Generally, elevated ketonesare treated with extra doses of insulin and plenty of unsweetened fluids.

The fluids keep people hydrated and flush out the ketones. The insulin allows the body to utilize glucose for energy instead of burning fat, which produces the unwanted ketones.

If you discover trace amounts of ketones in your urine and feel well, you are likely okay. Continue monitoring and inform your doctor.

When feeling unwell, even small amounts of ketones are a concern and should be carefully monitored to determine whether they are on the rise or decreasing. Call your physician if they continue to elevate.

Managing Elevated Ketones

With moderate or large amounts of ketones present in your urine, it is important to follow any instructions given by your doctor and contact your diabetes care team for immediate advice. If ketones are high and you are feeling sick, call 911 for a ride to the hospital.

Should ketone levels be low to moderate and you are doing okay, doctors usually recommend four things:

Drink a lot of water or other unsweetened beverages.

Take extra insulin if you have been taught how to do so (e.g., choosing insulin type, calculating dosage), otherwise wait for guidance from your diabetes care team.

Every hour or two, test your blood glucose and urine ketone levels until the ketones are cleared and the glucose is coming down.

Do not exercise with elevated ketones.

Always get help in the following circumstances:

Urine ketone levels are high or an elevated level is not coming down after you’ve started treating for ketones.

You cannot care for yourself or are experiencing drowsiness, rapid breathing, abdominal pain, nausea or vomiting.

You do not know how much extra insulin to take.

You cannot drink fluids.

You have an illness or temperature that does not improve.

Diabetes + Illness or Stress = Always Check Ketones

The main causes of elevated ketones affecting those with type 1 diabetes are missed insulin injections, not taking enough insulin, an insulin pump insertion coming out, or an insulin pump malfunction.

Primary causes of increased ketones in both type 1 and type 2 diabetes are infection or illness and traumatic stress on the body (stress hormones can cause fat breakdown and the release of ketones).

So anyone with diabetes who has an infection or is in a highly stressful situation should be prepared to check his or her ketone level. Keep ketone test strips on hand (or a ketone meter) and know how to use them.

Sources:; UC Denver

Photo credit: Stefanie Neves / flickr

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