What are urine ketones, and why are they dangerous?

For individuals living with diabetes, understanding various aspects of their condition is crucial for effective management. One such aspect is the presence of ketones in urine, a common concern among those with diabetes. This blog post aims to demystify urine ketones, explaining their significance, associated health risks, and how to manage them effectively.

In this article you will learn:

• What are Ketones?
• Health Risks Associated with High Ketone Levels
• Significance of Urine Ketones
• How to Test for Urine Ketones
• Understanding Urine Ketone Results
• Treatments for High Ketones
• Keeping Ketones in a Safe Range

We humans are magnificent creatures that have evolved to survive under a range of different circumstances. A process of evolution that developed over time as a means of survival during periods of famine is known as Ketosis and still supports our bodies to this day. (1)

Our body’s preferred source of energy comes in the form of glucose, which we get from eating and digesting carbohydrate-containing foods. To utilise glucose as energy, our bodies require the hormone insulin. Insulin is the key to transferring glucose from the bloodstream into the cells and without it, glucose stays in the bloodstream, leading to elevated blood glucose levels and decreased energy. (2)

When glucose cannot enter the cells, the body turns to another source for energy. This energy source is fat. (3)

Ketones are a by-product produced by the liver when the body breaks down fats for energy. This chemical process, known as ketosis, typically occurs when the body does not have sufficient insulin to use blood sugar from our food for energy, prompting it to turn to fat instead. This is a vital role, ensuring that the body’s organs, particularly the brain, receive adequate energy to function properly when energy is low like in periods of prolonged exercise. Because this is a secondary form of energy retrieval, small amounts of ketones aren’t particularly harmful. However, when ketones serve as an alternative energy source for longer periods of time, especially during fasting or low-carbohydrate diets, their overproduction can be harmful. For people living with type 1 diabetes, this can be a real concern if they have not had enough insulin. (3)

High levels of ketones can lead to Diabetic Ketoacidosis (DKA), a serious complication of diabetes that occurs when the body produces excessive ketones. DKA can cause symptoms like:

• Nausea
• Vomiting
• Abdominal pain
• Confusion
• Stomach pains
• Difficulty breathing

If left untreated, symptoms can progress and may damage vital organs. In worse case scenarios, it can lead to coma or even death. Therefore, it’s essential for people with diabetes, especially those with type 1 diabetes, to be aware of the symptoms of high ketone levels and seek immediate medical attention if they suspect DKA. (4)

People living with type 1 diabetes, or those that experience symptoms similar to those of DKA are encouraged to monitor their ketone levels. To answer the question of ‘what are ketones in urine?’ is simple, as it is the presence of urine ketones. This is a condition known as ketonuria, which indicates that the body is using fat for energy instead of glucose, a sign that blood sugar levels may be too high or that insulin is insufficient. The presence of high amounts of urine ketones highlights that the body is in ketosis and if levels continue to rise, the body is in danger. Monitoring urine ketones can be a crucial part of diabetes management, helping to prevent DKA. (5)

Testing for urine ketones is typically done using urine test strips, which are available over the counter or at a medical facility. This test can be done easily in the comfort of the home. These test strips change colour based on the concentration of ketones in the urine. It’s recommended that individuals with diabetes test their urine for ketones when blood sugar levels are consistently high, during illness, or when experiencing symptoms of DKA. Regular monitoring can help detect the problem early and prevent complications.

Urine ketone test results are usually categorised as negative, trace or small, moderate, or large. 

• Negative or trace amounts generally indicate no cause for concern and present as urine ketone results less than 0.6mmol/L.
• Trace or small amounts of urine ketones highlight that they are building up. They fall between 0.6 – 1.5mmol/L and require action to reduce them.
• Moderate amounts of urine ketones increase the risk of DKA developing. They fall between 1.5 – 3.0mmol/L  and require Immediate action set by your health professional.
• Large amounts of urine ketones require urgent medical attention as DKA is likely present. This is when the result is over 3.0mmol/L. (4) 

 It’s important to understand what your test results mean and we encourage you to consult with your healthcare provider for a plan of ketone management.

If high ketones are detected, treatment typically involves administering insulin to lower blood sugar levels and rehydrate the body to flush out excess ketones. This may require hospitalisation, especially in cases of DKA. Adjusting insulin dosage and carbohydrate intake can also help manage ketone levels. It’s crucial to follow your diabetes management plan and consult with your healthcare team for personalised treatment advice. (6)

To keep ketones in a safe range, people living with diabetes should:

• Manage Blood Sugar Levels: Regular monitoring and maintaining blood sugar within the target range is key.
• Adjust Insulin as Needed: Work with your healthcare team to adjust insulin doses, especially during illness or changes in routine.
• Stay Hydrated: Drink plenty of water to help flush out ketones.
• Follow a Balanced Diet: Ensure a diet rich in fruits, vegetables, whole grains, and lean proteins. (7)

Understanding urine ketones is essential for people with diabetes, as they can indicate potential health risks. Regular monitoring, along with effective diabetes management, can help prevent complications like DKA. Always consult with healthcare professionals for personalised advice and treatment plans.