When to worry about ketone bodies
If you have type 1 diabetes, finding ketones in your blood or urine can be a reason for concern. Ketones, also called ketone bodies, appear as the body switches from burning glucose to burning fat for energy. It can happen because you enter ketosis, a harmless state where you run out of stored glucose and you start to use up your fat storage. If you’re dieting, this is the desired outcome, and it occurs after fasting for an extended period, in starvation, or after eating a few low-carb meals.
Another potential reason for ketones is diabetic ketoacidosis, which is a life-threatening condition. Here, a lack of insulin forces the body away from glucose metabolism towards burning fat, and ketone bodies start to accumulate in the blood. Different from ketosis, the levels of ketone bodies are usually a lot higher. Typical ketone values for nutritional ketosis are between 0.5 and 3 mmol/l, so they can appear when you’re feeling ill if you’re struggling with eating, which many of us do.
What you need to look at is your blood sugar. If your blood sugar is normal but your ketone levels are moderately elevated there’s most likely nothing to be worried about. If, on the other hand, your ketone levels are up and your blood sugar is high you need to be on the lookout for diabetic ketoacidosis. The combination of high blood sugar and ketones is a no-no. There’s of course a problem with this. In diabetes, insulin resistance increases when you’re sick, and blood sugars typically rise, so high blood sugar is part of being sick for many of us. So is not eating much.
These circumstances make it difficult to tell whether you’re experiencing diabetic ketoacidosis or not if it’s never happened to you before. When I was diagnosed with diabetes, I presented with a serious case that left me in the hospital for a week. I’ve never felt so sick in my life, so based on this, I find it hard to believe that anyone would suffer the condition and miss it. If you feel like you’re going to die and you’re running to the toilet like there’s no tomorrow, it’s probably diabetic ketoacidosis. What sometimes happens is that clinicians misdiagnose diabetic ketoacidosis at the onset of diabetes as the flu, with the result that the patient dies without insulin. If you already have diabetes, most doctors would be quick to spot the symptoms.
As I follow a low-carb diet, I always have elevated ketone levels, including when I’m sick. And like most diabetics, my glucose levels go haywire when a virus hits. So the combination is not a definite case of diabetic ketoacidosis. What I look out for is high blood sugar, combined with high ketone levels. There’s a lot of misunderstandings amongst clinicians when it comes to ketones in type 1 diabetics. Some go as far as claiming that a low-carb diet is dangerous because it leads to ketones. As evidenced by the case that I’m still alive, I’d say this is not the case.
Keep an eye on those ketones, but don’t panic. Their presence doesn’t automatically mean that you’re heading for diabetic ketoacidosis. You might just have run low on cellular fuel and reverted to burning fat instead of sugar.