Why Test for Ketones?

According to my endo, I could start getting ketones at over 200.  When talking about situations like sick days, she said to test for them if I hit 200 or up: "And if you have ketones, you know you need to give yourself more insulin."

Then I'm walking down the hall and I go, "Wait... If I'm over 200, I'm going to give myself more insulin anyway.  So what's the point of that Ketone test?"

I get that it's valuable to test based on needing to know if you have a lot of ketones, and that you need to keep checking on it to make sure they go away once they show up, but did I miss something?  If you have a BG of 250 and trace ketones, would you bolus any differently than if you were at 250 without ketones?

Personally, I only check for ketones when I can't explain why I'm super-high.  The presence of ketones would help explain why I can't get myself to come down - and probably get me to inject some insulin on top of what my pump is administering. 

If you were showing keytones for an extended period of time (days), you'd want to seek medical attention.  That's why they want you to test, to my knowledge.

A positive ketone test may indicate:

 

"burn fat for energy when insulin is not present. Burning fat instead of sugar for energy releases ketones into the bloodstream and into the urine. Ketones in the urine may signal diabetic ketoacidosis, a dangerous condition that is caused by the buildup of ketones and very high blood sugar levels. "

Alert!

It is a poisonous substance.  Complications can include: fluid buildup in the brain (cerebal edema), heart attack and death of bowel tissue due to low blood pressure, and renal failure.

Go to the emergency room or call the local emergency number (such as 911) if you experience:

  • Decreased consciousness
  • Difficulty breathing
  • Fruity breath
  • Mental stupor
  • Nausea
  • Vomiting

 

 

Kim: That makes sense.  I think it was the "then you know you need to take more insulin" that threw me.

David: Science isn't my thing, and I haven't taken biology in oh, 10 years?  But I just haven't fully wrapped my brain around the whole ketone/ketosis/ketoacidosis thing yet.  I need to do some research.  It's stuff like that statement, "Burning fat instead of sugar for energy releases ketones into the bloodstream."  So... does burning fat at all make ketones?  And are they dangerous in that case?  Or is it that they're only that lots of ketones are bad for you, but they're otherwise a normal part of our metabolism?  And really-low-carb dieters can go into ketosis, and the ketones are supposedly a good sign, then?

BRAIN HURT!

(But I know that, at this point, I should just be considering ketones a bad thing for me.)

I agree with Kim.  We only check ketones when there is something unusual in the numbers like an unexpected high or when a sick day comes or appears to come. There have been many times my son has gone above 300 that can be explained plus he is getting really good at knowing his own body and will test for ketones when he things something is not right. 

To be honest I would be interested to see if the non diabetic medical community would suggest a ketone test over 200 or 300 as many times as they do if they had to do it also.  I think that sometimes it  becomes the non diabetic medical vs the real diabetic world. 

I tested fairly often growing up, but have learned (knock on wood!!!) I rarely get them. The most I've ever had is trace. So, now I test less often (high for an extended period). I'm sure endos would disagree, but I've had D for 28 years, and it seems to be working for me.

I main reason I'd want to know if I had ketones (other than DKA of course) is that exercising can make them worse. So, if you're high, a bit of exercise can help bring you down. (I sometimes go on a walk with a stubborn high). But, with ketones, you don't want to do that.

my blood sugar was just 356 i had no ketones?

I haven't tested for ketones since my first year of diabetes (1995).  My mentality is the same as yours: I'm going to be taking insulin to reduce my blood sugar anyway, so I see no need to test for ketones separately.

[quote user="Khendra"]

I haven't tested for ketones since my first year of diabetes (1995).  My mentality is the same as yours: I'm going to be taking insulin to reduce my blood sugar anyway, so I see no need to test for ketones separately.

[/quote]

Because with ketones you need more than your normal correction ratio from what I have read. So if Ri is 300 and has no keytones she would get 3 units if she is 300 with ketones she could get 4-6 units for the correction.

[quote user="Elizabeth"]

Then I'm walking down the hall and I go, "Wait... If I'm over 200, I'm going to give myself more insulin anyway.  So what's the point of that Ketone test?"

[/quote]

they try not to confuse the heck out of us, and then make things more complicated by oversimplification.

keytones are fine and they are normal and everyone of us diabetic or not will have keytones in our urine if we are losing weight or exercising (using the fat in our bodies).  there's no reason to call a hospital if you just have keytones. 

SO what's the point of the test?  okay, in the event your blood sugar is very high, typically as a result of way too little insulin, your body will begin to burn fat and muscle for basic energy, because the sugar can't be used for energy without insulin, even if it reaches 300+ in your bloodstream.  This can be corrected with insulin, however, if your sugar is high, and it's been some time, and your body is burning fat for energy - then keytones, the by-product of fat metabolism,  can reach a very high level, sometimes quickly, and this becomes a runaway reaction.  So "runaway" in fact that insulin isn't going to save you.  When this happens you need to get yourself ot a hospital for IV fluids, and continue insulin, and observation or (and now I'll simplify) you'll be horribly sick and can die.

so if you have high blood sugar, correct the way you normally correct.  if you have high bs and keytones... this means  "danger": so you correct and keep checking (bs comes down, keytones go away or are very small) till your good.  if you have high bs, high keytones, your bs isn't coming down with insulin and you have ketoacidosis symptoms... get to a ER.

sorry it's long... I am not sure if I made it better or worse... =)

Joe, you are the man with the answers!  I would answer 'Why check for ketones?" with "why not?"  We test for everything else.  And ketones are easier to check for than a glucose test.  

Ketones in your urine shows that your blood sugar has been above normal for an extended period of time, that's why someone can test at 400 and have no ketones or test at 200 and have an extremely high level of ketones.

Like David and Joe said ketones occur when fat breaks down... WARNING:SCIENCE - Our bodies need insulin to convert the food we eat into energy for our cells, when no insulin is available the cells find the next best food, which is fat, and wouldn't be a problem except for the fact that when our cells eat fat they kind of "poop" out ketones which is poisonous to our bodies.

The reason why you have to give more insulin when ketones are present in the blood is because when ketones are present it means your body is checked into survival mode eating away at those fat cells. However much insulin you would need to take down a 300 without ketones may be tripled when ketones are present. This is because our bodies need to make sure there is enough insulin present in the blood stream before switching back to normal mode from survival mode.... blah, blah liver, blah kidneys, you kinda get the point.

So basically, just test for ketones when your blood sugar seems like it ain't budging despite the insulin you've given for it. If you do not have the ability to get your blood sugar and ketone levels down that's when you should check into the hospital.

You definitely don't need to test for ketones every time you are high.

I think Joe and Andrea have done an esp. good job on explaining the why and what. I'll just chime in with my 2 cents on when to test, or when I test my son.

When he was on shots, we were told to test anytime he was over 300 for 2 BG checks in a row. So you'd see a 322, give him his bolus correction and then check 2-3 hours later. If still over 300, then test for ketones.

Now, that he is on a pump, we are supposed to check for ketones whenever he is over 300 at any test. We in practice, only do if it is an unexplained high. If we forgot to bolus earlier, then I don't. I still follow the rule of 2 checks in a row over 300 for the most part. Also, insulin works in his body for 3-4 hours so we can test his BG 2 hours post meal/bolus and he can be over 300, but if you correct then he has a good chance of being low 2 hours later. If we just wait till 3-4 hours after a meal, he'll be right back to his target range. (Partly this is because we bolus after meals because we are never sure how much he'll eat.)

Finally, a blood ketone meter is most accurate. Ketones won't show up in your urine until 2-3 hours after they start showing up your blood.

I always test when I'm over 240 and if I have ketones that I change my site (I have a pump) and get a shot with the insulin for my correction (plus I get more insulin for ketones than just a correction.

So like for large ketones I get the units for my correction plus 2 units.

[quote user="Andrea"]

Ketones in your urine shows that your blood sugar has been above normal for an extended period of time, that's why someone can test at 400 and have no ketones or test at 200 and have an extremely high level of ketones.

[/quote]

That makes sense.  I basically never got ketones in that first year I did test for them because I would always correct immediately once I felt my sugar getting high, so it seemed a waste to keep testing for ketones.  I can't tolerate high blood sugar for several hours the way so many other people can, so ketones aren't a worry for me.  When I feel my sugar getting high, I test and then do an insulin correction as needed.

Thanks everyone, all this input is really helpful!  I'll be able to ask better questions the next time I see my endo, and I'll have good "experience" info to draw on any time I'm facing ketones.

I haven't been given any particular amount of "additional" correction if I have moderate/high ketones, so I'll ask her about that next time.  In the meantime, I'll use the test to determine:

1. If I have any ketones.

2. If they're going away after I treat the high blood sugar.

3. If they're high enough to justify a call to my doctor or a trip to the ER.

I meet with her late this month, so hopefully I'll have more complete directions before I ever have to face ketones at all.  :)

I love Juvenation...  You guys are so knowledgeable and supportive!

I don't know if anyone has already mentioned this or not but if you do have ketones it tends to make it harder for your sugar to come down.  The last time I had high sugars and ketones I was told to drink as much water as humanly possible, check BG every hour until it was down, and to check for ketones every time I went to the bathroom until it was hard to tell if there was even a trace.  I was also told that I needed to check  for them if I was 240 or over, running above 200 for a long period of time, and/or when sick (whether BG is high or not, if not to check periodically).