Information About Ketones
What are ketones?
Ketones are chemicals your body produces when it breaks down fat for energy. This usually happens when there isn’t enough insulin available to use blood glucose (blood sugar), your body’s main energy source. When too many ketones build up, your blood becomes more acidic. If not treated, this can lead to diabetic ketoacidosis (DKA), a serious and life-threatening condition.
Common symptoms of high ketone levels may include:
- Nausea or vomiting
- Abdominal pain
- Heavy or rapid breathing
- Feeling confused or very tired
- Fruity-smelling breath
What leads to high ketone levels?
Ketones can develop and build up any time your body doesn’t have enough insulin or needs more than usual.
Risk factors for high ketone levels include:
- Taking insulin or certain other diabetes medications (like SGLT2 inhibitors)
- Missed or incorrect insulin doses
- Being sick, stressed, or dehydrated
- Having an infection
- Fasting or following a very low-carb eating plan
- Having an elevated A1C
- Having a history of DKA
- Being cared for in a supervised setting, such as schools and long-term care
- Being pregnant
- Belonging to certain age groups:
- Young children
- Adolescents becoming more independent
- Older adults
Signs and Symptoms of Ketones (What to Look For)
When and How to Check for Ketones
Check your ketones if you:
- Feel unwell (especially with nausea, vomiting, or fatigue)
- Are experiencing blood glucose ≥250 mg/dL for ≥2 hours (consider lower thresholds based on individual factors)
- Are sick, dehydrated, or under physical, emotional, or mental stress
- Are fasting or taking certain medications
How to check:
- Blood ketone meter (most accurate)
- Urine ketone strips
What to Do If Your Ketone Levels Are High
Talk to your healthcare team about making a ketone management plan based on your needs so you know what to do when your ketone levels are high. Depending on your age, where you are receiving care, and other factors, your diabetes care team may recommend checking ketones at lower blood glucose levels, such as 200 mg/dL. It is also a good idea to check ketones any time you are feeling sick
If ketones are elevated:
- Check your pump and infusion site daily for leaks
- Continue taking insulin as directed (never stop unless told by your doctor)
- Drink plenty of fluids (water or sugar-free drinks)
- Take correction insulin if it is part of your ketone management plan
- Recheck ketones in 2-4 hours
Call your doctor if:
- Ketones don’t improve
- You feel worse
- Go to the ER or call 911 right away if you:
- Have severe symptoms: vomiting, trouble drinking, confusion, or heavy breathing
- Ketones stay high or get worse
- Can’t reach your doctor
