Need a refresher on ketones!

I’m embarassed to say after more than 30 years with T1D, but I don’t really know when I should test for ketones and what to do if I test positive. It was mentioned much more in the 80’s when I was diagnosed, but I rarely hear it mentioned anymore and I just plain forget. I was in DKA at my dx and once more a few years later when I had a bad stomach virus. I have some Keto-Diastix, but they just sit there and I have to admit my ignorance. Anyone?

Hi angivan,

I was told to test for ketones when your sick, blood sugar stays above 10. I think it depends on the number you get but if its high go to the hospital. I don’t test for ketones because the test strips go out of date and I end up throwing them out.


Thanks! I’m thankful that I have been religiously getting flu shots for the last 12 years and have been really lucky. Once every 2-3 years I get a cold, but those don’t generally stress out my BG’s. That makes sense!

I’m pretty sure I haven’t tested for ketones in about 6 or 7 years or even more, but here’s what I think you “should” do:

Test every morning with your first urine.
Test if your BG is over 250
Test if you are sick

If you get a positive result:

If you wear a pump, change your pump site and reservoir immediately–something is probably wrong.

Take a correction dose of insulin by syringe (you may need more than usual to correct the high BG AND fight the ketones–ask your doctor for dosing instructions)

Do not exercise–this will make ketones worse

Drink plenty of water or other sugar-free drink to stay hydrated and help flush the ketones from your system.

Re-test as needed to see if ketones are gone (or getting smaller).

If you have moderate or large ketones you may feel sick and even throw up. If things get too out of control go to the hospital or at a minimum call your doctor.


not a doctor, but T1 for 43 years …

I agree with KSmerk12 except for the following:

DO DRINK WATER & Take long walks, BUT make SURE you have gotten you BG to a normal level with injections or pump. You can check up to as many times a day you feel you need to …

I keep a bottle on hand, just to be sure. If I happen to mis-guess my carbs and my BG is 350 … I will be running small ketones almost immediately … not good as it is a poison and you want your blood to be akaline not acidic (read all about it if you are into healthy foods, etc).

I also burn ketones if I restrict my carb intake too much, so my BG will be 125, but I’m burning mild ketones - they call it the Atkins diet, but that is not my intent. I typically eat a Paleo Diet so very few carbs …