KETONES AND TYPE 1 DIABETES

How will I know if I have ketones?

Ketones are very easy to test for. When your body is high in ketones, it tries to get rid of them very quickly. It does this by pushing them out in your urine. Testing your urine for ketones will give you a clear indication of how high your blood ketones are.

What does having ketones mean?

If you have Type 1 diabetes you are at risk of releasing dangerously large amounts of ketones. This can happen if you haven’t taken enough insulin, or if you have accidentally missed a dose, or when the insulin you have injected doesn’t work as well as it should, for example when you are sick. Your insulin needs will change in certain situations.

When you are sick or injured, your body becomes resistant to the action of insulin (your insulin can’t work properly) and your body’s need for energy increases. This is because your body needs extra energy to fight infection or heal from an injury. Ketones are acids that are released into your blood when the body can't use its normal source of energy (glucose). When you have Type 1 diabetes, ketone levels can sometimes build up to dangerous levels if you don't have enough insulin. So, to put it simply, having ketones means your body needs more insulin.

If you have a very large amount of ketones in your bloodstream, it can lead to a condition called ‘diabetic ketoacidosis’, sometimes called DKA. This can be prevented with early treatment as in the section below, “What should I do if I have ketones?”

How will I know if I have ketones?

Below are some of the symptoms of ketones in the blood:

·       excessive thirst and urination

·       fatigue

·       high blood glucose

·       presence of ketones in the blood or urine

·       abdominal pain (especially in children)

·       confusion

·       decreased sweating

·       dry, cool skin

·       nausea and vomiting

·       rapid weight loss

·       sweet, fruity odour on the breath (it may smell like nail polish remover)

·       deep and laboured breathing (a later symptom)

How do I test for ketones?

All people with Type 1 diabetes should have a CareSens Dual meter and ketone blood testing strips (check they have not expired).

When should I test for ketones?

You should test for ketones when your blood glucose is more than 15mmol/L and you have hyperglycaemia symptoms; OR if your blood glucose is over 15mmols/L twice in a row (three hours apart) and you do not have symptoms of hyperglycaemia; OR if your blood glucose is climbing and you feel unwell; OR if you are injured and your levels of blood glucose are increasing.

 What should I do if I have ketones?

Things you can do for yourself if your ketones are raised are as follows:

  0.2─0.6 mmol/L: Drink plenty of water, take your usual insulin at your usual time. Check your blood ketone levels again in 1‐2 hours. Hopefully, they will be dropping.

 0.6─1.5 mmol/L: Talk with your health care team. They will generally recommend that you take an additional dose of rapid or short acting insulin. They will also recommend that you drink lots of water and check your ketones every 1‐2 hours to make sure they are dropping.

 1.5 mmol/L─2.5mmol/L: Talk with your health care team urgently. They may want to see you immediately, or they may recommend that you take additional rapid or short acting insulin, drink plenty of water, and check your ketones every hour to make sure they are dropping.

 2.5─3.5 mmol/L or more: If you can't talk immediately with your specialist diabetes team, you need to go to hospital urgently. If you are feeling at all unwell, you are short of breath, or your ketones are very high, this trip should be in an ambulance. Your team will recommend that you take an additional dose of short or rapid acting insulin and drink plenty of water on the way.