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Keytones?
TESTING – SICK DAY MANAGEMENT
Ok, it might be time to dust off the sick day rules. This is the main reason people with diabetes ring their nurse! That’s part of the management plan but there are quite a few things you can do first. Maybe ask the doctor next time you have an appointment to put blood ketone sticks and an Optium Neo meter on the prescription if you don’t already have one.
UNWELL? START HERE…
WHAT ARE KETONES?
Ketones are acids that are produced when the body ‘burns’ fat for energy. The body normally uses glucose to create energy. This process requires insulin, which allows glucose to pass from the bloodstream to body cells where it is ‘burned’ for energy. When there is not enough insulin, glucose accumulates in the blood causing high blood glucose levels (hyperglycaemia). The body is unable to use this glucose without insulin and will switch to ‘burning’ fat as an alternative fuel for energy.
In people with Type 1 diabetes, ketones can build up in the bloodstream and cause an emergency condition called Diabetic KetoAcidosis (DKA) also known as diabetic coma.
DKA is a major life threatening condition for people with Type 1 diabetes (and rarely in Type 2 diabetes)
WHEN ARE KETONES MOST LIKELY TO OCCUR?
- during episodes of illness or infection – even if blood glucose levels are relatively normal
- when blood glucose levels are high (the level can vary from person to person and episode to episode but generally at 17 mmol/L or higher)
- when insulin has been forgotten or omitted for some reason
A small amount of ketones (usually less than 0.5mmol/L on blood test) may be seen in people who fast (don’t eat) for several hours, after vigorous exercise or in children overnight when fat is commonly used as an energy source. These do not require treatment.
WHEN SHOULD I TEST FOR KETONES?
- When you have an infection or feel unwell, especially if you have vomiting and diarrhoea, even if your blood glucose levels are relatively normal (from 4-15mmol/L)
- If your blood glucose is 17 mmol/L or higher, particularly if you feel unwell or your blood glucose level remains elevated twice or more in one day
- If you have symptoms of hyperglycaemia or DKA – eg. greatly increased thirst or volume of urine, feel unusually drowsy, feel nauseated, have rapid laboured breathing, abdominal pain or a fruity/acetone smell on your breath
HOW DO I TEST FOR KETONES?
- Ketones can be tested in the blood in the same way that you test blood glucose
- Blood ketone testing is more accurate than urine ketone testing
- Blood ketone testing can only be done on the Optium Xceed meters (which all Type 1s can get on prescription)
- Optium Ketone Test Strips are available on prescription
WHAT DO THE RESULTS MEAN AND WHAT SHOULD I DO IF I HAVE KETONES?
Blood ketone level |
Action |
0.5mmol/L or less |
Normal level
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0.6-1.5mmol/L |
Contact a health professional as ketoacidosis could be developing
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1.5mmol/L or higher |
Contact a health professional urgently as ketoacidosis could be developing
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3.0 mmol/l or higher |
CONTACT A HEALTH PROFESSIONAL You are at risk of DKA. The ketone level must be reduced urgently
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* refer to “correction insulin dose calculation guidelines” or ask your Diabetes Nurse about this
HOW TO USE OPTIUM KETONE ELECTRODES
until the meter begins a 10 second countdown
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