Ketones: Good Fuel or Danger Sign?

I remember a patient, let’s call him Mark, who came in feeling just… off. Terribly thirsty, a bit fuzzy-headed, and his breath had this odd, sweetish smell. Turns out, his body was sounding an alarm with something called ketones. It’s a word you might hear thrown around, especially with diets or if you’re managing diabetes. So, let’s chat about what they are.

What Exactly Are Ketones?

So, what are these ketones, exactly? Think of them as little acid compounds your body makes when it’s not getting enough energy from its usual source – glucose. Glucose is a type of sugar we mostly get from carbohydrates in our food. If there isn’t enough glucose available, or if your body can’t use the glucose it has (like in some types of diabetes), it cleverly switches to Plan B: breaking down fat for fuel. This fat breakdown releases ketones into your bloodstream. These ketones then travel around, giving energy to your tissues, and eventually, you pee them out.

It’s perfectly normal, even healthy, to have some ketones floating around. Your body is just being resourceful! It might ramp up ketone production when:

• You’re catching some Z’s overnight.
• You’re fasting for a bit.
• You’ve had a good workout.
• Or, if you’re following a specific eating plan like the keto diet.

You’ve probably heard about the keto diet. People on this diet intentionally cut way back on carbs and eat more fats to encourage their bodies to burn fat and produce ketones. This state is called ketosis. Now, while this can have benefits for some folks, it’s a big change for your body. It’s not for everyone, and honestly, it can be pretty tough to stick with. So, if you’re thinking about it, please, let’s chat about it first, okay?

Where does all this ketone-making magic happen? Mostly in your liver. Your liver sends these ketones out into your bloodstream, and off they go to power up your body. Once they’ve done their job, your kidneys filter them out, and you pass them in your urine.

When Ketones Become a Concern: Understanding Ketoacidosis

Now, while some ketones are fine, too many can be a real problem. If ketones build up too much, they can make your blood too acidic, and that’s toxic. We call this ketoacidosis.

The most common scenario we see this in is with diabetes, particularly Type 1 diabetes. In Type 1, the body doesn’t make insulin, the hormone that helps glucose get into your cells for energy. Without enough insulin, sugar builds up in the blood (hyperglycemia), but your cells are still starving. So, the body cranks out ketones. If this gets out of control, it can lead to diabetic ketoacidosis (DKA). DKA is serious, folks. It’s a medical emergency and needs treatment right away. It’s more common in Type 1, but it can happen with Type 2 diabetes too.

There’s another situation, though less common: alcoholic ketoacidosis. This can happen in people who drink a lot of alcohol, especially after a binge followed by poor nutrition, maybe due to vomiting. Just like DKA, this is an emergency.

Spotting the Signs: Symptoms of High Ketones

So, how would you know if your ketone levels are getting too high, especially if you have diabetes? Listen to your body.

Early on, it might feel a lot like high blood sugar:

• Peeing a whole lot more than usual (frequent urination).
• Feeling incredibly thirsty, like you just can’t get enough water.
• A dry mouth, maybe even some dehydration.
• Dry skin.
• A nagging headache.

If it’s progressing to DKA, and this can happen fast – sometimes in less than 24 hours – you might notice:

• Feeling sick to your stomach, maybe nausea and vomiting.
• Deep fatigue – not just tired, but really weak.
• Stomach pain.
• Feeling short of breath.
• Confusion or difficulty concentrating.
• A distinct, fruity smell on your breath (sometimes called “keto breath”).

If you experience these, especially the latter ones, it’s crucial to seek medical help quickly.

Checking Your Ketone Levels

If you’re at risk for DKA, it’s a good idea to know how to check your ketone levels. We can do tests in the clinic, but you can also get kits to use at home. Pharmacies have them, or you can order them online. Let’s talk about which type might be best for you.

• Blood tests: These are pretty accurate. You can get a kit that involves a small finger prick – much like checking blood sugar. A drop of blood goes on a test strip, and a meter gives you a reading. Some blood glucose meters (glucometers) actually check for both sugar and ketones, which is handy.
• Urine tests: These use little dipsticks. You pee in a clean cup, dip the stick, and it changes color. You compare the color to a chart. Urine tests tell you about your ketone levels over the past few hours, not necessarily right now like a blood test does.
• Breathalyzer tests: You might see these marketed, especially for people on the keto diet. They try to measure a type of ketone called acetone on your breath. Honestly, the technology is still pretty new, and we need more research before we can say they’re super reliable for medical decisions. If you’re at risk for DKA, a blood or urine test is the way to go.

What Do Your Ketone Test Results Mean?

Knowing your numbers is key. It helps you understand if you’re heading towards DKA and need to act. The ‘normal’ or ‘high’ levels can vary a bit from person to person and depending on the test.

But generally, for blood ketone levels:

• Below 0.6 mmol/L: Usually considered normal. Phew.
• 0.6 to 1.5 mmol/L: Means you’re making more ketones than usual. This is a heads-up. Time to think about why and maybe re-check soon.
• 1.6 to 2.9 mmol/L: This is a moderate level. You’re at increased risk of DKA. You should definitely be talking to your doctor or diabetes care team for advice.
• 3.0 mmol/L or higher: This is a high level and means you could have DKA or are very close to it. You need to seek medical attention right away – often this means a trip to the ER.

When Should You Check Your Ketones?

If you have diabetes, we’ll work out a plan for when you should check your ketones. Generally, it’s a good idea when:

• You have any of those DKA symptoms I mentioned.
• You’re sick with something else, like the flu or an infection. Illness can throw your sugar and ketone levels off.
• You’ve missed one or more insulin doses.
• Your blood sugar is running high, say over 240 mg/dL (or 13.3 mmol/L).
• You’re pregnant. Managing diabetes during pregnancy needs extra care, and that includes watching ketones.

Treating High Ketones

How we treat high ketones depends on how high they are and what’s causing it. If they’re just a bit elevated, we might be able to guide you on managing it at home. That could involve:

1. Adjusting your insulin dose.
2. Making sure you’re getting enough fluids and the right kind of food.
3. Figuring out what level of activity is safe.
4. Checking your blood sugar and ketone levels more often.
5. Knowing exactly when to call us or head to the emergency room.

If your ketone levels are dangerously high, or if you have DKA, hospital treatment is usually needed. This often involves IV fluids to rehydrate you and insulin given through an IV to bring your blood sugar and ketone levels back down safely. We’ll discuss all options for you, of course.

Keeping Ketone Levels in a Safe Range

The best approach is prevention, especially if you’re at high risk for DKA.

• Stick to your routine: If you have diabetes, following your meal plan and insulin regimen is so important for keeping blood sugar stable, which in turn helps keep ketones in check.
• Insulin pump users, take note: If you use an insulin pump, make sure you understand how it works, how to spot any problems with it (like a blockage or if it comes disconnected), and always have a backup plan for getting insulin if your pump fails. This can really reduce your DKA risk.
• Know your numbers and when to test: Understand what’s a normal ketone level for you and when you need to act. We can make a plan together.
• Be ready: Keep those ketone test kits handy if you’re at risk. And have a clear plan for what to do if your ketones are high – when to call the doctor, when to go to the ER. Time is critical with DKA.

Key Takeaways on Ketones

Here are the most important things to remember about ketones:

• Ketones are your body’s backup fuel, made from fat when glucose (sugar) is low or can’t be used properly.
• It’s normal to have some ketones, especially during fasting, prolonged sleep, intense exercise, or if you’re on a ketogenic diet.
• Too many ketones can make your blood acidic, leading to a serious condition called ketoacidosis. Diabetic ketoacidosis (DKA) is a major concern for people with diabetes, particularly Type 1.
• Be alert for symptoms of high ketones or DKA, such as extreme thirst, frequent urination, fruity-smelling breath, nausea, vomiting, stomach pain, and confusion.
• You can monitor ketone levels at home using blood or urine tests. It’s important to know your target range and when to test.
• If you have diabetes, working closely with your healthcare team to manage your blood sugar effectively is crucial for preventing dangerously high ketone levels.

It might sound a bit complicated, but understanding ketones is just another piece of the puzzle in managing your health, especially if diabetes is part of your life. You’re not alone in figuring this out, and we’re here to help every step of the way.