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Roberta Kleinman

What You Should Know About Ketones

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When the body cannot obtain energy from food sources of carbohydrates such as bread, potatoes, rice, noodles, cereal, etc., due to the lack of available insulin, the body is starved for energy and starts breaking down fat as an energy source. A by-product of fat breakdown is ketone production, which is toxic to the body. This complication is known as diabetic ketoacidosis (DKA) and can lead to illness or even death.

Ketones are produced mainly by type 1 diabetics (children and adults), insulin pump users who may stop getting their insulin for some reason, as well as pregnant women who have gestational, type 1 or type 2 diabetes. Although more rare, people with type 2 diabetes can also produce ketones when they are ill, have an acute trauma incident, or have an infection. During illness, the body is under a great deal of stress and produces extra hormones like adrenaline. Adrenaline helps fight off the infection, but this works against insulin, which then leads to ketone production.

Ketones accumulate in the blood and can be recognized in the blood about 2-4 hours prior to appearing in urine. This makes a blood test more accurate than a urine test to detect ketone levels. Time is very important in diagnosing ketoacidosis.

There are multiple urine ketone testing strips on the market, but a new meter called the Nova Max Plus has the ability to test glucose as well as ketones in one meter. Here is how it works:

  • The meter will alert you to test for ketones when the glucose reading is over 250mg/dl.
  • A blood drop is taken only from your finger tips (not an alternate site) and used with a special ketone strip, which is green (the blue strip is used for glucose testing).
  • The meter will indicate KET to let you know you are testing for ketones. The strip must be used within 2 minutes of opening and blood cannot be reapplied to the same strip. DO NOT OPEN the strips until ready to use.
  • This ketone test should be done when your blood sugar registers over 250mg/dl, when you are sick, or when you have symptoms of diabetic ketoacidosis (see below).
  • Make sure you use the control solution and check to see that the strips are in range before using. This is the same procedure as the glucose strips.
  • Do NOT use ketone strips past the expiration date on the box. Store ketone strips - as well as all your supplies - in a dry, room temperature area.

Low carbohydrate diets like the Atkins's diet or phase 1 of the South Beach diet can cause ketone production as well. The difference is, this is dietary ketosis and NOT diabetic ketoacidosis. The healthy body will remove these ketones through the urine and the levels will stabilize after a few weeks. Many believe these diets are stressful to the kidneys, liver and destroy muscle mass. It is recommended that people with diabetes should stay clear of these super-low carbohydrate diets - consult your doctor and diabetes educator about a dietary plan based on your special needs. Ketoacidosis can also be seen in starvation as well as in alcoholism.

Symptoms of Diabetic Ketoacidosis (DKA)

  • Blood sugar above 300mg/dl
  • Dry skin and dry tongue (dehydration)
  • Rapid breathing or Kussmaul breathing (hyperventilation or labored breathing associated with DKA) to blow off the acid through the lungs
  • Fruity breath due to acetone production
  • Nausea and vomiting due to acid build-up
  • Weakness due to lack of glucose for energy
  • Drowsiness and fatigue due to fluid and electrolyte loss

Treatment for Diabetic Ketoacidosis (DKA)

  • Ketoacidosis is a serious condition to be treated by your doctor.
  • Remember, test every 4 hours to see if ketones are rising.
  • You will have fluid replacement.
  • You will be given insulin.
  • You will be given electrolytes to prevent complications.

NOTE: Consult your doctor first to make sure my recommendations fit your special health needs.

Roberta Kleinman

About Roberta Kleinman

Roberta Kleinman, RN, M. Ed., CDE, is a registered nurse and certified diabetes educator. She grew up in Long Island, NY. Her nursing training was done at the University of Vermont where she received a B.S. R.N. Robbie obtained her Master of Education degree, with a specialty in exercise physiology, from Georgia State University in Atlanta, Georgia.

She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.

She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.