Have you ever heard the word 'Ketones'? Maybe you have diabetes, or if you are someone who is following the very popular 'Keto diet' these days, you probably hear this word a lot. What exactly are these ketones? Why do they come out with our urine? Is this normal, or is it something we should be worried about? Let's find out exactly what all this is about today.
Simply put, what are ketones?
Think of our body as a car. The main fuel for this car to run is 'Glucose', which is simply sugar. Our body gets this glucose from the foods we eat that contain carbohydrates, such as rice, bread, and potatoes.
But, what happens if for some reason the body can't use this glucose fuel? Just as a car switches to reserve when it runs out of gas, our body switches to a second fuel source. That is, the fat stored in the body .
So, when the body starts burning fat for energy, the chemicals that are produced as a byproduct of that process are called ketones . They are actually a type of acid. Like other waste products produced by the body, these ketones eventually leave the body in our urine (pee). Sometimes they can also be found in the blood. The presence of ketones in the urine is what we medically call 'ketonuria'.
The important thing is that it is normal to have a very small (trace amount) of ketones in your urine. It is normal to produce small amounts of ketones when we are sleeping, fasting, or on a low-carb diet because our bodies use fat in this way.
But the problem is when these ketones get too high . Then they can be toxic to our bodies. This causes our blood to become too acidic. We call this dangerous condition ketoacidosis . This mainly affects people with diabetes, and it is called Diabetic Ketoacidosis (DKA) . This is a medical emergency that can be life-threatening .
How do you measure ketone levels in urine?
There are two main ways to check for ketones in urine.
| Test method | How it happens |
|---|---|
| At-home tests | You can buy ketone test strips at a pharmacy. You take a small amount of urine in a clean container, dip the strip in it, and leave it for a while. Then it changes color. You can compare the color chart on the box to see if your ketone level is "negative," "trace," "small," "moderate," or "large." These are often used by people with diabetes and those on the keto diet. |
| Medical tests | A doctor can measure ketone levels with a simple urinalysis. However, if ketoacidosis is suspected, the doctor will often order a blood ketone test . This is more accurate than a urine test because the blood test shows the exact level of ketones in the body at that moment. |
Why do ketones appear in our urine?
As we discussed earlier, ketones are produced whenever our body is forced to burn fat for energy. There are a few main reasons for this:
- Diabetes: A person with diabetes either does not produce enough insulin, or the insulin they produce does not work properly. Without insulin, glucose cannot enter the cells. This causes blood sugar levels to rise. Also, the body starts burning fat because it has no other way to get energy. If insulin levels remain low, ketones can build up in large amounts, leading to a life-threatening condition called diabetic ketoacidosis (DKA) .
- Excessive alcohol consumption: When you drink alcohol excessively over a long period of time, your body cannot properly absorb nutrients and store glucose (as glycogen). This can cause your body to burn fat, leading to a dangerous condition called alcohol-related ketoacidosis .
- Pregnancy: Gestational diabetes can cause ketones in the urine. Apart from that, ketones can also occur during pregnancy due to other reasons mentioned in this article.
- Prolonged vomiting or diarrhea: When you continue to vomit or have diarrhea, your body's glucose reserves are depleted and your body begins to burn fat for energy.
- Eating disorders and fasting: Eating disorders such as anorexia or prolonged fasting can cause the body to not get enough carbohydrates and increase ketone production.
- Intense, strenuous exercise: During very strenuous, prolonged exercise, when the body's stored glucose (glycogen) is completely used up, the body begins to burn fat for energy.
Can someone without diabetes have ketones in their urine?
Yes, it is possible. It is normal for a person without diabetes to have a "trace" or "small" level of ketones in their urine. This can happen during a urine test when we get up in the morning and walk around.
But if you don't have diabetes and your urine test shows moderate or large ketone levels, don't ignore it. It could be a sign of undiagnosed diabetes or another serious condition. In such a case, see your doctor immediately or go to the nearest hospital's Emergency Department (ETU).
What are ketone levels and their symptoms?
The symptoms vary depending on the amount of ketones in the urine. Let's understand this clearly.
| Status | Common symptoms |
|---|---|
| Ketosis (Usually low ketone levels) | This is not usually a dangerous condition. People on the keto diet may experience these symptoms.
|
| Ketoacidosis (High ketone levels - emergency medical attention required! ) | Early symptoms:
Later serious symptoms:
|
If you or someone you know, especially someone with diabetes, has one or more of these serious symptoms of ketoacidosis , take them to the nearest hospital's Emergency Department (ETU) without delay.
What is a dangerous ketone level for someone with diabetes?
For someone with diabetes, any ketone level above "trace" levels can be a warning sign.
- "Small" level: This indicates that you are at increased risk of developing ketoacidosis. If your blood sugar level is also above 250 mg/dL, call your diabetes doctor for advice.
- "Moderate" or "Large" level: This indicates that you are at very high risk of developing ketoacidosis. Go to a hospital immediately for medical attention.
Although ketones are not harmful in small amounts, they can be life-threatening in high amounts. If you are at risk for ketoacidosis, talk to your doctor about how to manage it. You can help ensure your safety by making a plan for what to do if your ketone levels become high.
Take-Home Message
- Ketones are a byproduct of the body burning fat for energy.
- It can be normal to have very small amounts of ketones in your urine.
- However, elevated ketone levels, especially in people with diabetes, are very dangerous. This condition is called ketoacidosis and requires emergency medical treatment.
- Be aware of the symptoms of ketoacidosis, such as nausea, vomiting, stomach pain, fruity breath odor, and confusion.
- If you have diabetes and your urine ketone levels are moderate or high, or you have the above symptoms, go to a hospital's Emergency Department (ETU) immediately.
- Always talk to your doctor about any health concerns.
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