Survival Skills


Learn how to stop ketone super-villains.

Bob Weishar

5 min

When I was first diagnosed with type 1 diabetes, I found out before anything bad happened and I had to be hospitalized (many aren’t so lucky)! As it turns out, our bodies need insulin to break down sugar for energy. With type 1 diabetes, our bodies stop making insulin and, without it, bad things happen.

My one and only hospitalization came a year after my diagnosis. I was studying for finals — anxious, stress-eating (literally taking down bags of Swedish fish in the law library), and doing everything but taking care of myself and diabetes. In my haste to cram for Econ 201, I skipped 2 of my long-acting doses of insulin (more about his here) and had even stopped checking my blood sugar altogether.

I had just finished my exams and was headed home for Christmas break when I realized something was seriously wrong. I suddenly felt really lightheaded and sick. I went to go sleep it off but I woke up feeling worse than before. And things only got worse throughout the day. My friends kept checking on me before finally deciding to bring me to the emergency room.

And lucky for me they did, because my blood sugar was sky-high and I was in diabetic ketoacidosis (DKA). It was one of the scariest couple of days of my life. It was also entirely avoidable.

Today we talk about ketones and how to avoid making my same mistakes.


Today we’re talking ketones.

What are ketones? Ketones are chemicals that the body creates when it breaks down fat to use for energy. The body does this when it doesn’t have enough insulin to use glucose, the body’s normal source of energy.

Basically, when the body doesn’t have any insulin — maybe because you skipped a few insulin doses like I had — it looks for other ways to get energy. The way it does this is by breaking down fat in your body. When ketones build up in the blood, they make it more acidic. They are a warning sign that your diabetes is out of control or that you are getting sick.

This Town Ain’t Big Enough for the Two of Us

This can be really dangerous! Initially, it just starts as a tiny amount of ketones, and it’s not a huge deal. You may experience things like:

  • Thirst or a very dry mouth
  • Frequent urination
  • High blood glucose (blood sugar) levels
  • High levels of ketones in the urine

But over the course of hours and days without insulin, the amount of ketones builds up and can become life-threatening. You’ll feel worsening symptoms, like:

  • Constantly feeling tired
  • Nausea, vomiting, or abdominal pain
  • Difficulty breathing
  • Fruity odor on breath
  • A hard time paying attention, or confusion

So what can you do? The good news is that there is a clear way to avoid ketones: insulin.

Fun Fact: The Barbara Davis Center for Diabetes estimates 95% of hospitalizations for diabetic ketoacidosis are avoidable.

How to Stop Ketones

The best way to prevent ketones is to ensure your body is getting the insulin it needs. This stops fat breakdown and ketones from being made. One of the riskiest times for ketones is when you are sick, so be extra cautious and always try to monitor for ketones.

If you live with type 1 diabetes, you will get ketones from time to time. To find out, you can perform a ketone check.

Checking Ketones

There are 2 ways to detect ketones:

  1. Urine test using a test strip
  2. Blood ketone test using a ketone meter

Either works perfectly fine — though some people (ok…me) are a little weirded out by the urine ketone testing and prefer the blood ketone test even though it’s more expensive.

Fun Fact: Urine ketone test strips cost less than .25 per strip, while blood ketone test strips cost about $1 per strip, plus the cost of the meter.

Step 1— When to Check Ketones

Just like the rest of the diabetes, monitoring ketones is all about knowing your body and being aware of the times that they’re likely to appear.

These times include:

  • Illness / vomiting: Whenever you’re sick or vomiting, you’re at higher risk for ketones and should be checking.
  • Blood sugar above 300 mg/dL (> 16.7 mmol/L): This may be an indication your body does not have insulin.
  • Missed insulin dose / insulin pump blockage: If you’ve missed a dose (or several), you’re more likely to make ketones.

Step 2 — Check Ketones

If you meet one of these criteria, now it’s time to check your ketone level. There are 2 options.

Option 1: Urine Strips

  1. Pee into a small container.
  2. Dip the strip into the urine.
  3. Wait exactly 60 seconds.
  4. Compare the color of the test strip to the side of the test strip bottle (will read as negative, trace, small, moderate, large, or extra large).

Option 2: Blood Ketone meter

  1. Insert the calibration strip into the meter.
  2. Insert blood ketone strip into meter.
  3. Apply a drop of blood on the target area at the end of the strip.
  4. Wait 10 seconds to get your result (will show you a number reading).

Step 3 — Interpret Result

With your result in hand, you can interpret how many ketones you have.

  • For urine test strips, the color indicates the amount of ketones from 0/trace thru very large).
  • For blood ketone test strips, you will get a number reading. Check out the graphic for ranges.

Step 4 — Take Action

The amount of ketones will tell you what to do: the more you have, the more serious things become.

  • Trace Ketones: No action needed
  • Small to Moderate Ketones: Extra Insulin / Fluids
  • Moderate to Large Ketones: Call healthcare team
  • Very Large Ketones: Go to ER


Time to practice!


Hopefully you learned a few things about ketones and what to do when you may have them!