HELP ON DIABETES

MEASURING KETONES

Ketones are chemicals made by the liver when the body uses fat for energy. If your diabetes goes severely out of control, ketone levels can rise excessively in the blood and urine. This can occur with illnesses such as a bad case of the flu or a gastroin­testinal infection or pneumonia. It can also occur when people with type 1 diabetes forget to take their insulin, if the insulin goes bad, or if their insulin pump malfunc­tions. High ketone levels with nausea or vomiting indicates possible DKA, and medical evaluation and hospital treatment may be necessary.

You can measure ketones in the urine using ketone strips (Acetest, Ketostix), or you can measure it on a blood drop just like glucose using the Precision Xtra glu­cose meter (made by Abbott), which not only measures glucose but also measures one of the blood ketones called beta-hydroxybutyrate using special strips. Since beta-hydroxybutyrate is the major ketone in DKA, this is the preferred test. Beta­hydroxybutyrate levels below 0.6 mmol/L are considered normal, and levels above 1.5 mmol/L are of concern for DKA.

If you have type 1 diabetes, you should measure your ketones if your blood glu­cose levels are unexpectedly high (more than 250 mg/dl) and won’t come down and/or you feel ill with nausea, vomiting, or dizziness. Table 5-3 summarizes what you should do in these cases.