If glucose levels are very high Type 1 diabetes, then blood ketones may be formed and lead to a serious, potentially life threatening complication known as Diabetic Keto Acidosis (DKA). This is an emergency condition and should be treated in a hospital. If glucose levels are very high and not responding to insulin treatment then a blood ketone test should be done at home. If ketones are elevated GO TO THE EMERGENCY ROOM for further treatment.

What are Ketones?

In diabetes, there is not enough insulin to help your muscles absorb glucose from the blood. And when your muscles are starved for energy they start to "burn" fat. This produces breakdown products called ketones. These are toxic acids. The accumulation of these acids in the body may lead to the condition called ketosis and as it gets more serious, ketoacidosis or DKA. We can test for ketones using urine ketone testing strips or we can test for blood ketones. The Canadian Diabetes Association Guidelines suggest that blood ketone testing is more appropriate. There is one glucose meter in Canada that can also test blood ketones, this is the Precision Xtra meter and there are special ketone testing strips available, they come in a package of 10 and cost about $20:00. Most private drug plans will cover the cost though the Ontario Drug Benefit plan and some other provincial plans do not.

Diabetic Ketoacidosis (DKA)
  • Occurs when excessive levels of ketone accumulate and the body becomes acidotic.
  • It is a potentially life-threatening condition.
  • -Hydroxybutyrate is the predominant ketone associated with DKA.
-Hydroxybutyrate: A key to DKA Detection, Better Clinical Decisions

Sick-day management requires increased monitoring of blood glucose and assessment for ketosis. Testing for -Hydroxybutyrate is a key to early diabetic ketoacidosis (DKA) detection. Blood ketone testing methods are now available and preferred over urine ketone testing for diagnosing and monitoring ketoacidosis.

Clinically Accurate -Hydroxybutyrate Measurements

-Hydroxybutyrate Reading Interpretation
1.6 to 3.0 mmol/L Readings above 1.5 indicate you may be at risk of developing diabetic ketoacidosis or DKA. Contact your healthcare provider immediately for advice
0.6 to 1.5 mmol/L Readings between 0.6 and 1.5 may indicate the development of a problem that may require medical assistance. Follow your healthcare provider's instructions.
Below 0.6 mmol/L Readings below 0.6 are in the normal range.

Ron Zacker, RD, CDE, is currently working as a diabetes educator at Froedtert Hospital while attending the Graduate Physician Assistant Studies Program at Marquette University in Milwaukee, Wisconsin. He can be reached at