In healthy individuals, carbohydrates are the body’s main energy source. When the body is unable to use carb sources like glucose, it breaks down fat for energy—this commonly occurs when there is not enough insulin to use glucose for energy.
When there is too little insulin, ketones will likely show up in the blood or urine. Ketones are the chemical byproduct produced when the body burns fat for fuel.
Ketonuria is the medical condition when ketones in urine are present. High ketone levels, in combination with high blood glucose levels (hyperglycemia), can lead to a dangerously toxic body and the condition known as diabetic ketoacidosis.
What Is Ketoacidosis and Ketonuria?
Ketoacidosis or ketonuria can occur when a type 1 diabetic doesn’t take their insulin. It also occurs when insulin-dependent diabetics fail to meet the higher insulin demands from stress, injuries, or an illness. Ketoacidosis and ketonuria may also occur in type 2 diabetics who are sick and insulin-deficient.
Ketoacidosis can be the first sign of diabetes, especially when there hasn’t been a formal diagnosis. Uncontrolled diabetes may have ketones in the urine or blood without ketoacidosis, when the diet is very low in calories, nutrients, or carbohydrates.
Ketones in urine can be produced from weight loss, hyperthyroidism, prolonged vomiting, or excessive aspirin use.
Diabetics may also opt for the ketogenic diet, which is low in carbohydrates and calories. In this case, the body may compensate for the lack of carbs and calories by breaking down fat to use ketones for energy.
When there is enough insulin, ketoacidosis should not be a problem with the ketogenic diet.
Why Should You Test for Ketones in Urine?
Ketoacidosis is a medical emergency, and it is potentially life-threatening. Progressive ketoacidosis can lead to metabolic problems; however, it can even lead to a coma or death.
Ketoacidosis is associated with alcoholism, fasting, starvation, ingestion of the toxic chemical isopropanol, and high-protein diets.
Diabetics who take insulin and have blood sugar levels higher than 14 millimoles per liter (mmol/L) should definitely test for ketones on a regular basis. A home ketone test will be able to check for ketones in urine or blood.
There are several reasons why a ketone test is necessary:
- It is considered a convenient method to monitor diabetics, especially when they are sick.
- It is also useful for people on a high-fat or low-carbohydrate diet to monitor ketone levels.
- Ketone testing is also used for someone that cannot eat due to fasting or eating disorders like anorexia. The person may also experience symptoms of diarrhea or frequent vomiting.
- Pregnant women with diabetes or gestational diabetes should also be monitored with a ketone test. Gestational diabetes is a form of diabetes that sometimes develops during pregnancy, and it often disappears when the baby is born.
When Do You Test for Ketones?
It is best to consult your doctor or nurse to help you understand when you should check for ketones in your urine. Your health history and symptoms are the best indications of whether ketone urine testing is necessary.
When is it a good time for a ketone urine test? Pregnant women may be advised to monitor ketone levels any time the blood glucose reading jumps above 200 mg/dl, or before breakfast.
You should also test for ketones in urine when you experience one or more of the following symptoms associated with ketoacidosis or ketonuria:
- Your blood sugar number reads over 300 mg/dl.
- You have fruity-smelling breath.
- You experience hyperventilation or trouble breathing.
- You experience dry mouth and excessive thirst.
- You experience frequent urination.
- You lack energy and feel mentally confused.
- You have dilated pupils.
- You are sick or injured. (Injuries, infections, and illnesses are causes of sudden high blood sugar levels.)
- You experience abdominal pain, nausea, or vomiting.
- You have flushed or dry skin, or your skin lacks color.
When any of these symptoms persist, it is likely that ketone levels are high or above average.
How to Test for Ketones in Urine
The ketone blood test is often the most accurate method for measuring ketones; however, a urine test is most recommended by doctors. The ketones in urine tests are often measured as “spot tests.”
Ketone urine kits are often available at the drug store. The kit will contain chemical-coated dipsticks that react with the ketones.
1. How to Perform the Urine Test
Simply place the dipstick in the urine sample. If the dipstick changes color, then there are ketones in the urine. The results are then compared with a color chart that is supplied in the kit.
Your doctor may also give you a clean-catch kit that will help you obtain more accurate results. The kit contains sterile wipes and a cleansing solution.
2. How to Prepare for the Test
Your doctor may tell you to avoid medications or supplements that may falsify the test, such as glucocorticoids, levodopa, phenazopyridine, valproic acid, inositol, metformin, methionine, captopril, and ascorbic acid (vitamin C).
3. How the test feels
You should feel no discomfort with the urine ketone test, and it only involves urination.
What Do the Results Mean?
The next step is to interpret your ketone results:
- A normal ketone result is under 0.6 mmol/L. Normal may at times indicate a negative test result.
- A result of 0.6 to 1.5 mmol/L is an indication that there are trace amounts of ketones. This may also read as less than 20 milligrams per deciliter (mg/dl). Basically, there are more ketones than normal. It may be a sign that ketones are starting to build up. The test should be taken again in a few hours to see if the number changes.
- A result of 1.6 to 3.0 mmol/L is an indicator of high ketone levels, and ketoacidosis or ketonuria may be risk factors. It may also read as a moderate score of 30 to 40 mg/dl.
- Above 3.0 mmol/L is considered a dangerous ketone level, and immediate attention is required. A high score is more than 80 mg/dl.
Also, make a note that exercise is never recommended when ketones in urine reveal to be moderate or high; overall, moderate to high ketones in urine are a dangerous sign that diabetes is uncontrolled, and your doctor should be informed immediately.
It is also good practice to keep track of your ketone urine test results to help your doctor in the process.
Keep in mind that abnormal urine ketone test result may also be a result of burns, fever, acute or severe illness, anorexia, fasting, high protein or low carb diets, long-term vomiting, starvation, hyperthyroidism, lactation, or pregnancy.
How to Avoid Ketonuria or Ketoacidosis
The best way to avoid high levels of ketones in urine is by controlling blood sugar levels. A healthy diet is the best approach for blood sugar control. A good first step is the consumption of low-glycemic index (GI) foods. These foods have a GI of 55 or below.
Glycemic load (GL) foods will also be the amount of carbs per serving in the particular food. Low GL foods will be 10 or less. It is important to note that foods that are low GI may not necessarily be low GL.
There are a variety of low glycemic vegetables such as:
- Swiss chard
- Collard greens
- Turnip greens
- Brussels sprouts
Low glycemic fruits include:
Low GI grains include quinoa, amaranth, buckwheat, oats, spelt, and wild rice. They are also considered medium GL, and it is best to pair them with low glycemic vegetables to help balance blood sugar levels.
Type 1 diabetics should remember to inject insulin at appropriate times to avoid the buildup of ketones.