Ketones — The 6 Must-Knows

Editor's Note: Kyla Schmieg (BSN, RN) is a practicing pediatric endocrinology nurse in Cincinnati, OH, USA, and Type 1 Diabetic, working on the same unit she was diagnosed at 26 years ago. 1 - What are ketones? Ketones are chemicals that build up when your body starts to burn fat for energy. The most common cause of ketones in diabetics is insulin deficiency. Without enough insulin, glucose builds up in the blood stream and can’t enter cells. The cells then burn fat instead of glucose. This results in ketones forming in the blood and eventually spilling into urine. 2 - Why ketones can be bad? Having ketones can be bad because they can indicate that your body needs more insulin. Ketone build up can also lead to Diabetic Ketoacidosis (DKA). Signs of DKA include moderate or large ketones, nausea,vomiting, abdominal pain, fruity or acetone (think nail polish remover) breath, rapid breathing, flushed skin, and lack of energy. 3 - When should you check for ketones? Ketones should be checked anytime your blood sugar is above 240 or any time you are sick. This includes any minor illness such as a cold. 4 - Can you get ketones with a high blood sugar? Ketones typically accompany high blood sugar. Ketones indicate your body needs more insulin. Most often if your body needs more insulin, it means your probably have a high blood sugar. Also, when an illness is present, your body releases hormones in response to the stress. These hormones lead to elevated blood glucose. That is why it’s recommended to test ketone levels during illness. 5 - Can you get ketones with a normal or low blood sugar? Ketones can also be present when your blood sugar is normal or low. These are sometimes referred to as "starvation ketones" or "nutritional ketones." During an illness or extreme diet change, if you have a significant decrease in carb intake, this can lead to the body using fat for energy because there are not enough carbs present to burn. Your blood sugar could remain normal or even be low in this case but your body could still be producing ketones. 6 - What should you do if you have ketones? It is recommended that you drink 8 ounces of water or carb/caffeine free beverage every 30-60 minutes to help flush out the ketones. Again, ketones are a sign that your body needs more insulin. Some people might already have an insulin dosing plan in place related to ketones. It’s typically a percentage of your daily lantus dose or percentage of your total daily basal volume (for pump users) based on whether ketones are small, moderate or large. It is always best to call your endocrinologist to verify what they recommend when ketones are present.

Why is Type 1 Diabetes Misdiagnosed?

Many people with Type 1 share a similar diagnosis story. They display all the classic symptoms (extreme thirst, weight loss, frequent urination, nausea) and were fortunate enough to be accurately diagnosed by their primary care doctor. However, some people with Type 1 are not as fortunate to quickly receive a correct diagnosis.

All About DKA

Diabetic ketoacidosis (DKA) is a complication from diabetes that can be serious and life-threatening. DKA is often a common factor when first diagnosed with Type 1 diabetes and can often be mistaken for flu symptoms. It occurs when the body is not receiving enough insulin to break down glucose, which forces the body to start breaking down fat as fuel. Ketones are then released into the body. Elevated ketones in the urine, severe weight loss, extreme thirst, blurry vision and disorientation are all signs of DKA.

DKA On The Rise: Dr. Satish Garg Explains Why

"15-20% of Type 2 diabetes cases are misdiagnosed. These patients have antibody positive Type 1 diabetes. So clearly their Type 1 diabetes was totally mistreated and misdiagnosed. That's why the actual number of people who are living worldwide who are insulin requiring is more like 150 to 200 million people, out of which probably closer to 70-80 million people actually have classical Type 1 diabetes, if you define by antibody positive."

DKA at 30,000 Feet

PK shares the harrowing story of her daughter's experience going into DKA while on a plane. Thankfully, the two were surrounded by professionals.

Flaws in Technology: A Case of DKA

Ilse Michelle Mora Rodríguez is a doctor who has lived with Type 1 for nearly her entire life. Her brush with DKA came when she least expected it.

‘This Doesn’t Happen To Me’ — A New DKA Perspective

Neil Greathouse shares his DKA experience and how the incident truly humbled him.

Lessons Learned: Michelle’s Unusual DKA Experience

Michelle Lord shares her DKA experience + the importance of testing for ketones.

A Deadly Lack of Information

Jillian Rippolone shares the story of one of her DKA experiences. She laments not having more information and her inability to recognize symptoms.

STICH Protocol for DKA Management

With SGLT inhibitors increasingly being used off-label to treat Type 1 diabetes, it is vital that patients on these drugs know when and how to treat for ketones.

Ketone Meters: What to Look For

You might be surprised to hear that ketones are a necessary part of your body’s metabolic processes – after all, any mention of “ketones” is usually accompanied by feelings of dread among PWDs.

Testing For and Managing Ketones

A fundamental component of spreading DKA prevention is to address ketones. Here you'll find the commonly recommended steps for ketone checking and handling.

Ketones vs Ketosis vs DKA

What are the differences between ketones, ketosis, and DKA? These terms are commonly used in the Type 1 community but what do they mean? Here is a breakdown of their definitions and differences.

‘Previously Healthy’ Nominated for Best Writing (Editorial) in the 23rd Annual Webby Awards

Type 1 diabetes story nominated for a Webby alongside work from BBC Future, The Guardian, The New Yorker, and The Intercept.

Four Years Later: Reflections on Losing Will

As I approach the four year anniversary of Will’s death, I find myself reflecting on what my life looks like now compared to before.