose level is below or between 200-250 mg/dL and your ketones are steady and below the high mmol/L level, you are in the safe zone. Resolution of normal glucose and insulin levels signify DKA is reduced or resolved. 

Now, here is our take on ketones, advice and conclusive thoughts:

Conclusion

Ketones are easily confused with ketosis and ketogenic diets, which are natural occurrences in most people when they diet. However, ketones are a much more serious medical concern and the two should not get muddled.

Ketones are a medical concern which can be caused by physical and mental actions, not enough self-care or type 1 diabetes and can lead on to be life threatening. They are something everyone should be aware of and understand how to manage and treat if needs be. 

It is rare for normal people to have a dangerous ketone level, but it can happen. It is more common for those with type 1 diabetes as ketones are increased and become dangerous with a low level of insulin. With the right checks and treatments, they can easily be managed and prevent the patient from fatality. 

For the right treatment for high ketones and DKA, always seek professional medical advice from a doctor. Everyone has different needs and in many cases, most DKA patients need different treatment. It is advised to seek help when you notice symptoms and for those who are diabetic, always check your ketone and blood sugar levels regularly to inhibit any danger to your health.

If you have any more questions, concerns or feedback, feel free to share them with us in comment !

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