Diabetic Ketoacidosis (DKA)
What are Ketones?
In diabetes there is not enough insulin to help your cells to absorb glucose from the blood and when your cells are starved for energy that they start to “burn” fat. This produces breakdown products called Ketones. These are toxic acids that appear in the blood first and then eventually overflow into urine. The accumulation of these acids in the body may lead to the condition called Ketosis and, as it gets more serious, ketoacidosis or DKA.
If left undtreated DKA is a life threatening condition. Symptoms may include ketotic breath (often compared with the smell of peardrops), frequent urination, weakness, nausea and vomiting, confusion and eventually loss of consciousness known as Diabetic coma. DKA can occur in both Type 1 and Type 2 diabetes, but it is more common in Type 1. Ask your healthcare professional how blood ketone testing can be incorporated into your sick day management plan to help prevent progression to DKA.
How to test for Ketones.
You can use the inexpensive urine testing strips (approx. £4 – 5 over the counter, or free on prescription) but urine testing only gives information about what your ketone levels were two to four hours before you tested and is dependent on you being able to pass urine. Blood ketone testing is preferable and more reliable, but at present there is only one meter manufacturer producing blook ketone strips in the UK. The manufacturer is Abbott and they produce blood testing strips only for the Optium Xceed meter. However, these strips are expensive, £19.95 per 10 strips for the NHS to purchase, therefore it may be difficult to persuade your team to prescribe them. They do, however, detect ketones far earlier than the urine strips and much more reliably since the urine strips rely on you “reading” them within a certain number of seconds and refer to ketones as being +, ++, ++++ etc. The blood ketone strips will give actual mmol/L in the same way as your meter tells you your BG in mmol/L. Plus they are giving you an early warning of impending DKA.
When should I test for Ketones?
Ask your healthcare professional when you should test for ketones. Many diabetes experts advise to test for ketones during acute illness or stress, and/or when blood glucose levels are consistently elevated.
How do I test?
If you are using urine strips carefully read the “patient information leaflet” in the pack. It is essential that the results are read at EXACTLY 15 seconds from applying the urine sample. The colour on the strip is compared with the colour chart on the outside of the tub. The colour blocks represent nominal values, actual values will vary around the nominal values. The colours will represent relative amounts of ketones. Proper read time is critical for accurate results
Testing your blood with Optium blood ketone strips, in the same manner as you test your BG, will give actual values as of right now.
What does my blood ketone result mean?
Above 1.5 mmol/L
When your blood B-Ketone reading is higher than 1.5 mmol/L and your blood glucose reading is higher than 16.7 you may be at risk of developing Diabetic Ketoacidosis (DKA). Contact your healthcare professional immediately for advice. (I’ll add to that… if your HCP is unavailable go to A&E).
0.6 to 1.5 mmol/L
When your blood B-Ketone reading is between 0.6 and 1.5 mmol/L and your blood glucose reading is higher than 16.7 , this may indicate the development of a problem that may require medical assistance, follow your HCP’s instructions. (which will probably be…. drink lots of water to flush out the ketones and give correction dose).
Below 0.6 mmol/L
Results below 0.6 mmol/L are in the normal range. Follow your HCP’s advice before you make any changes to your diabetes medication programme.
The symptoms of diabetic Ketoacidosis (as opposed to Ketosis) are as follows:
- feeling sick (nausea)
- abdominal pain
- loss of appetite
- shortness of breath
Left untreated, more advanced symptoms will develop such as:
- rapid heartbeat (tachycardia)
- rapid breathing, where you breathe in more oxygen than your body actually needs (hyperventilation)
- being sick, which can make dehydration even worse
- low blood pressure (hypotension), which can make you feel dizzy and lightheaded
- a noticeable smell of ketones on your breath, which is often described as smelling like pear drops or nail varnish remover (not everyone is able to smell ketones)
- mental confusion
- unconsciousness (coma)
Above all, be aware and be wise, but don’t panic.