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2. Not enough food. When people are sick, they often do not feel like eating. Again your body needs energy and because there is no other food for it to break down, it starts breaking down body fat. Ketones are produced from this process. The same may happen if a person who is not ill simply does not eat, for example, they simply skip a meal, or if they have an eating disorder.

3. Hypoglycaemia (low blood glucose). When blood glucose levels fall too low, the body must use fat to get energy. If testing shows high ketones in the morning, you may have had a hypo while asleep.

4. Changes during pregnancy. Women with Type 1 diabetes who are pregnant are at high risk of producing ketones. The rapid changes in your body during pregnancy and changing insulin needs can mean that your body is not getting enough insulin or food. As explained in Points 1 and 2, both of these scenarios can lead to ketones.

Ketones are NOT an infection. An infection can give you ketones, as explained at point 1 above, but ketones are not a type of infection. Antibiotics will not fix ketones.

Ketones and DKA are NOT related to kidney function. The small particles that blood tests look for when someone's kidneys aren't filtering properly are called microalbiminuria. The presence or absence of ketones in your urine does not indicate anything about your kidney function. The two things are entirely different.

Do I have ketoacidosis/DKA?
When ketones are moderate or high and the chemical balance of your blood is upset, you will know about it! The symptoms of ketoacidosis include nausea, vomiting and abdominal pain. Some people also experience fast and heavy beating of their heart. It is scary. You are clearly unwell. And you should speak to your doctor or go to hospital immediately.

Catch it early. Stay out of hospital.
Ketones can be tested at home with a simple blood or urine test.

Urine tests are done with testing strips available from your chemist or your NDSS outlet, the same way you buy blood testing strips. You pee on the strip, wait as indicated, and check the colour against a chart on the container. This is cheap and easy, but is not very accurate and only shows the ketones that were in your body 2-4 hours earlier.

Blood testing of ketones has recently become available. The Optium and Optium Xceed blood glucose monitors are the only meters which allows this function (as well as doing regular blood glucose testing). You will need different testing strips to your normal ones for blood tests, but otherwise, it is quite simple to use the Optium monitors.

You should test for ketones when:

• You are ill
• You are under stress
• Your blood glucose levels are consistently high eg. above 16.7 mmol/L.

I have ketones. What do I do now?

Download as a Fact Sheet

What are Ketones?

Ketones or ketone bodies (acetone, acetoacetic acid, and beta-hydroxybutyric acid) are waste products of fatty acid breakdown in the body. This is the result of burning fat, rather than glucose, to fuel the body.

The body tries to dispose of excess ketones as quickly as possible when they are present in the blood. The kidneys filter out ketones and excrete them into the urine.

Should you care about ketones?

YES! If they build up, they can lead to very serious energy problems in the body, resulting in diabetic ketoacidosis, a true medical emergency. If the condition is not reversed and other systemic stresses are present, ketones may continue to rise and a condition known as diabetic ketoacidosis (DKA) may occur. This condition can progress very quickly and cause severe illness. It is potentially fatal even when treated. Recognition of DKA and rapid treatment by your veterinarian can save your cat's life.

Signs of Diabetic Ketoacidosis (DKA)

• Drinking excessive amounts of water OR no water
• Excessive urination
• Diminished activity
• Not eating for over 12 hours
• Vomiting
• Lethargy and depression
• Weakness
• Breathing very fast
• Dehydration
• Ketone odor on breath (smells like nail-polish remover or fruit)

Causes of Diabetic Ketoacidosis (DKA)

• Insulin dependent diabetes mellitus
• Inadequate insulin dosing or production
• Infection
• Concurrent diseas that stresses the animal
• Estrus
• Medication noncompliance
• Lethargy and depression
• Stress
• Surgery
• Idiopathic (unknown causes)

Risk Factors for DKA

• Any condition that causes an insulin deficiency
• History of corticosteroid or beta-blocker administration

Diagnosis

Treatment

If the cat is bright, alert, and well-hydrated, the cat will not require intensive care. Your cat will require insulin, food, constant access to water, and close monitoring for signs of illness such as vomiting, anorexia, and lethargy.

Treatment of cats who show signs illness require inpatient intensive care. The goal of treatment is to correct dehydration, electrolyte depletion, to reverse the high ketones in the blood and the metabolic acidosis that is present, and to increase the rate of glucose use by insulin-dependent tissues.

Veterinary care for DKA involves intravenous (IV) fluids, usually supplemented with potassium, monitoring by observation and urine and blood tests, and sometimes feeding by a tube. Treatment may involve a hospital stay of five days or more and often costs about US$2000. Without treatment, "sick" animals with DKA will die.

Testing for Ketones

Simple urine tests can detect ketones. This is done by collecting a urine sample and inserting a special dip stick into the urine. Some urine ketone strips detect only ketones while other types test for both glucose and ketone levels. Urine ketone strips will detect only some of the ketone bodies produced by the body, not all of them. Strip storage, handling, and testing procedures are similar to those used for glucose test strips. Strip test results are indicated by presence of color changes, indicating presence of ketones, either quantitatively (giving you a number for the ketone concentration) or by descriptive terms (for example, negative, trace, small, or large). False positives may occur if you are also using certain medications or vitamins, or if the strips have been handled or stored improperly. If you wish to test blood instead of urine for ketones, there is a meter that allows for home testing, the Abbott Precision Xtra meter. Outside of the US, the meter is known by the brand name Precision/Optimum/Xceed. The premise behind blood testing for ketones is the same as that for favoring glucose testing of blood over urine. The Precision Xtra meter is offered by Hock's online pharmacy for US$29.95 in October 2006. The ketone test strips are about US$30 for a box of 50. The Precision Xtra also does blood glucose testing with standard blood glucose test strips made for use with the meter.

When to call the vet

In a diabetic, any urinary ketones above trace or trace urinary ketones plus some of the signs listed above, are cause to call a veterinarian immediately. If your vet doesn't offer after-hour emergency care, be sure to have the number and location of a 24 hour emergency veterinarian.